So I had my total hip replacement 17 months ago on my right hip. Now I had my surgery posterior, not anterior. They went through all of my gluteus minimus and gluteus medius muscles to get to the hip bone to replace the joint. If you are thinking about getting a total hip replacement it is important to know what approach your hospital/doctor uses as it will create scar tissue around the muscles. It is also important to know since you will have more hip precautions if your doctor using the posterior approach. If you have a direct anterior approach your hip precautions will be different. I also have been told that many people with anterior approach have better flexibility after their surgery. But then again, I did dislocate my hip when I was 13 and I’m going to assume (I know I shouldn’t) that many people that have a total hip replacement is not due to having their hip pop out and dislocate at the age of 13 and then decide to have a THR at the age of 38. I’m going to assume that the majority of people that decided to have a THR are over the age of 55 (many are probably around 65-70) and their joint is just “old” and needs to be replaced. So at 38, my hip joint looked like the joint of an 88 year old woman. That is what I was told. It was not round and all of the protective cartilage around my hip was gone. By the time I was 18 I had arthritis in my hip. Since I stopped my hamstring exercises when I was about 20 or so my legs got very tight. But I was still able to reach my right foot with no problem at 25. It wasn’t until age 30 that things started to change for me. Fast forward to after my THR in 2013.
I was walking daily a week after my THR, about 1/4 mile. By 8 weeks I was walking 1/2 mile. Once I was off my cane, three months after my THR, I was walking a mile a day. I felt so good since I had no pain in my hip – that mile soon turned into almost 2 miles a day. But I forgot one important thing. Stretching my legs before walking.
I noticed great pain in my left calf about 5 months after surgery (Jan 2014). I started to stretch that calf out daily. I’m not sure how many days I stretched out my calf, but I’m going to guess I did it daily for 4 weeks. Then I went to 2 miles a day.
I started doing hip flexor stretches about 4 months after surgery since I got very tight after surgery. I had to wait at least 3 months to do some of these exercises due to my hip precautions. (You will feel very tight after surgery so make sure you do the exercises that you are told to do). I continued to do my hip flexor stretches daily. By year one (Aug 2014) I stopped stretching my hip. I was able to barely reach my right shoe and tie the laces around June 2014. I guess I thought I have “arrived” and that I could stop the hip flexor stretch in Aug 2014.
I had long stopped stretching my calf muscle out on the stairs by June 2014. I remember going to physical therapy from Aug 2013 to November 2013. Then I went back for more in March 2014 for 6 weeks. It was around April or May 2014 that I started using the stairs again to do the calf stretches. I was told in 2013 that stretching out my calf is important to do before my walk.
How to do the calf stretch:
(Using stairs is the best way to stretch out the calf muscle. It allows you to drop the heel down below the stairs and below your toes – that way you can feel the stretch in your calf. I don’t do the “push your heel into the floor” thing. I use stairs since my heel will go lower than my toes. I also stretch the tendon near my ankles. If you stand up straight on stairs (face the stairs upward) and place one foot near the edge so only your toes are on the stairs and the other foot in the middle, you will feel a stretch in your calf. But if you stick your but out- just lower your but a little as if you were going to sit down. Now you should feel the stretch around your ankle. I believe that is the achilles tendon. Both the calf and achilles tendon should be stretched out before your walk.
Plantar Fasciitis: Now, why am I talking about hip and calf muscles after a total hip replacement? Everything is connected. I was diagnosed with plantar fasciitis in April 2014. I remember daily waking up for a good 6 weeks and thinking “Why is my heel hurting so bad first thing in the morning?” I was told that I must exercise my feet from my doctor. Told to do toe exercises and also get a water bottle and fill it with cold water and roll that sucker under my foot (or get a tennis ball and roll it under my foot in the arch of my foot). I did this for about 4 weeks. I believed it was time consuming and I really didn’t think it worked. I noticed some relief. Now at this time my PF was not that bad. My heel did NOT hurt all day long.
Heel pain all the time:
By the time August 2014 came around, my heel hurt all the time. I believe it was due to the heavy intense dance I was doing with someone I worked out with in the summer of 2014. She had Nintendo Wii and she had Dance Off or some kind of Dance workouts. They were very fun. I remember going over to her place and doing a dance competition with her. I wanted to do the 60 minute routine since I felt so damn good. Remember. My hip was dislocated at age 13 so I developed arthritis at a very young age. I had hip pain for many many years. So after my THR my hip pain was GONE! I wanted to move my hips and jump and run (even though my doctor says “no running ever). I still wanted to move. So the summer of 2014 was an active year for me. I had tons of fun working out that summer. I also danced in my own garage. By September 2014, I didn’t work out with this person since her kids went back to school and she had other priorities. Also by September my heel hurt all the time. Sometimes in July I also hurt my knee from twisting something.
I had to go to my doctor and ask for an x-ray on my feet it hurt so bad. I was diagnosed with a bone spur in my left heel on Halloween 2014. Now, I needed new shoes I’m guessing sometime around August 2014. If you read any article on shoe life, you will find out they last about 300-500 miles. If one walks 2 miles a day and only has one pair of tennis shoes (like I did at the time) and wore that single pair of shoes all the time (like I did), then your shoes are going to die and wear out by 5 months (300 miles). In 8 months I would have walked 480 miles. This 2 miles a day is not counting walking in store, or to mailbox or at mall. It was only counting my 2 mile walk around home – and I walked outside with my dog daily – faithfully I’d take my 50 minute walk about 6 days a week. My mom purchased a new pair of shoes for me in August 2013. I got them right before my THR. I needed a new pair in August 2013. But by August 2014, my “new pair” was already dead. I didn’t have $50 or $90 laying around to get a new pair. So I just continued to use them.
