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Do we need physical therapy?


lexi
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My dd age 9 broke her leg in a bike riding accident. Spiral fracture of the tibia. She has been in a cast for two months. The cast came off on Monday and the doctor gave her a walking boot. She will NOT walk on it or even attempt to. She uses her crutches for everything. I've told her that she can walk slowly but she has a total panic attack about walking. She doesn't complain about pain. She just has an anxiety attack when we try to encourage her to walk.

 

What do I do? The doctor said it will probably be a few days before she's confident enough to put weight on it. But it has been days and we are making no progress. She prefers to hop on one foot or crawl around the house.

I really want her to be mobile again.

The doctor did not prescribe physical therapy but now I'm wondering if therapy might be a good thing.

 

We are in the process of moving and things are so stressful right now. I really can't have a 9 year old who is crawling around to get places. This is awful.

 

What do I do? Do they normally prescribe therapy after a broken leg? Do I demand therapy? When will she attempt to walk a little?

 

She is my very anxious drama child and I'm trying to be patient but the screaming is getting old.

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Do you have access to a pool? I wonder if walking in a pool would help (if the boot can go in the water)?

I do have access to a pool but the boot cannot get wet. It's also been raining all the time and hasn't been warm enough to swim.

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You might need physio, but Maybe before walking, try just encouraging her to stand. 5 seconds. Then 10. Starting really slow for her to rebuild confidence in her leg. Maybe a "you can do anything for 5 seconds" will help ease the anxiety a bit. Good luck.

 

:grouphug:

 

DS (also 9) just had his "long arm cast" (ie: elbow has been 90* for six weeks) removed this afternoon. He's pretty scared to use his arm, too. He actually wished he had it back about 20 minutes after removal because he now has to be careful - he's on restricted "feet on the ground" activity for another 6 weeks: no running, scooters, bikes, monkey bars, etc.

 

Ortho has us watching for progress in arm usage, with possibility of physio if he's not progressing over the next couple weeks.

 

We also just moved. Last week. Stress. It's what's for dinner.

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Oh, I am so sorry you are having to go through this!  DS broke his leg about a year and a half ago (he was 13 at the time), and was in a full leg cast.  The transition to a walking boot was... something I hope to never live through again!  It was a slow, painful process.  Their fear and anxiety are real.  Let her continue to use the crutches and start with just standing and supporting weight on that leg.  Baby steps, baby steps.  DS went through PT.  The fact that he was in a full leg cast was a huge contributing factor.  He could not straighten his knee, and the muscle cramps were horrible.  And he has a very high pain tolerance (broke his leg during karate practice!).  The good news is that 6 months from now this will all be a memory.  Just no fun going through it!  Hugs, mama!

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Oh, I am so sorry you are having to go through this! DS broke his leg about a year and a half ago (he was 13 at the time), and was in a full leg cast. The transition to a walking boot was... something I hope to never live through again! It was a slow, painful process. Their fear and anxiety are real. Let her continue to use the crutches and start with just standing and supporting weight on that leg. Baby steps, baby steps. DS went through PT. The fact that he was in a full leg cast was a huge contributing factor. He could not straighten his knee, and the muscle cramps were horrible. And he has a very high pain tolerance (broke his leg during karate practice!). The good news is that 6 months from now this will all be a memory. Just no fun going through it! Hugs, mama!

Thank you for sharing your story. It makes me feel better that this is not unusual. I thought she would be doing much better once we got the boot. I was very wrong. I was totally unprepared for her anxiety and all the tears and drama. I'm trying so hard to be patient as I pack our house and prep to move on June 3rd. This is so very hard!

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I can relate to your daughter because I am in her situation right now.  I have found that my ability to put weight on my foot and to walk in the fracture boot has come much more slowly than the doctor had suggested it would.  I was very concerned until I talked to people who had a similar injury and found out that they experienced what I had experienced.  These are the things I have learned:

 

1)  At first I had a lot of swelling/inflammation which did cause a great deal of pain.  Switching to a different anti-inflammatory made a big difference regarding the pain level.

2)  The leg muscles become weak after lack of use; the lack of strength is scary when you try to put weight on the leg

3)  Pain medication and anti-inflammatory medications can make you anxious

4)  It is much easier to put weight on the foot if the foot is in the boot properly--that is a bit of trial and error--the heel of the foot needs to be all the way into the back of the boot.  At first, my foot was so swollen that I couldn't feel the proper placement of my foot.  The boot needs to be tight enough to provide proper support; but if it is too tight, it will cut off circulation.  

5)  My boot is about 3 inches tall--that makes "walking" difficult unless you have a three inch shoe on the other foot--a supportive shoe on the good foot that evens out the height as much as possible is helpful.

6)  The bottom of my boot "rocks"  rather than being flat; that is a scary feeling when you aren't used to it.

7)  The thickness of the boot makes it impossible to "feel" that your foot is really on the floor.  You just don't have a feeling that your foot is securely planted

8)  Putting some weight on the foot when holding onto a counter or railing was much easier at first than doing it with crutches.  

9)  I really had to "ease" into putting weight on it.  You are using muscles you haven't used in a while and muscles that you don't usually use for walking.  If I did too much at once it was uncomfortable and was discouraging to then try the next time.   

