Day 18/19 - Long travel & business meetings

Not much to add today and yesterday - I am functioning normally, attending a conference; the only limitations are that 1) I cannot wear my best shoes. It does not bother me too much; I expect to be completely fine in a few weeks, 2) I was unable to participate in a run in the morning - my foot is not yet good for running, and the extent of movement is very poor. I am treating the toe hard; I need to get it going.

I have read that many people use orthotics to prevent bending the toe. I think, in my case, it would be completely wrong - I want to get the toe bending, and the best exercise is just to use the foot as nature intended it to be used. I respect it may not be possible for everyone, though.

I am lucky I do not need any PT; I would not stand anyone fiddling with my foot, not to mention the waste of time and personal freedom!

Day 17 - The toe is bending!

Today I noticed that I can bend the toe upwards and downward (just a little) - it may have something to do with yesterday's visit to the beach and walking on the soft sand. Anyway, this feels great, and there is practically no pain in the joint. The scar is OK; scabs are falling off.

Tomorrow I am off to the West (of the US) - so far, so good, so I expect this to be uneventful.

Day 16 - Gym!

Actually, I did go to the gym today. I managed to put on my squash shoes. And I was perfectly OK. Obviously, no running, but I spent 30 mins on the training bike (no problems whatsoever), stretched, and did weights. In the afternoon, I went with my daughter to the beach and had a nice swim in the waves (the ocean was quite unrest).

Day 15 - The first swim

After much hesitance (scabs after stitches are still there), I decided to go to the swimming pool today. Actually, I rode the bicycle, which was absolutely fine. Then, I swam a few lengths of the pool - that felt great.

I do not think I will make it to the gym tomorrow - I tried my trainers, and my foot was very uncomfortable. The foot is still very swollen.

Next weekend perhaps.

Day 14 - Travelling by air

Travel was uneventful - except that I could not whiz through the airport. No excessive swelling, etc. Lots of walking at the airports may have helped with the joint's mobility; today, I can jump a little!

Day 13 - Long walk bare footed

Very good day, further improvement. I thought about going to the swimming pool today, but when I looked at the scar, I decided to wait until Saturday (the skin is still very thin, and there is crust after the stitches, so I thought it would not look well to others, and perhaps I could damage it). So I went for a walk instead; I could not walk in flip-flops, as the scar was too sensitive, so I walked barefoot and was OK.

Tomorrow I am flying for the first time since the surgery; a short flight only.

Day 12 - Working full steam

Not much to say - I worked full steam from early morning to late evening. Then, at one time, I forgot I had had surgery. Then, at night or in the morning, the scar became burning and itchy; I got up and walked around the house for a while, and the sensation disappeared.

Still cannot wear my best shoes, but I am OK with soft ones that are wider fit.

Day 11 - Back in my own shoes

Today I managed to put on a "normal" shoe (laced oxford), and I drove to the office. I took the post-op shoe with me just in case - but I did not need it. The normal, soft-sole shoe helped me start bending the foot, and the swelling decreased. I am back at home and quite happy; walking is not perfect, but there is no constant pain I had before the surgery.

Day 10 - Stitches out

The dressing was removed today, and stitches were taken out. The foot is swollen, but I can walk quite well. No need to wear the post-op shoe if I do not want to. In the evening tried to put my foot into a "regular" shoe. The shoe went on without much problem, but walking is not too comfortable. So I think I will wear the post-op she for another few days. But I will have a shower without the "cast protector"!

My Doctor showed & emailed me a photo taken during the operation. Unfortunately, part of the cartilage is badly damaged, so I may need the fusion soon. There's probably nothing I can do about it.

I will be working from the office this week. Friday flying for a meeting. I will go to the gym on the weekend (but no running definitely, this will have to wait).

Day 9 - A little DYI

At night I got something like muscle stretch of the entire body, which must have stretched something in the wound, as there was some very unpleasant pain. I even thought of taking Percocet, but I did not. In the morning, it was still painful, especially when I was having a shower. Then I started walking around the house (actually I can walk without the post-op shoe, but I do not want to as it makes the dressing .... 'grey'), and the pain was immediately gone. I drove, walked, and functioned all day, and in the evening I was so fed up with constant resting, that I decided to do some DYI... I used power tools, took off the patio door from its hinges, out it back.... just to give you the feel of what it was. It is 8 pm and I am feeling great now.

Tomorrow is the follow-up visit, I hope the dressing will be gone, and anyway I am planning to go to work afterwards and for a business dinner in the evening! I am going to take several pairs of shoes with me to the clinic, and just see what will work...I love the challenge.

Day 8 - Back to driving

Things going as expected - further improvement. I drove probably about 30 miles today with no problems. Walking all day, no swelling. Waiting for the dressing to be removed on Monday.

I would say that walking is actually more comfortable than before the surgery.