I noticed the outside of my heel on both shoes was totally worn off by December 2014. This means I underpronate. This is common in people with a high arch. Since I got a job in November 2014 I was able to make more purchases with my new income. And boy did I need that income. I purchased the “custom” orthotics by Dr. Scholls in Dec 2014. My number used to be 440 (blue) in 2012. But by 2014, it changed to 110 (yellow). I guess the machine could sense I needed a LOT of heel padding. Well, it made some difference. But not a lot. What I needed was new shoes. Those orthotics cost $53. I try to purchase those orthotics once every 12-16 months since they do wear out. I finally purchased new shoes in Jan 2015. I knew I needed a shoe with a lot of heel padding. If you see that the bottom of your shoe has patches of tread that is totally missing and is bald – it is time to replace your shoes. Get a new pair and if you were them daily for everything – watch to see if they wear out in 5 months. It is important to replace your shoes once they are dead. They will not hold up your arch like the shoe is designed. If you see small creases, cracks or tears in your shoe near the sole/bottom that means they are not supporting your feet. The cushioning in the shoe wears out after several months. If you weigh more, it wears out faster. A year is too long to wait for a new pair of shoes – unless you don’t wear them daily and may be you have 4 pairs of tennis shoes you can wear. This will make your shoes wear out much slower.
I purchased a new pair of boots so I can wear them when it is raining. I also purchased converse so I can wear them only going shopping at one store – since those shoes seem to have less padding I’m not planning on doing any long walks in them. Then I purchased two tennis shoes for my long walks. I can tell a huge difference in my feet. It is like night and day. I also made sure I purchased walking shoes with great padding and a high arch. I got a pair of Asics and I also got a pair of Nike. One was $54 and the other was $59. Now I have four pairs of shoes and I don’t have to wear ONE pair daily.
If you are thinking about getting total hip replacement you got to make sure you stretch out both your hips and calves daily. You can’t do it for 4 weeks and think “Okay, I did it enough”. If your hip feels as good as mine does after your THR – you may want to start walking 2 miles a day. You may walk 4 miles a day. If you are not used to walking – you need to know that stretching is just as important as an aerobics workout or walking. It can be a very time consuming task to stretch out the hip flexors and calves (it can take 10-15 minutes) if you have a tight schedule if you work full-time, but you also need to message the plantar fascia.
How PF comes from not stretching your calves.:
If you are not used to walking 1- 2 miles a day and you start walking without stretching those calf muscles it is going to put more stress on your feet. Your feet will know it. Your feet will say “Woah, what is this new pressure on my feet?” and your feet will correspond with painful scar tissue. Your arches will start to fall. The Plantar Fascia does NOT stretch. It is a tendon. Think of trying to stretch a hard nail. Look at your feet. Imagine something pushing your feet down to where your heel and your toes keep on getting further and further away from each other>>> The opposite of a high arch. If that tendon does not stretch what do you think will happen? The back end of the plantar fascia is connected to BONE. Once the arch flattens out, BONE will grow to fill the gap. That is what a bone spur is. And once you get that it is very painful. If you are overweight or obese this will also contribute to more pain in the feet and will likely cause the foot to flatten when you are walking. If you work on your feet all day – it is important to purchase shoes with high arches. Were the orthotics in them all the time. My mistake was purchasing new shoes once every 12 months.
If you walk 2 miles a day (not counting walking you do to go shopping or around the house), you are probably going to need to replace your shoes once every 5 – 8 months. If you work on your feet and were your shoes daily for work, you may have to replace your shoes once every 4 months. Don’t get a shoe that says “Motion control” unless you overpronate. You will know you over pronate if the inside of your soles wear out, around the toes. I underpronate, which means the outside of my heel hits the ground first and I push off with my little toes. Hence – my arch must be supported. (I didn’t underpronate until AFTER my THR. My THR changed my gait).
If you can afford to purchase two pairs of running shoes (one for work, one for walking at home) the go ahead and spend $100 – $120. But don’t stop messaging the feet in the PF area (this is the arch and the heel) and don’t stop stretching your hip flexors or your calves. Many doctors will say that if you have tight calves you will end up with PF or they will say you got PF because you failed to stretch out your calves. Spend a good 10 minutes in the morning massaging your PF area of both feet. Do the same when you get home from work. If you can . .perhaps you don’t work full-time . .try to massage your feet in the middle of the day. There is a tool called “The Soother” (I believe) and you can use this to deeply massage your arch of your foot and the heel pad. It is also a great tool to massage your calf muscles deeply. Our hands can only apply so much pressure. I use something else I have here to massage that area. I can hear a crackling noise in my left foot/arch area and I found out that noise is scar tissue in my foot. My body knows it is something foreign in my foot.
My feet love me now that I have new shoes. New orthotics and a good foot massage does wonders for me. My heel pain is not entirely gone as I’m sure I still have the heel spur, but at least when I’m walking with my dog – I don’t limp with heel pain. I notice if I miss one day of stretching my calf, my feet notice it. I had a shot of pain killer in my foot on Halloween. I’m going in for another shot the end of Jan 2015. I think the pain killer lasted for about 8 weeks. Perhaps it will last longer now that I have new shoes. Let’s hope so.
If you have PF, I recommend you read these articles: