Before and After

I thought it was about time I changed my xray pic to a before and after shot so here goes...this is the one I took in the hospital before I had the second op.  As you can see, the toes are BEAUTIFULLY straight and the arch is considerably flatter.  One of my most exciting moments after the first op was putting on a sock and looking at my foot thinking 'wow...I look like I have normal feet'.  After acquiring more flexibility in my toes my second most exciting moment was when I realized I could wave my big toe...very cool, couldn't really do that with the crunchy 'before' toes!

After...............................Before

6 Weeks P.O. - Officially Nothing to Report

Toes still a pain in the proverbial but basically nothing I can do on that front.  On the other hand I am now in shoes and walking unaided, admittedly at the speed of a rather elderly relative but people tend to be understanding about these things.  I have also managed a number of other milestones, showering standing up, walking up the stairs, etc.Oddly the up stairs is much easier than the down stairs, possibly again to do with ankle flexibility.

So from here on in its just a case of speeding up the walking and reducing the ever-present puffiness. My marker for reduced foot swelling is when I can see my veins and when I can see my tendons when I wiggle my toes...I will of course update you when that happens but as far as I can tell, 6 weeks P.O. everything is almost back to normal!

40 Days P.O. - Shoe Time!

So I just thought I'd let you know I managed a one crutch trip to our corner shop at the weekend - twice!  Our corner shop is only a 5 minute walk away but you can imagine how long that took but it wasn't like I had anything else to do, and besides, there was NOTHING in my fridge!  I am also sporting the shoe look this week, thus far this has taken the form of either sloppy boots (probably very bad for my rehab but very comfy) or birkenstocks plus bandage.  The latter does look a little like I'm going for the socks and sandals combo but I think the crutch helps confirm that I'm not.

My one memory that is bought back that I will try and pass on is that right now walking is a little like exercise.  Basically you haven't done it for a while so muscles that you normally use, like your hip flexors, will suddenly start to hurt.  It's also a lot easier if you don't sit down for extended periods after walking because things tend to hurt more when you get up again.  The main example of this is the heel part of the op, I find that a good long (10-15 mins is long for me right now) walk, if it's followed by a half an hour sit down, will kill my heel if I try to stand up again.  It just feels super bruised.  The trick is to largely ignore it and gradually increase the amount you walk around on it.

Grim toes looking a little better although still oozing, will update pics later in the week!

5 Weeks P.O. - Miscellaneous

So despite the toe issues 5-weeks P.O. seems to be much the same as last time.  Incredibly bored with the whole cast affair which, possibly contrary to medical advice, I don't bother to wear around the house.  I still wear it to work but I find at home, to aid with the whole weight-bearing thing, its better to stomp around in my increasingly bloody and grubby fluffy slipper (see below).  I have, however, reached a number of important milestones.  The first was a trip from the kitchen to the front-room carrying a plate and glass entirely unaided.  The second was standing up from sitting on the floor without having to shuffle to an appropriate piece of furniture.  And the final and most exciting was putting trousers on STANDING UP rather than sitting down like an old person.  I realize these are small achievements for all you two legged people but seeing as I have done none of them in the last 5 weeks for me, I feel like I have done something.

The infamous polar bear foot!

I have found after both ops that at this point it is perfectly possible to walk unaided.  Admittedly still with a bit of a limp and not in any kind of a hurry but still, on two feet and without crutches.  The current problems only exist with bending.  Because of the 4-5week interment in the 90degree cast my ankle joint is somewhat reluctant to bend at a more acute angle which, if you think about how you walk, is entirely necessary.  Also the last phase of the gait cycle requires you to lift off from your toes.  Again, these have been pinned for a long time and are now slightly unhappy with the idea of bending so I've found sitting around manually bending each toe and standing in a calf-stretching exercise pose helps with both joints.

The only other main points of note at this point are that feet still tend to be swollen.  As you can see from a side-by-side comparison (below), the toes are still distinctly puffy.  They do become less so with my nightly foot-up and ice routine which I achieve by resting my foot on the arm of the sofa with an ice pack tied to it for half an hour.  But still, puffiness 5-weeks post surgery I am lead to believe is completely normal and fret not, it does diminish.

Just in case you needed direction...the one on the left is one I made earlier!

