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It's hard to believe it's been one whole month since I went under the knife! Much has happened in the last two weeks with my recovery. Three weeks post-surgery I had my first official post-op appointment at OHSU. My bulky splint finally came off and I got to see and touch my foot and lower leg. After being stuck in the splint for three weeks the skin on my leg was dry and scaly and my calf had atrophied quite a bit, which was all to be expected. There was some dulled sensation in my lower leg due to minor nerve damage. Apparently this should resolve completely in several months. To both my and my doctor's surprise, there was almost no swelling or bruising in my foot and ankle! This is good for two main reasons: 1) less swelling usually means less pain, and 2) less swelling means stitches heal better. Having no swelling with major foot surgery is highly unusual. I chalk this up to keeping the foot elevated most of the time and possibly my continuation of bromelain and curcumin supplements - both anti-inflammatories. The stitches on my lateral ankle and top of my 1st metatarsal had healed well enough that I got them removed during the appointment - 11 stitches total. Not too bad for a major surgery! After the stitches were removed I went into a pretty comfortable CAM boot which I will wear for another 9 weeks. As this was week 3, I still have to be non-weightbearing for a while longer. I had my first post-op physical therapy appointment this week as well. This doctor also remarked in all her years of practice she has never seen so little swelling after foot surgery. With my foot out of the boot, I did some ankle dorsiflexion exercises with her, which I have to continue 3x/day for the next three weeks. My ankle feels very stiff and weak but I'm sure if I do the exercises regularly mobility will improve. One of the week's most exciting developments is finding a way to do cardio at the gym. I have been lifting weights 3x/week but miss getting my heart rate up more - plus, I want to stay in decent aerobic shape until I can get back in the pool or on a stationary bike again (3 more weeks!). The rowing machine at the gym was the ticket. I simply placed a platform next to the machine and rested my boot on the platform. I took care to not place any weight through the foot as I pivoted lightly on the heel. The current plan is to incorporate the rowing machine into my gym routine 3x/week. 
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Only two weeks out from surgery and I now have ZERO pain. In all honesty I am amazed at how fast my body is healing.
Last week, about 10 days after surgery, I started my PT exercises at home. The current PT focus is on hip abductor and gluteus medius exercises with a Theraband. I have also been working on strengthening my abs with boat pose and bicycle crunches and my upper body with modified push-ups. The first day I tried my PT exercises I was pretty exhausted after 30 minutes but it did feel really good to move my body again! Over the weekend I also started going to the gym again which was a massive win. Using my knee scooter to get around, I was able to do upper body exercises on several of the machines and also tried some quad raises with less weight than I typically do. While it felt good to get back into the swing of resistance training, I also found that I needed a nap afterwards. I also made sure to have a large protein shake as soon as I got home. A game changer in terms of regaining some independence at home this week has been the iWalk 2.0 hands free crutch. Although the name and branding are a bit over the top, I have found this mobility device to be indispensable around the house. Being able to make my own coffee or a simple meal the past few days has meant not only my husband gets a break from caretaking, but I also get to use my surgical leg in a quasi-walking manner. Due to some expected atrophy of my right leg, using the iWalk the first time was definitely challenging. Over the past few days I have tried using it a little more each day to the point I was able to fix myself a meal yesterday, and even clean up the kitchen afterwards! Just four more weeks to go of non-weightbearing - I can do this! This last week has been a bit of a blur, but I am happy to report that my surgery on May 16th went very well. I arrived at the OHSU Center for Health and Healing at 5:45am and went home around 1pm after a four hour long procedure. In addition to sedatives and general anesthesia, I was given two regional nerve block shots in my right leg before the surgery, rendering it completely numb from mid-thigh down. The anesthesiologist used an ultrasound device to place the nerve blocks in the correct spot. It took longer than expected because they said I had so much leg muscle it was hard to find the nerves! After the procedure, the anesthesiologist installed a nerve block catheter in my leg to numb the sciatic nerve for 72 hours after surgery. A slim tube protruded from behind my knee which was attached to an external pump releasing a set amount of nerve block per hour. I believe this absolutely helped me control my pain levels with less narcotics after surgery. The first few days at home were challenging. Getting used to life on crutches, especially with one numb leg, was its own hurdle. I needed help going to the bathroom and getting in and out of bed, which was where I spent most of my time. Pain management consisted of elevating my foot above my heart 23.5 hours per day, staggering Tylenol and ibuprofen, and occasionally taking prescription pain