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.