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I really want her to be mobile again.

 I really can't have a 9 year old who is crawling around to get places.

This is awful.

What do I do?

Do I demand therapy?

When will she attempt to walk a little?

She is my very anxious drama child and I'm trying to be patient but the screaming is getting old.

 

Maybe you care too much.

 

What would happen if you acted like you don't care whether she walks or not?

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I can relate to your daughter because I am in her situation right now. I have found that my ability to put weight on my foot and to walk in the fracture boot has come much more slowly than the doctor had suggested it would. I was very concerned until I talked to people who had a similar injury and found out that they experienced what I had experienced. These are the things I have learned:

 

1) At first I had a lot of swelling/inflammation which did cause a great deal of pain. Switching to a different anti-inflammatory made a big difference regarding the pain level.

2) The leg muscles become weak after lack of use; the lack of strength is scary when you try to put weight on the leg

3) Pain medication and anti-inflammatory medications can make you anxious

4) It is much easier to put weight on the foot if the foot is in the boot properly--that is a bit of trial and error--the heel of the foot needs to be all the way into the back of the boot. At first, my foot was so swollen that I couldn't feel the proper placement of my foot. The boot needs to be tight enough to provide proper support; but if it is too tight, it will cut off circulation.

5) My boot is about 3 inches tall--that makes "walking" difficult unless you have a three inch shoe on the other foot--a supportive shoe on the good foot that evens out the height as much as possible is helpful.

6) The bottom of my boot "rocks" rather than being flat; that is a scary feeling when you aren't used to it.

7) The thickness of the boot makes it impossible to "feel" that your foot is really on the floor. You just don't have a feeling that your foot is securely planted

8) Putting some weight on the foot when holding onto a counter or railing was much easier at first than doing it with crutches.

9) I really had to "ease" into putting weight on it. You are using muscles you haven't used in a while and muscles that you don't usually use for walking. If I did too much at once it was uncomfortable and was discouraging to then try the next time.

Thank you for this! So helpful!

I was not prepared for the amount of swelling that we've had.

And yes, the dr thought she would have much more mobility than she actually does. This is a very slow process!

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Maybe you care too much.

 

What would happen if you acted like you don't care whether she walks or not?

(Smile) We just started doing this. I realized that I was stressing way too much and that it was probably making her more anxious. I handed her the crutches and told her to do her best and do what is comfortable for her. I'm going to let her work it out herself.

 

Hopefully if I let her take charge of the situation she will relax and figure it out.

 

Deep breath. I have to step back. I know I'm struggling with anxiety over our move. The broken leg issue has been a huge added stress.

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A few more things I thought of:

 

I found it much more comfortable to wear a sock with the boot when trying to walk.  I couldn't put my foot down into a sock.  DH has large feet and I took an old, stretched out sock and cut a slit down the front of the sock to about the ankle.  That way I could slip my foot into it more like a slipper but it didn't bunch up.

 

Baby powder in the boot can help absorb moisture and prevent chafing.

 

I found that placing ice on my leg after being up on it helped prevent discomfort and swelling; it is amazing how much cold still gets to it through the boot.  Continued elevation helped.

 

The boot can be heavy and when laying in bed, my foot would flop to the side (causing my knee to get tired).  Propping pillows along side the boot to hold it straight helped.

 

Can your daughter wiggle her toes in her boot? I found that once I could gently wiggle my toes I had more awareness of my foot and felt more confident placing some weight on the foot.

 

Can your daughter left, move her leg independently--without moving it with her hands.  I found that once it was not painful to just move the leg from one position to another and once I had the strength in the leg muscles to move the leg without using my arms I was more confident and had enough strength to put some weight on the foot.

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I do have access to a pool but the boot cannot get wet. It's also been raining all the time and hasn't been warm enough to swim.

 

My sister bought some device from Amazon that covers and seals the boot so you can go swimming or get in the hot tub. I don't know what it was called, but it should be easy enough to search. 

 

Yes, she may need at least a session or two of physical therapy just to get over the fear. I would call the doc and discuss. 

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I would not trust anything claiming to keep a shoe boot (which covers more than just shoe area) dry while swimming.

 

I'm sorry your daughter is so frightened to put weight on the boot.  (although I can understand her fear)  Unless you have a worthless orthopedist, she would not have been prescribed the boot until it was safe to use. 

 

Consulting a pediatric psychologist might allay her fears.

 

jdahlquist gave excellent, detailed advice! 

 

Twelve years ago, I broke both lower leg bones clear through in three places (thus, six breaks).  I spent one week in hospital, then two in a rehab hospital.  When I was graduated to a shoe boot, mobility became so much easier.  One-and-a-half years passed before I could ascend the stairs in our home. 

 

Until the anxiety (which is what this does seem to be) is resolved, why not allow her to use the crutches while simultaneously placing weight on the boot.  This provides a "psychological support" mechanism.  (Just make sure that she really does place weight on the boot.)

 

:grouphug:  to your daughter from someone who has BTDT!

 

As for additional physical therapy, if it should be needed, that will take place after the leg is "out of wraps".

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