medication if I had breakthrough pain. I had a series of alarms set on my phone to remind me to take my medications before they wore off, and a notepad to keep track of what I took when. Overall my pain levels in the first 72 hours never got above a 2 or 3 because of this system. I was also prescribed a 'baby aspirin,' 81 mg 2x/day to help prevent blood clots from forming due to inactivity. One thing that surprised me was my huge appetite. I ate so much the week after surgery and drank about twice my normal amount of water - which is already a lot! I tried my best to stick to my diet of high quality protein, fresh veggies and fruits, and whole grains, and my amazing husband brought me all my meals (and coffee!) in bed. I started drinking cups of bone broth throughout the day, because it felt nourishing and was high in collagen. On Thursday morning my nerve block catheter had to be removed - a moment I was dreading, because this meant the feeling in my leg would return. In anticipation of higher pain levels I took an Oxycodone an hour before the removal. My husband gently pulled out the catheter from my leg, which in itself was a painless procedure. Then I braced myself for what ended up being the worst pain I have ever experienced in my life. About an hour later, I could acutely feel the screws and plate bracing my 1st metatarsal. I could feel the large incision on my lateral ankle, inside which my newly sewn ligaments and tendons were throbbing. Bone and ligament pain was a brand new - and nauseatingly visceral - sensation for me. It was something I had to breathe, and occasionally scream, through. Thankfully, this passed within a few hours and I was just left feeling exhausted. One sensation that has not gone away after the nerve block wore off was a burning pins-and-needles feeling in my right great toe which extended to the sole of my foot. My toe, which is poking out of the bulky Jones dressing, is hypersensitive to any kind of touch - if a blanket or piece of clothing brushes it, a zap of pain shoots up my leg. I am hoping this is temporary nerve damage or bruising and not a permanent problem. It seems to improve every day but is still very much present. Throughout the week I have had a number of visitors which really brightened my mood. Boredom has not fully set in yet because daily life tasks take so much energy. Regular naps are imperative. For instance, taking a shower was such an ordeal that I slept most of the day after. Although still cumbersome, crutches have gotten much easier although I am in bed 99% of the day. Yesterday evening two friends came over for a backyard BBQ. It was gorgeous out and I was grateful they could carry me down the four steps so I could sit out in my backyard. When things were wrapping up I crutched back over to the steps, thinking I could make it up to the house by myself. I was not so lucky. After two steps, I was about to lose my balance and caught myself on my splinted foot to stop from falling. It was excruciating, partly because I landed on my great toe, and partly because I was so angry at myself for not accepting help when I could have used it. I sincerely hope touching down with part of my weight for a split second doesn't prolong the healing process. Of course I can't make it a habit, but ultimately I don't think it did too much damage.  With my foot reconstruction surgery on the horizon, I have decided to start 'training for surgery'! My goal is to be in decent aerobic and strength training shape and have a strong immune system going into surgery, so I can come out stronger on the other side. The only issue is choosing activities that don't worsen my condition.
My training plan for the next seven weeks is:
Until surgery I am wearing a BioSkin TriLok brace on my right ankle to prevent any further damage to my foot. I am pretty much wearing it any time I am up and about and it definitely gives me more confidence moving around in the world just knowing I am less likely to hurt myself. I also started on a pre-surgery supplement plan and am trying to eat 100 g or more of high quality protein per day along with a TRUCKLOAD of fresh fruits, veggies, and whole grains. As a daily supplement I am taking Standard Process Ligaplex II, 3 capsules 2x/day for seven weeks before surgery. Please keep in mind, I am not a doctor and this is only my opinion, not medical advice! My supplements 10 days before and after surgery:
5 days before and after surgery:
10 days after surgery:
After surgery I also switched to Standard Process Ligaplex I, 3 capsules 2x/day. * None of these linked products are sponsored, I just listed them in case they are helpful to you! Hello and welcome! I started this blog as a way to record my journey through foot reconstruction surgery and reach others who have experienced similar surgeries. After countless hours of scouring the web for personal accounts of those who have undergone major foot and ankle operations, I came up largely empty-handed except for a few sporadic blogs on specific procedures. A little background on me: At the time of writing this post, I am 33 years old and live in Portland, Oregon with my husband Paul and our two poodles. Since I was a child I have always had very high arched feet. I never thought it posed a problem until recently when my feet started to not fit into "normal" shoes and my heels and lateral ankles started killing me nearly all the time. Granted, in my adulthood I had increased my physical activity levels. But never did I relate the multiple ankle sprains and "wobbly" ankle feelings I've had for years to my high arches. I have pretty much always been active in sports, especially competitive swimming, In the last decade I also picked up hiking, dancing, running, and cycling, eventually competing in my first triathlon in July 2021 where I placed 7th out of 70 women. Besides the triathlon I also trained for and competed in several open water swim races as well as the Portland Half Marathon in 2021. Unfortunately as an athlete I am all too used to just pushing through the pain - which is not always beneficial.  