WHAT WRITERS NEED TO KNOW ABOUT LOWER-LEG INJURIES


Not my foot, but similar to what mine looked like after surgery


In the writing world, I occasionally see articles such as "What Writers Need to Know about Archery" or "Horse Misconceptions in Fantasy Writing." So today, I'll put my legendary clumsiness to use and write about a similar subject.

We frequently see characters get seriously hurt (or, less frequently, sick) in both fiction and nonfiction. In many cases, authors sort of skip over the healing process to get back to the action. But if someone almost dies—or even if they have a non-life-threatening but serious problem such as pneumonia or a broken bone—they won't be back to 100 percent for a while. They'll have to deal with a shocking number of both small and large inconveniences throughout that period, and their condition will dominate their waking thoughts for a time. Even if they make a full recovery, they may still suffer lingering effects for the rest of their lives.

Having characters break legs or sprain ankles are favorite tactics among fiction authors, especially during fight or chase scenes, but such wounds rarely seem to have long-term effects on their victims. In my experience, that's not realistic at all! Based on my three-year adventure with my Lisfranc injury, here are some facts that might help you write more accurately about a person (real or fictional) who seriously hurts their foot or lower leg:

  • For the first day or two after the injury, the patient will probably be told to elevate the injury above their heart to reduce swelling. This is really hard to do while sitting up, so the person will likely spend a lot of time lying down. Surprisingly, even with the leg propped up by things like pillows or the arm of a couch, the muscles in that leg still get tired.

  • If the patient likes to sleep on their side or their stomach, they either won't be able to do it at all or will have a hard time getting comfortable, especially if they're in a cast, boot, or postoperative shoe.

  • Particularly for the first few days, the patient might experience constant pain at varying levels of intensity. Even slight movements, like adjusting the position of one's foot, can cause sudden spikes of pain. (The day after my injury, I couldn't even tolerate the weight of a small bag of ice on my foot.) It's exhausting. To minimize the discomfort, the patient will probably avoid movement as much as possible.

  • If modern medicine is available, it won't take away the pain completely. For me, at least, it often seemed to merely take the edge off, if that.

  • If the patient has surgery, they'll probably have to take an antibiotic. They might also have to wear special devices like these on their lower legs for several days to prevent blood clots. At worst, the squeezing feels like painful charley horses in the calves. 

  • Normally, moving from a sitting position to a standing position would just require rolling one's weight forward onto both feet. But with an injured leg or foot, the patient instead has to pull on something and/or push off of whatever they're sitting on.

  • Showering with only one good leg is all sorts of fun. A shower chair is a must, and an able-bodied person might have to help the patient get in and out until they're strong and coordinated enough to do it with just their crutches. (Depending on the patient's personality, this might be embarrassing.) The patient might need to use a cast cover, which fits painfully tightly around the knee, or something similar to keep a cast or bandages dry. A handheld showerhead is a lifesaver. Once the patient can finally wash the injured part of the leg/foot, no matter how gentle they try to be, it's going to hurt.

  • Getting dressed is an acrobatic exercise for someone who can't stand on both feet. I usually had to lie on my bed to put on anything below my waist except socks. I was lucky enough to only be in a cast during warm weather, so I could put on capris or shorts fairly easily. But if a patient is in a cast during cold weather, getting their bandaged/casted limb through pant legs might be a challenge.

  • A healing injury can itch like crazy. Doctors say not to stick anything inside a cast (broken skin could lead to an infection), but I found that using a plastic ruler with rounded corners was a great way to get relief.

  • If the patient likes to cross their legs while sitting, a cast makes this hard because it both presses against the leg on the bottom and prevents the patient from bending their ankle. 

  • A walking boot can end up getting all sorts of dirt, grass, and sand (ugh!) in it.

  • Turning around while on crutches requires the patient to swing the crutches to one side, hop to catch up with them, and repeat until they're facing the direction they want. On a knee scooter, the patient needs even more room because they have to turn the handlebars as much as they can, scoot forward, turn the handlebars the other way to back up, and repeat. Scooters do not make tight turns.

  • Once the patient finally feels up to leaving the house, going anywhere takes way more time and energy than usual. A knee scooter gives more support and is much less tiring to use than crutches, but someone has to collapse the scooter, hoist it into the trunk or backseat, and then reverse the process upon getting out of the car. I eventually learned how to do all this by myself while standing on one foot, but it was a lot of work and probably not the safest option.

  • The more the patient goes out, the more they'll realize that the world is designed for able-bodied people. The patient will become acutely aware of things like non-automatic doors, standing in line, curbs, buffet-style meals, narrow aisles and hallways, electrical cords underfoot, and other everyday obstacles that are super difficult to navigate when you can't walk. 

  • Crutches cause soreness and tired muscles in the armpits, upper back, chest, arms, wrists, and hands. Crutch pads can make it easier on the armpits and hands.

  • It's next to impossible to carry anything while on crutches unless the patient uses a purse, backpack, or similar device.

  • This happens a lot: https://tenor.com/bbGT0.gif If there's no elevator, the patient has to get creative. They might sit down and push themselves up backwards, crawl up using just their arms and one leg, or give someone their crutches and hang onto the railing for dear life as they hop up on one leg. They'll probably have to rest along the way and/or at the top.

  • Once a cast comes off for good, the area underneath literally stinks because the patient hasn't been able to wash it for weeks. Dead skin peels off for several days, and the hair might be bent at strange angles because it couldn't keep growing straight up.

  • The patient might need physical therapy to regain their strength and mobility. Especially at first, the still-healing body part is weak and sensitive, and the patient has gotten used to protecting that area, all of which makes the exercises both painful and difficult. (This is also true of starting to put weight on the injured limb again.)

  • Psychologically, the patient goes through quite a roller coaster. The initial injury, like any traumatic experience, can cause shock. There's a lot of frustration as the patient deals with long periods of weakness, frequent and sometimes intense pain, limited mobility, and the inability to perform even basic chores or enjoyable activities, such as tidying a room or playing soccer. The injury and its effects on the patient's life—attending doctor appointments and undergoing any specialized procedures (especially when they cause the patient to miss work), figuring out how to sit comfortably at one's desk at work, wrangling with insurance or worker's compensation, learning how to move to minimize pain, and so on—can dominate the person's waking thoughts. Yet progressing from non-weight-bearing to weight-bearing with crutches to walking unassisted brings unexpected wonder and joy at each new stage.

  • Even once the person has healed, they might still have long-term effects, such as these:

  • Numbness from nerves damaged by the injury and/or that had to be moved out of the way during surgery and then put back

  • Scars from the original injury or from surgery

  • Sensitive spots on or near scars

  • Pain when walking long distances, such as on a hike or after several hours of shopping

  • Pain when the weather changes, even for young people (scientists still don't know why this happens)

  • Pain and unsteadiness when walking on uneven ground

  • Pain for no apparent reason!

  • A limp that might or might not go away

  • Reluctance to engage in activities that might irritate the limb, such as running

  • Difficulty finding comfortable shoes


When I was a kid, I used to want to be on crutches just to see what it'd be like. Oh, how silly I was. 😁

Now, I didn't write all this to make you feel sorry for me. This is simply an example of how complicated a person's life can get while healing from a serious injury. If we write about characters or people who've had or who end up with major medical problems, we need to show the repercussions of those injuries/illnesses. People don't just bounce back right away, especially from brushes with death, and they don't always return to their old selves. We need to respect that process and what we're getting our characters (real or fictional) into.


Write on,

Candice

("Two Weeks After Surgery" by - EMR - is licensed under CC BY 2.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/2.0/)


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