Final problem at this stage is a little gross and yet satisfying at the same time.  Because of the constant life in cast and the lack of leg showering (I have still not progressed out of my limbo because of toe issues...more on that to come), skin tends to not rejuvenate at a pleasant or appealing rate.  My feet do now appear to have sunburn and are peeling in quite a fun way, little sheets come off when I do my morning inspection.  This is entirely satisfying if you enjoy peeling sunburn, as many people do but just won't admit it! 

Pain-wise nothing serious to report.  I've found that more weight bearing activities tend to give me heel-ache.  This also happened last time.  It feels somewhat like your heelbone (calcaneous) is bruised, so standing on it for any length of time is not that comfortable.  This gets better over time but for the first few weeks of weight bearing at least its better to pay attention to it, if it starts aching, have a bit of a sit down!

So other than fairly gross peeliness feet are looking relatively OK, scars particularly so:

Still puffy but all under control

As a colleague pointed out this is not a flattering foot angle and may make everything seem larger than it actually is, possibly because I've just cut the edge of my ankle out of shot...

These two sets are my favourite scars...is that weird?

The two infamous toes are still causing problems.  I managed Monday and Tuesday to keep them dry and stop them oozing but then Wednesday something happened, they got damp coming out of the shower or something ridiculous and so they got cracked and disgusting and it took me all of Wednesday to get them to dry again.  They have now been dry since Wednesday evening so what I'm hoping is that they'll stay dry across the weekend and then I shall try and go castless on Monday (shhh...don't tell my surgeons), a purpose for which I bought a pair of particularly sloppy and comfortable boots.  I will let you know how this progresses...

GROSS TOES!  Not painful, just pretty disgusting!

3-4 Weeks P.O. - Readmission - Oops!

I'd just like to preface this entry with my last foot experience.  3-4 weeks post op last time I was happily stumping around weight bearing and by the end of week 4 my pins were working their own way out of my toes.  Week 5 I popped in and had the pins whipped out, an incredibly quick and surprisingly painless process.

This time, unfortunately, the toes that had pins whipped out have been problematic.  After the stitch removal they managed to swell up in an impressive manner and then from nowhere in particular, burst.  I was quite happy to dress them myself but after 5 days of serous fluid soaking into two bandages a day, lots of skin sloughing and finally a little bleeding I thought it was probably time to consult a professional.  I have nothing against local practice nurses but I thought this needed a bit of a professional eye so I rang the hospital, expecting awkwardness but was met by a lovely woman who told me to come in first thing the next day (Friday) and Mr Cooke would squeeze me in.

I turned up at 8.30 having warned work I would be a little late...this became an understatement. I was expecting to be redressed, told I was being silly and sent on my way.  As it was there was some tooth sucking noises, some tutting and finally a 'I think we'll take those pins out and then re-admit you....do you have your stuff with you?' Erm....no.  Funnily I thought I was going back to work after this.  I was promptly found a bed (solo this time so I could watch TV into the night) and abandoned across the bank holiday weekend.  It was basically enforced bed rest with compulsory antibiotics (the toes were really quite red and unhappy - indicating infection of some kind), as much as I tried to rest at work and at home you have to get up to get food and various other bits and pieces whereas in hospital you can stay in bed and not move for 6 days, which is essentially what I did.  Over this time my toes gradually dried up and on Wednesday I was released into the world with the instructions to keep them out in the air as much as possible.

Since then I have been airing them under my desk at work and as much as possible at home.  The tops now look much less like they're dissolving and while the bottoms are still scabbing they're considerably neater than they were about 4 days ago.  The benefit of this is of course that while I am technically supposed to still be wearing my cast this doesn't necessarily apply at home where I have something my other half affectionately refers to as my polar bear slipper, something that's nice and soft under foot and allows me to gingerly weight bear. 

I'm now comfortably going one-crutched in the house, its slow as a method of progress but I'm getting better.  The main problem with re-learning to walk on the newly constructed foot is the issue of having had it fixed at 90 degrees for 3 weeks and its consequently unwilling to bend to a more acute angle which, if you think about it, is necessary for walking.  My knees and hip have also got used to lifting everything on the right of me up slightly and it now feels slightly odd to be standing level once more.  This has facilitated more stretching exercises which keep me occupied in the evenings.

I've got a check up on my newly scabbed toes next Friday but will do my best to include some up to date pics in between.