The week after the marathon I was out for a run when I felt my right ankle give way for what seemed like the millionth time. This one somehow felt different than normal, though. I barely made it home 4 miles. I did the usual protocol of RICE for two weeks afterwards (Rest, Ice, Compression, Elevation), but even after two weeks my symptoms did not resolve. I'm still not sure exactly what I injured on that run, but I suspect some damage to my peroneal tendons occurred. Or maybe I just became acutely aware that my body was trying to tell me something was wrong. Regardless, fast forward 6 more weeks and I was still in a whole lot of pain. A small and very painful bump had started to appear below my lateral malleolus. My ankle was still swollen and at my local Zoomcare I was misdiagnosed as having an ankle sprain - even scolded by the PA for not RICE-ing enough. I was given a naproxen prescription, which was a Band-Aid for my symptoms but did not really address the root cause of my pain - or what the "bump" was. Three months down the road from the October injury, I was in so much pain I stopped being able to take my dogs for even short neighborhood walks. Going to the grocery store was next to impossible. I couldn't wear certain shoes or sit cross-legged because any pressure on the bump was excruciating. Driving hurt because it involved flexion of my right foot. At this point I was really starting to get depressed because I couldn't run or cycle anymore. I made an appointment at a local podiatrist's office, at which the doctor proclaimed what I had was "very unusual and extremely rare" and promptly placed me in a fracture boot until I was able to get an MRI. Now, all of us Americans know how convoluted our healthcare system is, but I had never had a firsthand experience of it until this year. It took me weeks to be able to get the MRI cleared by my insurance, make an appointment, and get the results. In the mean time, thankfully, I was able to find a much better qualified foot and ankle orthopaedic surgeon who I wanted to work with, Dr. Bopha Chrea at OHSU. At my first appointment, Dr. Chrea took a close look at my images, examined my foot, and was able to pinpoint my diagnosis on the spot. I should have just gone to her in the first place! I was diagnosed with severe cavovarus foot, peroneal tendon pathology, peroneal tenosynovitis, hypertrophy of the peroneal tubercle, and chronic lateral ankle instability (CAI). All of my pain started to make sense with these diagnoses. Dr. Chrea laid out a treatment plan: in order to permanently address my peroneal tendon problems, I also needed to concurrently address my cavovarus foot deformity (the medical term for a very high arched foot) and my CAI. The procedures she recommended were bony work in addition to soft tissue work. There would be a very high rate of failure if I just elected to get solely the tendon repair. Hypertrophy of the peroneal tubercle is a rare disease and essentially means part of my calcaneus had overgrown due to excess friction from the peroneal tendons. This is what the bump was! There is a medical link between hypertrophy of the peroneal tubercle and tenosynovitis of the peroneal tendons: an inflammation of the tendon sheaths surrounding the tendons. When it came down to it, the idea of having bony work honestly scared me, as a person who has never had surgery or broken a bone in their life. I trusted Dr. Chrea and wanted to take her medical advice since she presented her reasonings so clearly. She encouraged me to seek other doctors' opinions in the coming weeks because I had such a complex diagnosis. In the weeks before surgery I met with several other doctors who had no skin in the game. They all 100% agreed with Dr. Chrea's plan. For the bony work, Dr. Chrea proposed a lateralizing calcaneal slide osteotomy as well as a 1st metatarsal dorsiflexing osteotomy. The chances of painful hardware and/or nonunion with the calcaneal slide were quite high even under the best circumstances, so I opted to only get the 1st metatarsal osteotomy, which lowers the arch of the foot. Having the calcaneal slide would make return to sports at a high level difficult if not impossible. On the other hand, there is typically a high success rate with the 1st metatarsal osteotomy making it likely for me to return to sport sooner. The middle ground I decided on was to get custom orthotics after my surgery to correct any remaining cavovarus alignment issues in my hindfoot. The soft tissue work included a tenodesis of the peroneal longis tendon to peroneal brevis tendon. This involves suturing the two tendons together, essentially rerouting the deforming force on my foot. I also was going to get a Broström-Gould procedure, which tightens two ligaments in the ankle - the ATFL and the CFL - to remedy my CAI. Recovery from a surgery like this would be 6 weeks non-weightbearing (NWB) and 6 weeks partial weightbearing (PWB), ultimately looking at 6-12 months until full recovery. All in all, at the end of March 2022 I had signed up for an absolutely massive surgery to take place on May 16th. Better start training for it!  |
