As if a replacement knee wasn’t enough, I had to have foot surgery a year later. Graphic images warning: if you dislike scars and stitches, proceed with caution. Note: the painted toes above are BEFORE surgery – thought a scary pic was not a good opening pic!
There was a bit of a story to it: innocent little me asked the knee surgeon to remove a couple of annoying ganglion cysts on top of the bunions while he had me under for the knee. Seemed logical to me, I was going to be asleep, he’d have a scalpel or two lying around!
He was horrified. Knee guys, I discovered, do not touch feet – at least not at the same time as fiddling with knees. Infection control. Fair enough, keeps me safe! So off I went to see a foot guy.
Engineering comes into play here. The surgeons prefer to go down the leg – so hips, then knees and lastly feet. But yes, my feet needed some surgical intervention. Foot refurbishment was his jocular phrase to my physician. I liked the term, but I’m assured it isn’t actually a medical term.
The plan, therefore, was to wait until I’d had the second knee done. However, the second knee recovered relatively well from the strain of the extra load during recovery from the first knee surgery, while the big toes were not so happy. The ganglion cysts had faded, but would most likely come back if the feet weren’t refurbished. So the decision was made to fix the feet before the second knee (which might last for a couple of years if I’m lucky). At this point I was just having the bunions (on big toes) and bunionettes (on little toes) corrected (which would remove the driver for the ganglion cysts). Unfortunately, I needed to change surgeons prior to the surgery and the new surgeon had a whole different plan of attack.
First step was an MRI of my left foot to confirm his suspicions. Yes, my big toes needed a “fusion of hallux” (fusion of the 1st MTP joint) and there was a cyst drilling a hole in my metatarsal bone. Oh. That needed a bone graft. OH.
It seems that just like my knee, where there had been a cyst dissecting my popliteus muscle, here was another cyst only this time it was attacking my bone. The osteoarthritis and the psoriatic arthritis had found another place in my body to have a party, it seems. Together, they are more destructive than alone, I am learning.
He also wants to replace my ankles, but that is a story for another day. One step at a time!
Preparation was very similar to the knee replacement preparation, so I won’t go through it all again. Had the same physician, Dr M, who is a darling. ECG, bloods, etc etc.
So on May 6, 2021 I arrive at the hospital at 6 am.
Just for later comparison, here are my toes before surgery – as you can see there is no gap between my big toe and the second toe. But this is not nearly as misaligned as some photos I have seen.
What I woke up to was this view of my feet! The pink stuff is the antiseptic wash they use in theatre and my feet are elevated. For the first two weeks, the feet are elevated 23 hours a day. ONE hour a day “feet down” is permitted for toilet privileges. Shower with the feet bagged. So the pink stuff stays, really. All weight is through the heels when walking, no rolling of the foot at all. No toeing off! No driving. There is never any driving.
This is what I now have in my big toes. There was discussion about these prior to my going into theatre. I wanted to know if they are actually this pretty blue colour. While the surgeon looked at me as if I was from outer space, the surgical Fellow assured me yes, they are. It is an important detail. I refer to these as my toe jewellery. The bone graft to fill the hole drilled by the cyst was synthetic bone – yes, I asked that question too.
Apparently, I also have screws in my little toes now, I only found that out at my six week post-op review.
Of course I had nail polish and lippy on as soon as I was allowed – it was a whole THREE days before I was allowed nail polish! Naturally it matches my PJs – well, that pair, anyway.
The anaesthetist, the physician and the surgeon had all warned me that post operative pain management can be difficult with feet, so I had mentally prepared myself. Although I was sure foot surgery would not cause the glute spasms that the knee surgery had caused, I still watched the clock until the 10 hour mark (that was when the spasms kicked in after the knee surgery) had safely passed. Despite the warnings, which were much appreciated, I was one of the lucky ones. I had a virtually pain-free recovery. I cannot express how grateful I am for the excellent care, although I do understand there may have been some luck involved. The nurses would come around to do obs and ask the “On a scale of 0 to 10, how is your pain” question and I would say zero. Admittedly, the pain medications were kept on schedule, but really, it was a pain-free journey.
The hardest part was no movement. I hated it with a vengeance. I am told the ankle surgery is longer, so I am not in a rush. Psychologically it is really, really difficult for me to do nothing physical: no walking, no swimming, no weights.
I didn’t hire the cushion from the surgeon for elevating my feet in bed at home. My daughter and I elevated the foot of my mattress to achieve the same effect.
At two weeks the stitches came out, steri strips went on and I was FINALLY allowed to get my feet wet!!! This was a wonderful day! I was shocked at how dry my skin was after two weeks of being untouched. I also suspect the antiseptic wash had quite a drying effect. This dryness resolved very quickly, thanks to QV Cream and being able to finally shower (but definitely NOT soak) my feet. I also was given smaller duck feet. The nurse taking the stitches out was quite horrified at the size of the duck feet I had been put in after surgery. Now I could see my toes!
These smaller duck feet were also easier to walk in. The next four weeks were pretty much the same. I started working again, from home, and kept my feet as elevated as I could under the desk. For that my daughter set up an aerobic step platform on two reams of paper. Necessity is the mother of invention. It worked. Swiss balls are excellent for elevating when sitting in a lounge chair.
At six weeks I went back to see the surgeon for the post-op all clear to walk and drive and live a normal life again. He was pretty pleased with my progress, as was I. I had started 500 metre walks on the Saturday prior, so I had cribbed a couple of days. It was my birthday, I could not stand being cooped up on my birthday! All was well. The shot below was taken exactly a month after surgery. Now, nearly three months after surgery, that gap between the toes still stuns me – compare with the top photo with no gap. It is not this dramatic when standing on my feet!
In hospital, during one of the frequent checks, a nurse asked me if I could spread my toes. I looked at her stunned. I didn’t know anyone could spread their toes like we can spread our fingers. Apparently being able to do so is good for our feet and our balance. I also discovered I am not the only one that cannot spread my toes. I can wiggle, I can bend: but no spreading.
I have had to buy a couple of new pairs of runners as my usual runners were just a little snug when I was first allowed out of the duck feet. I also developed blisters on the lateral wounds (little toes). Nurse said that is not unusual as the skin becomes very calloused where there are bunionettes. The blisters weren’t really an issue though, just applied Betadine for a few days.
The right foot little toe took a little longer to feel 100% than the left foot, but we can’t expect mirror image healing.
Now there is hardly even a scar to be seen, I’ve healed very well.
I had a great recovery. I will end this with this caveat: not all patients will necessarily be as fortunate as I was, there may be some post-operative pain. Even so, the medical profession are constantly improving pain management. Discuss it with your surgeon.