Need Advice Post Surgical Weight Bearing
 

When we first planned the surgery, the ortho surgeon originally said no weight bearing for two weeks while the screw holes start filling in. Then she decided that might be risky with CRPS, and decided he should start walking right away using the orthopedic boot to reduce the risk of re-fracturing.

But he's finding that it irritates the incisions, even through all the bandaging, and hasn't been able to manage it.

His foot is ice cold tonight, so I had him start using the heating pad again. He hasn't used it since the surgery because we didn't want the heat to increase swelling. I'm going to call tomorrow about these things, but I wondered if anyone here had any ideas on how to continue weight bearing if he can't tolerate the boot yet, but isn't allowed to weight bear without it. :confused:

[QUOTE=swimtime;1182993]When we first planned the surgery, the ortho surgeon originally said no weight bearing for two weeks while the screw holes start filling in. Then she decided that might be risky with CRPS, and decided he should start walking right away using the orthopedic boot to reduce the risk of re-fracturing.

But he's finding that it irritates the incisions, even through all the bandaging, and hasn't been able to manage it.

His foot is ice cold tonight, so I had him start using the heating pad again. He hasn't used it since the surgery because we didn't want the heat to increase swelling. I'm going to call tomorrow about these things, but I wondered if anyone here had any ideas on how to continue weight bearing if he can't tolerate the boot yet, but isn't allowed to weight bear without it. :confused:[/QUOTE

This is were knowing ones body comes into play....if he can't tolerate the boot he should not be putting weight on it....there were times I had to rip off my boot. But little steps, no pun intended....putting on boot a few mins then off...now I had my hardware in my jaw...so soft foods and slowly getting into the routine.... When he can't he can't.... Etc :grouphug:

Can he press on something when he is in bed?

I started by pressing my foot on a pillow, then on the mattress, then on the wall above my bed, also pressed it into the arm of my couch.

I also used the wondercore to "peddle" pushing my foot into it, starting with my toes and gradually working down to my heel.

Try using a portable infared heater. I did not find this heat increased swelling.

I was not able to put considerable weight on my foot until I spent multiple sessions in the pool.

Hi Swimtime,

I have to say the weightbearing thing sounds a little scary to me. How much like swiss cheese are we talking with those holes? My concern would be deviating from what is known about laying down new bone and preventing fracture.

I wonder if there is a happy medium in here like Bio suggested. There are multiple ways to deal with this. I can understand having boot pressure on the anterior ankle incisions being uncomfortable. Do you have a rolling walker at home? I used mine post-op to partially weightbear by supporting much of my weight with my arms. I wore a surgical shoe for this and it is much less cumbersome. If the goal is CRPS prevention he may not really need to be putting all his weight on that foot now to get benefits of pressure feedback.

Free movement may help as much as anything, so starting whatever gentle ankle circles, alphabet, etc. is allowed. They don't have to be full range in the beginning.
:hug:

Having to try weight bearing so soon after surgery sounds a bit strange, but it does help promote bone growth. I was lucky to be living with my parents having full access to a private gym, my dad is a fitness nut, and be able to use a Total Gym set at a very low setting for initial weight bearing exercises. Not having access to that anymore, my PT has given some simple exercises to try such as bridging exercises... http://www.netfit.co.uk/public/images/assets/042.jpg ...and sitting at the side of the bed/sofa and applying pressure as can be tolerated. I can understand the doctors concern about trying to apply pressure as soon as possible. Trying to get things to heal quick and get things moving again is one of the best ways to slow down the CRPS and control the pain a little better. I hope things start to go better for him and the doctors give you some answers as to what to do to help. I am sure they know the situation better than anyone else other than you and your son. Healing hugs go out to both you and your son:hug:

Sorry, the photo example of the bridging exercises was a little larger than I thought.

Thanks for all the suggestions! The heater was a great idea. I did some gentle massage and (very) gentle range of motion to help him get it moving and looser, and he did a few pushes against my hand for pressure feedback. The ortho doctor said no stretching because it could pop the stitches. He's moving it around as much as he can tolerate and was able to sit with it on the floor a couple times today. Mostly right now the difficulty is simply the pain from the incisions. But there's no burning or stinging pain anywhere, so I'm very hopeful that the CRPS won't flare up. I added some extra strength tylenol to his post-surgery pain meds (after checking with the pharmacist for med interactions) and that seemed to help quite a bit. Third day post-op can be a bear. ;) He'll be able to get in a pool in a couple weeks once the stitches are out, that should help too. As far as the "swiss cheese" factor, the fibula has 6 screw holes in it and the tibia has two. Given the narrowness of the fibula, I think that's the bigger concern for refracture.

I am so glad there's no burning pain!!! The ROM and push back against the hand seem like a great start. IMHO, if you are doing these things and some touch down pressure (straight on, no bending maybe) that ought to do the trick. Keep those bones safe!

You're right about third day post-op, 4th too. I would expect doing much at this point to be a challenge. Incisions are just sore for a while CRPS or not.

I am sending hugs and prayers for continued healing. :hug:

Sounds like he is doing great and the hardware was a big source of his previous pain. I wonder if they will reevaluate the crps diagnosis once he is better from this surgery.

I too just had my hardware removed and was non weight bearing for several weeks. I was able to do ankle pumps since it didn't affect the incision. I bet he is going to feel so much better once those stitches came out. I had same struggle with the boot. I found once I could bear weight walking barefoot was most comfortable even though made surgeon nervous. I ensured him I was going slow.