Day 7 - Tried driving with a post-op shoe

I drove the car today - it is possible. The post-op shoe on the right foot is not the most convenient kind of footwear to wear for driving, but it works. Actually quite OK. Need to practice the stopping distance, though.

I also noticed that there was practically no swelling tonight. So I went to a shop; I was OK.

So I opened a bottle of wine in the evening!

On Monday, I am going for a follow-up. I think I will opt for no dressing afterwards. I wonder why my recovery is so incredibly fast compared to everything I read on the web - possibly because I am very fit; I used to run 5-7 miles 3 times a week, so my circulation and the muscle strength in the foot must be both be very good, thus draining the site of the surgery and not allowing for passive hyperaemia (i.e. blood getting stuck there).

I look forward to going to the gym next week on Sunday - and I mean it!

Day 6 - Shower in standing position (!)

Further improvement. I showered in the morning without using the chair and tried walking without the post-op shoe. The foot gets quite swollen after sitting or walking, so best to stay on a sofa or a recliner keeping it up n the air.

The dressing makes me crazy; the skin under the bandage is itchy, and I had to use a screwdriver for scratching it (not at the incision site, of course). I am tempted to take it off and wash my foot properly; my reason tells me it is not the best thing to do. Need to get through a few more days.

Walking is not a problem, even in the garden - on the grass, sand etc.

Day 5 - See day 4

See Day 4 :-)

Day 4 - Painkillers not needed anymore

No pain at all; therefore, no painkillers are needed. I can walk without any problem (well, the post-op shoe is a problem - I would happily take it off together with the dressing). I am moving my toes and bending my foot as much as the dressing allows. I have not tried jumping yet...

Day 3 - Stopping Percocet

I took the last dose of Percocet at 10 pm yesterday and missed my 4 am dose. I got up, and I am feeling OK, no pain at all at rest; I can 'walk' wearing the "shoe". I am limping as I need to put my foot in the correct position to avoid pain - it is all possible. I can climb the stairs. I would not feel comfortable driving (but probably would drive if I had to). Tried to simulate an emergency break pushing against a piece of furniture - pressed hard, and there was no pain (although I could feel the stitches).

____

I got through the day without any painkillers - which is great. I worked all day from my "bed office". Then, I went to a shop and post office with my wife driving. The foot got swollen at the end, but this quickly subsided when elevated upon return home. So, things seem to be on the right track.

Day 2 - Percocet and plastic sock

Yesterday evening I had a shower using a leg-sized plaster protector bought at a pharmacy store (it is sort of a huge plastic sack (or sock?) with a rubber seal on top, you just put your leg into it, and it works! Also, my wife went to Walmart and got a cheap ($38) plastic chair for showering; it does help to be able to sit under the shower; perhaps I will keep it for some Friday evenings :-)

Keeping Percocet 5-325 2 tablets every 6 hours gives me no pain while resting. Some discomfort when walking without crutches; need to avoid putting any load on the toes/front of the foot. When I put my foot sideways and use the heel, there is practically no pain (but it looks comical!). Of course, using the post-op sandal.

The foot was elevated approx 30 cm/1 ft all night, and the swelling seems to be subsiding - the dressing feels very roomy. A nice surprise! If things keep going like this, I should be able to drive the car very soon. Today I will try to reduce the dose of Percocet by half and see if pain control is sufficient.

____

It is almost noon - I took only one tablet of Percocet at 10 am (scheduled time); pain control is sufficient, and I can walk quite comfortably without pain as long as I put the body weight on the heel only.
I went outside and had a snack on the porch. It seems that I do not need crutches anymore. Life is good!

____

It is 7 pm - no pain when lying down with my foot elevated. Can 'walk' without crutches. Went outside and BBQ-ed some stuff for dinner (!). But after 30 mins, I can feel that the foot gets swollen and a bit (not much, really) painful again, so I need to go back and put it on my pile of pillows. 10 mins later, I am OK again - no pain, no swelling.

How did I get there, the surgery, and first 24 hrs after

I will be sharing my experience from the treatment of hallux rigidus. It is a condition where one gets osteophytes (spurs) over the metatarso-phalangeal joint (this is the one on the base of your big toe), plus damage to the joint's cartilage. With time, these cause pain, limited dorsiflexion (ability to bend your toe upwards), and there are "lumpy knuckles" that cause aesthetic problems, especially to the ladies (we guys usually do not care that much, although some do....). The condition is developed after acute or chronic trauma, can be genetically conditioned, or - like many things in human medicine - one simply does not know the causes yet.

I got mine in the right toe several months after I "stumped it" - I hit the toe quite strongly against the base of a sliding bathroom door in a hotel bedroom. It was at night, so I was wearing no shoes, and you can imagine that my body was fully relaxed, so any protective muscle tension was very low - which I think must have contributed to the scale of the damage. It hurt rather bad, but I 'walked it through' - and even continued running on a treadmill  (this was my routine - I was 44 at that time and ran up to 7 miles 3x in a week). I had it X-rayed, but that did not show a fracture or any other damage.

