“The purpose of this blog is to show that physical therapy initiated after a surgery is focused on caring for the client’s concerns about walking, restoring movement and foot usage and managing the healing process. In the example below, this client had experienced many years of recurring pain before having surgery. The information in this blog is based on a real client seen in 2011, the identification of the person has been modified only.”
A client, J.W., had surgical decompression of the Tarsal Tunnel of her right foot in late February 2011. Prior to surgery, their medical condition had caused significant pain and functional limitations for 3 years. Her symptoms began in the heel and arch, would gradually worsen throughout the day and were present at night. Sitting did not provide relief. She was an avid power walker, which she enjoyed doing on a lake path around her home. Her physical therapy was started 1 month after the surgery. Since surgery she had been wearing a protective boot and using 2 crutches for walking. Her surgeon did not want her to put any weight through the foot for 2 month. Her rehabilitation goals were to walk around her neighborhood the mall with her daughter without pain. She also wanted to wear regular shoes again. She expressed fear about putting weight through the arch of her foot, as this was what caused pain before surgery.
During the initial evaluation, she was unable to place her right heel on the ground when standing out of the boot. She had swelling around the incision and ankle. Restrictions were identified in the ankle joint and muscles. Active movement was restricted on the right ankle because of the pointed position her foot was kept in while wearing the boot. The tissue around the incision was stiff and painful when touched.
In standing, the client is unable to place the right heel on the ground.
Physical therapy treatments were started the first day. A home program was established to help the client restore movement in her ankle, improve flexibility and gently promote putting weight through her foot and arch.
Stretching activity using towels to help restore flexibility and motion
.
Gentle weight bearing activity using towels.
At her second visit, she was feeling better about putting weight on her involved foot and stated her pain was improved. She could move her ankle and foot more than at the first visit. She was using pain management strategies of elevating the foot, warm foot soaking and icing at home. She was starting to walk in her home with the crutches but without her boot. When walking in the community she kept the boot on and used crutches.