19 Days P.O. - Hopping Along

Here are some post-clean up pics to see how things look after all the stitches have come out.  Clean up op didn't take too long but plenty of dried blood to be getting on with!

As you can see the scar between toes two and three has oozed considerably at some point.  Since this happened to the last one its not bothering me overly, its not still oozing and its not infected, its just a bit messy.

My two side wounds have healed up very nicely according to the nurse.  The one that runs along the inside of my foot is my favourite on the other side!

This is a rather unflattering angle and makes everything look much puffier than it actually is but it shows the re-attachment site for the tibialis posterior (the incision mid foot), as well as its re routing site (the one closest to the bottom border of the photo).  If you squint you can just see the new fancy tiny incision they made to do the heel shift on the outside of the foot, its such a tiny scar I didn't think it warranted a picture of its own despite the new fangled techniques in place to do it!

As you can see from pic number 1 toes 2 and 3 are still rather unhappy after their pin removal.  They have been quietly blistering and oozing for a number of days now and there seems to be very little that can be done.  They get a good clean and dressing change twice a day, as much air as is feasible considering I'm trying to work during the day, and the odd coating of Sudocrem or Savlon.  Unfortunately, the stripping of the lining of my cast means there's nothing to absorb anything that does leak out of these toes so I end up sweltering in my own ooze.  I realize that's quite disgusting but you came here for the facts and these are the facts!  I've taken to selotaping an old bit of material in the bottom of the cast that I can take out occasionally and either wash and put back or throw away, make it all more comfortable.

On the walking front I've managed a one crutch hobble a couple of times but because of the lack of ankle bend in the cast I do feel a little unbalanced so these one crutch trips are strictly out of necessity (laundry, bin emptying, etc.).  Most of the time I do feel I should be weight bearing so I just hobble slowly on the bad foot and keep the second crutch around for balance purposes.  Having said that it is just MUCH quicker to go one legged most of the time!  

I've also been doing some foot rotation in the evening and I think tonight is the night for weight bearing bare-foot.  This is done with strict care and doesn't really involve walking.  It mainly involves standing on both feet with both crutches down and the gently easing the weight onto the new side as well as putting the good foot forward and doing some calf stretching exercises on the bad leg.

Will keep you up to date with pics once all the scabs have come off!

14 Days P.O. Stitches Out!

Had my first official viewing of the whole foot since the surgery and was almost as upset as last time.  If you glance back to the 1.5 days P.O. photos you will notice the foot hasn't really had a chance to swell.  Over the past two weeks it's definitely caught up on that front!

As you can see, the toes are most definitely stuck together with puffiness, in fact toes two and three are quietly oozing after their pin removal - yuck!

Love this set of stitching down the inside of the foot - very cool!

Stitch removal largely painless but incredibly dull.  There's a lot of stitches here so it takes about an hour all in with dressing removal and clean up.  Stitch in toe number 4 was AGONY but I'm not really sure why, and it was only agony for a very brief period.  Skin condition on toes 2 and 3 slightly concerning but I've still not had a proper clean up and moisturize so when that's done I shall show you more decent pics!

On the progress side I am now tentatively weight bearing (now I know wounds aren't going to burst inside my  cast).  This largely involves leaning on the crutch closest to the leg and doing a little hobble.  My subconscious is still not happy with me putting any more weight on it because if I'm too far away from a seat my body will currently throw its arms out rather than put the foot down but I suspect I will grow out of this with practice!  Handily the removal of the stitches not only means I can get on with my cleaning and BioOil routine but also means I can start some range of movement exercises.  To start off I found the following helpful:

- Opening the top of the cast only and pulling it back slightly on your leg, i.e. away from your body.  This tightens up the angle of your ankle and stretches your calf muscle.  After two weeks of inactivity it feels WONDERFUL!  

- As a follow on to this exercise, once the cast is off I've found it helpful to place my foot on something relatively low (a footstool when you're on a sofa, or a box when you're on a chair, or anything where you're foot is supported) and just do some non-weight bearing calf raises.  Just lifting the heel and lowering it back again really helps get everything moving.

- Finally, once I've moved the calf and leg around sufficiently it's nice to bring the calf up across the opposite knee (so you're sitting cross legged, man-style) hold the foot and gently rotate the ankle.  Again, because of the tendon moves and the inactivity this will feel lovely and as the days pass you can remove your hand and just use your own muscles to do the rotating.