With time, things got worse - it hurt while running, and even during the rest, I got lumpy knuckles that were quite painful. Unfortunately, things were not improving, so I decided to see a podiatrist in November 2011. He X-rayed the foot and saw the osteophytes grow on the dorsal (upper) side of the joint - he gave me three options: do nothing and withstand the pain, or have a cheilectomy (chisel away the spurs), or do the fusion (immobilise the joint with a screw).

It took me a few months of thinking; eventually, I decided to have it treated with a cheilectomy. An orthopaedic surgeon was recommended to me  (no offence to the podiatrist, but as I was about to have my joint open, I wanted to make sure that I would have carefully chosen the person who would do it), and I went for an appointment. He confirmed the diagnosis and agreed that a cheilectomy would probably be the best treatment (it was stage II of joint involvement). So we scheduled the surgery for mid-May.

Before the surgery, I was reading a lot about the recovery time, and there were reports of anything from no pain at all and walking and driving after 3-4 days up to a long recovery of several months. So I took the middle case and assumed that if I have the surgery on Friday, I should be able to work from home the following week, perhaps start driving 10-14 days after the surgery, and maybe even fly for a conference 3 weeks after the surgery.

So it is 12th May today - and I had surgery yesterday.

The surgery experience was excellent. I went into the hospital at 7 am, got all the information collected several times, and got my foot scrubbed and shaved (I am a hairy animal). The anesthesiologist suggested a local nerve block plus putting me to sleep shortly (rather than proper general anaesthesia). I agreed. So I had to change into a gown, got my bar code wristband, got "plumbed and wired" (vein access + electrodes for heart monitoring), and the anesthesiologist gave several anaesthetic injections into various places (probably 6-8 or so - I do not remember). These are not pleasant, of course, but I would not say they hurt. A few minutes later, my foot was numb completely (which he confirmed by squeezing, pinching and pricking my toes).

I was taken to the operation theatre at quarter to 9 am and jumped onto the op table. They gave me the "heavenly milk of dreams" (it is white and looks like milk. It is propofol - the same that was overdosed in Michael Jackson). Then I heard "it is over"; in fact, it was over - I was moved back to the cart and taken to the post-op room. I must say that immediately after waking up, I felt happy and fantastic (if not the best I ever felt in my life - that must be the effect of propofol or something else they gave me). There was a huge dressing on my foot and a post-op black shoe. No pain whatsoever - I was in an excellent mood and was joking around and teasing the personnel. They gave me biscuits and a soda; I asked for coffee and got it too! We phoned my wife to get there. It was 10:40 am, so less than an hour. She came 10-15 minutes later, and I was given a walking aid (the balcony-like one) and told to go to the bathroom to change back into my clothes. I had no problem with that (again, no pain at all). As soon as I was in my clothes, they put me into a wheelchair and gave me an ice pack to use at home; five minutes later, I was in my wife's car going home (with my foot on the dash because I remembered to keep it elevated). We stopped on the way to buy shower protection for the foot, and that was when the numbness started to subside, and I started feeling some pain. I took two Percocets at that time. 15 minutes later, we were at home; I limped from the garage to the living room using crutches and laid down on the sofa with my foot elevated. I had a huge bowl of ice cream and got incredibly sick (after Percocet mixed with the remains of anaesthesia in my body, I think), but I did not throw up.

For those who are more curious, I have attached a photo taken during the surgery - it is a photo of an open joint, so if you are too sensitive, do not look there.

The surgery was yesterday. I was taking two percocets every 4 hours yesterday, today reduced it to every 6 hours, and it keeps me in very good shape. On the one hand, the pain is much less than I had expected or read about - practically non-existent; on the other hand,  oxycodone induces some sleepiness which does help (and general pleasure, too - in the end, it is quite a strong opioid). I am taking it on a fixed schedule, so the pain is prevented and not fought against; they also say it is the best way to avoid dependence. I had some nausea after the second or third dose, but now I am 100% OK. I can walk in the post-op sandal with crutches or limp around without; I can wiggle my toe, and I think that I can bend the joint a little (although I do not want to break the stitches!). Most of the time, I stay in bed with my foot lifted;  I cannot see much use of the icepack - the dressing is too thick to let me feel the cold. The dressing has leaked a bit, and there is an ugly stain on it - but this is normal, so who cares. I am going to have a shower later today.

All in all, this is much less difficult than I had expected or read about; I hope to be able to reduce/stop Percocet in a few days. I will keep writing about it daily, hope it may help someone who is planning to undergo a similar procedure.

As an MD, I know very well that everyone is different, and everyone's surgery and recovery after surgery are different. So this is my personal experience - which I hope will be helpful.