Get Up!

Back in the day, we used to listen to cassettes. Yes kids, those rectangular plastic devices that held up to 90 minutes of toe-tapping hair-raising fun and a whole lot of background noise (Dolby reduction!) on a long, easily tangled reel of magnetic tape. And also back in the day, surgeons mandated extended periods of immobilization after surgery, foot and ankle included. And while this facilitated bone and soft tissue healing initially, long term healing and results were not entirely favorable, hence the more recent shift to early mobilization and the call to get up and stand up- early.

If you’re in the market for any elective or non-elective orthopedic or podiatric surgery, this blog is for you. If you’re not, think of it as a metaphor for life. In the early days of surgery, immobilization was considered to be the key to a full and speedy recovery after an injury or procedure. Keep the affected limb from moving, the thought went, and it will heal anatomically- and then it can be rehabilitated. First healing, then motion. But the motion was slow to arrive after the initial healing period. With the advent of rigid internal fixation in the form of screws, plates and wires, the alignment of fracture fragments or bone realignment could then be maintained during a period of early mobilization. It was then discovered that patients who started walking and moving immediately after surgery generally recovered faster and better. Patients were encouraged to walk out of the hospital after fracture repairs, joint replacements, and yes, even bunion surgery and other foot and ankle surgeries. And as I tell my NYC podiatry patients, early ROM is the key to recovery, to the extent that when a less than optimal foot surgery outcome limps into the office, I can almost predict that the history of the postoperative recovery involved an extended period of time in the ubiquitous and dreaded and oh so ugly surgical shoe. And that is why our patients are generally transitioned into a comfortable shoe as soon as possible after foot surgery, most typically not more than two weeks after surgery.

And so it goes in life. Sometimes it’s tempting to remain in the comfort zone that is the virtual surgical shoe of our lives. But no, my young NYC podiatry patients. We have to step out of that shoe, and onto the next plateau and into the next phase of healing. For it’s only when we challenge the site and ourselves that we can regain the motion and mobility that is so integral to stepping forward and getting better. Or something like that.

See you in the office.

Ernest Isaacson

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