Some Health Updates

61 Days Until I Can Walk

Hello folks! Looks like I missed yesterday’s blog post. Sorry about that!

First, I just want to say that I am working on my next long form article, which will be about macros in Rust, as I would like to use them in several places during The Great Refactor. I find the syntax for macros a little confusing, so I’m hoping that a dedicated weekend of study should help me to get them under my belt. That article will drop tomorrow.

Yesterday I had an appointment with a specialist about my foot to talk about the best way to rehabilitate the joint and improve how the bone will heal. I figure, seeing as that was the big news of yesterday (and this blog is, at least in part, about my recovery), I would take a little time to talk about this. My break is apparently extremely rare. The doctors who saw me in Germany had never personally seen this. Indeed, it is possible that I was the first case seen by the surgeon who operated on me. The GP who referred me to my current hospital had never seen this break before. Friends of my family who work in medicine have asked for details of my case because it is the first case study they have seen.

This is all quite scary. I feel like I’m wading into the unknown a little. So I wanted to condense some of what I now know into a little article today. Especially now that I have spoken to some people with actual experience treating my kind of fracture. Maybe someone like me will stumble on this article and will hopefully get some use out of it.

With that out of the way, for the squeamish among you, this article may not be for you.

What Exactly Happened

When I fell off the wall, I came straight down on my heel which caused an explosive fracture that drove some bone up into my ankle and split my calcaneus. The bone rotated and was displaced. There is also some nerve damage in the foot. Even now I have no feeling in the back of my foot, but this may come back with time.

What Was Done

The displaced bone was set during surgery. An incision was made along the outside of my foot and hooking back up behind my ankle and a plate was inserted. This required 14 screws, which sounds like a lot, but apparently is fairly typical for this kind of surgery. A drain was inserted through the back of my heel to stop blood from pooling under this skin. This was in place for several days.

When the would was suitably healed, and the risk of infection was considered low enough, the drain was removed and I was fitted with a boot to support my ankle. This is way fancier than the plaster cast that you may be see worn by other people. I can take it off and on, enabling me to clean my wound and change my dressings. But I must sleep with it at night to protect my foot.

At this stage, healing is a process of being patient and waiting for the body to do its thing. But there are exercises you can do to improve the quality of your recovery

So What Can You Do?

This is where a lot of the conflicting information about my road to recovery kicked in (so to speak). The first physiotherapist I saw the day after the surgery gave me some exercises to do. And I did those religiously for a week, until a second physiotherapist told me that I absolutely should not be doing those exercises and must keep my foot rigidly still for the first few weeks. This was not outright contradicted by anyone when I asked for clarification, so I’ve had my foot immobile in a boot for two weeks now. This was incorrect.

The specialist I spoke to informed me that movement is absolutely essential. I must flex the ankle up and down, and rotate it in small circles very regularly. Hourly, was his suggestion.

The big thing to avoid, and this is so critical that every doctor emphasised this, is putting weight on the foot. It must not bear any load. For how long? Some doctors said six weeks, then I could slowly start building up the weight over the course of six more weeks. The specialist has told me that this too is wrong. I must keep weight off the foot for the first 10 weeks of recovery (so still a way to go yet). But after that I can start walking on it, and in a week or two will be back at full weight. At that stage my boot will come off and I am advised to wear good, lace up boots with ankle support. From there I will move down to runners and gradually to regular shoes again. All going well, by week 12 I will be walking without the aid of crutches or a boot.

A diet with a good supply of calcium and vitamin D is essential.

In short, here is the advice that actually seemed to work for me and was either consistently dolled out, or else given by an expert in my case:

1. Keep the foot elevated to reduce swelling pre-surgery, and for a while after surgery too
2. Keep the wound dry for about four weeks after surgery. That’s two weeks before stitches are removed, and then two more weeks again before the skin is healed enough for a shower. Sponge baths are your friend
3. After surgery, flex your ankle up and down, and rotate it in small circles. Do this lying down on a bed with your foot elevated so you aren’t driving your heel into a surface. Move the joint to increase your mobility post-recovery
4. Do not put load on your foot under any circumstances. It will be 10 weeks before you can walk on it again (at least). Get used to hopping about on crutches.

What Does Recovery Look Like

This is a very nasty break, and the overwhelming information I’m getting from doctors is that it will never be quite “right”. Although just how bad it will be, no one can really tell me.

The analogy that was used is that it is like shattered marble. You can glue it all back together, and it will be solid and whole, but if you run your hand over it, you will feel the cracks.

I’ve been told that, with physio, I can probably get about 50% mobility back in the ankle. So I may walk with a bit of a limp. Or not. I really don’t know. But my aspirations of becoming a professional ballet dancer are probably behind me. That’s probably for the good of the art form anyway.

I’ve always had pretty stiff joints. My ankles don’t flex much anyway. At a rough estimate, I’d say my broken foot needs about 1cm more of arc to be back to where it was. That feels manageable.

The big risk for me going forward will be arthritis. There are preventative measures that can be put in place with surgery, but the best thing to do is just be gentle with the bone and not subject it to too many high impact sports. Don’t go running a marathon or anything like that. It isn’t that I can’t run a marathon. Rather I have significantly reduced the life of the bone in my foot, and what life is left must be spread out over the remainder of my lifetime. I’ll learn what that means as time goes on.

But rock climbing is still a possibility. So is sailing. And that, to me, is very encouraging.

Conclusion

So there you have it. I really hope this information is helpful for someone, or at least interesting for you folks as readers.