The Tibia Reconstruction: A Continuous Process

I have had a total of three surgeries now on my right leg as a result of the repositioning of the tibia and re-growth of two centimeters of bone to lengthen my leg. The first surgery, see "An Exterior Fixator to Fix a Problem," resulted in my having six metal wires inserted into and though the tibia and leg to realign the bone and fill in the two centimeters that was lost when I originally broke the tibia and fibula in 1972. After 37 years of working on concrete floors in greenhouses as a horticulturist, the stress began to deteriorate my right knee and ankle to the point where walking became extremely painful.

Because the tibia showed no growth in the x-rays in January of 2009, 10 months after the initial surgery, my surgeon decided to send me to a trauma surgeon to finish the process he started. The surgery to remove the fixator was scheduled three days after my first visit with the new surgeon. When x-rays were taken a week after the removal of the fixator, we could clearly see that over one third of the tibia had filled in the space between the top and the bottom of the bone. Needless to say, I was ecstatic. I then had an IV inserted into my upper left arm and had to endure one hour of an antibiotic drip twice a day at home to prevent infection of the bone due to the several external openings in my leg. Then on April 23, a little over a year after the process began, I had a titanium rod inserted into the tibia to aid in the fusing of the two sections of bone.

When the initial surgery took place, I had to adjust the fixator by turning six turnstiles over a period of 20 days to place the tibia in the prober position. After this was completed, I noticed that my leg seemed to curve inward. After mentioning this to my doctor, he commented that it looked that way because of the way I was standing and putting most of my weight on my left leg. After seeing the trauma surgeon for the first time, he also commented on how the tibia had been angled too far to the left. Before the surgery, my bone angled to the right, and now it was angled to the left almost as far in the opposite direction. This took the stress off the knee. I did grow in the entire two centimeters, and now stand without having to wear a lift in my right shoe to make my hips even.

For three months, I returned to the doctor every six weeks to check the progress of the healing and each time I received a different cast. On June 1, 2009, I had a really good walking cast put on and was given a cast shoe that allowed me to walk more normally. I was ecstatic and walked daily to try to get the tibia fused. I began walking with only one crutch, but I found I was having pain in my entire foot. After walking, I had to rest the remainder of the day because the pain was too intense when I put weight on my foot. The tibia where the break was did not hurt at all, but the entire foot and ankle really hurt every time I stepped. After a while, I began walking with only one crutch, and by the time I went back the the doctor's office on July 13, I could even hobble for a while with no crutches. I felt I was making headway, and was hoping against hope that the pain I felt when walking was from the cast pushing on my foot and ankle bones.

The final cast was removed and I could finally scratch my lower right leg! I returned home and as soon as I walked in I went directly to the shower and scribed the leg and shaved it. For over half an hour, I rubbed and shaved until not one hair remained. Boy, did that feel good! I could now sleep with absolutely nothing on my leg for the first time in almost a year and a half. But the pain in my foot and ankle, however, did not go away. Because the tibia had been over compensated when adjusted, it caused my foot to be turned to the inside as well. When standing, my foot angles in and the takes the brunt of the weight. I was given another boot, this one goes to the knee and wraps the foot an ankle in soft padding inside a rigid frame that aids in walking. When I was being fitted for this boot, I asked for an insert that would angle my foot to the outside but not raise it. When put it beneath the padding in the boot, my foot is returned to a more normal position and walking became a bit easier. But the foot and ankle are very stiff.

I now go to physical therapy two the three times a week and exercise my foot and ankle trying to build up the muscles in my calf and stretch the ankle and foot muscles so I can flex the foot when I walk. These exercises have made a huge difference and I am able to walk well with only one crutch. When I get up in the morning, I find my foot is the most flexible because it is not swollen and is well rested after the night. I can limp around the house and go up and down stairs to the basement very easily now. I am definitely making progress, but I feel it will be a long time before I can walk normally again.

My next appointment is at the end of August. I hope to be able to show the doctor how much better I can flex my foot and ankle, but also how the rod inside the tibia was the cause of this p[pain. All the time I had the fixator, I had no pain in my foot or ankle and could walk putting 75% of my weight on the right l leg. After the fixator was removed and I was is a cast only, my foot and ankle were fine; not painful nor swollen. It was not until the rod was inserted and I began putting weight on the foot, that the pain became most prominent. At my last visit, the doctor commented on the fact that he may be able to remove the rod and pins in about a year. Even though the bottom of the tibia and foot will always be slightly angled to the inside, the pain may disappear. I, of course, will have to continue with the physical therapy until I can walk with no pain. I will remain hopeful and pray that the rod will be removed in the future and I can begin to lead a normal life again and do the things I love to do. I am hoping I can continue with my two-mile daily walks with each of my dogs, continue show-shoeing, dog sledding, hiking and pack packing. For now I will do what I can and ice the foot and ankle at night after the strenuous activities of the day.

The exercises I do daily to loosen the muscles are:

1. Placing a wide strap around the ball of my right foot and sitting straight, I pull back on the strap to bring my foot forward as much as possible. When the physical therapist measured the flex of both feet at the beginning of therapist, I could flex the left foot to plus 10 degrees, which is the beginning of normal fixation. That is as far as I can go with it. The right foot measured minus 7 degrees. It has a long way to go.

2. Standing with my right leg behind my left about two feet, I lean forward with hips straight and bend my Right knee and ankle as far forward as I can. The left leg remains rigid. I repeat this 10 times. Then I bend both knees and stretch forward as far as I can, repeating 10 times.

3. Using a plastic crate 12 inches high, I raise up onto the crate with my right leg, not using the left at all. I then lower the left leg to the floor. This helps build strength as well as flexibility. It also aids in building the calf muscles that atrophied while the leg was incapacitated.

4. I put the right foot on the crate with the left on the floor and I bend forward as far as possible keeping the right heel glued to the top of the crate. This increases flexibility with the ankle.

5. I use the bicycle for 6 minutes at a setting of about 10 degrees up so I can work the leg and gain strength and muscle. I do this before each session and after, and I go in on the days I do not have a session to use the equipment without supervision. This is to develop strength and gain back some of the endurance I lost over the past year and a half.

6 I now use my right leg to pull myself up the stairs when ever I am out. This helps build strength in the right leg as well as increases flexibility.

These few movements are normal for most people in everyday activity, but in only a few months I lost the ability and endurance to perform these simple things and have to practice them to get where I was before all the surgeries began. At the beginning of each therapy session, the therapist measures the forward flex of my ankle. In week I went from minus seven degrees to a plus 1 degree. As a result of practicing these simple movements twice a day, I can feel the ankle beginning to relax and become more flexible. I can walk easier without the crutch inside my home, but still use it outdoors. I continue to have pain, however, and do not know how long that will last. After an extremely tiring day of housework; IE: bed changing, dishes, bathroom cleaning and vacuuming, I have to ice the foot and use both crutches. But by morning, the foot is much better and I begin all over again.

My greatest desire is to be able to walk without any pain in either foot, ankle or knee. If I do not give up I know that goal is obtainable. I am only a 60-year-old baby-boomer and am not ready to give up the ghost yet!