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Foot & Ankle Problems Message Board


Foot & Ankle Problems Board Index


Hi JessStar and everyone else, I thought I would simply note what happened to me, trying not to give any opinions-I learned a lot from this site before my surgery, maybe this will help someone else know what to expect.
I am an active runner and ran Boston this year. I chose a surgeon who is a triathlete, someone who "gets it" that I want to be active after this. I had PTTD on right foot-medial pain went away but lateral ankle pain was worse after runs of 20 miles or more. Short, fast races no problem but I definitely felt lack of explosive pushoff power in right foot.
On Oct 11, I had a medializing sliding calcaneal osteotomy (saw heel bone base off and slide to medial side 7-8mm then screw together with 2 screws), an Evans osteotomy (designed to lengthen lateral foot by inserting bone from hip in lateral side of foot, one more screw) and FDL transfer (tie off dysfunctional tibialis posterior tendon to healthy flexor digitorum longus tendon). My surgeon has done several hundred of these (Manoli and Pomeroy "All American") procedures. No mention of stem cells.
Even considering that I won a race 2 days before the surgery and ran Boston 6 months earlier, I was told to expect a year to 18 months for full recovery (i.e., back to running again). No weight bearing or driving for 2 months. No swimming or PT either.
At 48 hours post op, nerve block wore off and pain was indescribable. Even with Percocet and total bedrest, did not sleep more than 90 minutes for first 6 days. Pain log says 8-9 on a scale of 10. Switched to Lortab 7.5 500mg acetaminophen, worked part time first week back because the swelling really causes most of the pain, gotta elevate the foot.

At 2 weeks, my surgical bandages came off. Never was a cast. Boot goes on.
At 2 weeks, xrays taken again. At this stage, foot very swollen (e.g. I could not get a sock over it) and wearing no gauze or bandages.
On crutches for 60 days, wearing boot 24 hrs except to take a shower (if you ever bump your foot against anything without the boot on, you will know why).
I am about 35 days out. I take extra strength Tylenol at work, then Lortab at night. Weekends are best for keeping foot up. I will probably use pain meds for another week or so. Sutures look good, many have fallen out after this first month and foot looks much less swollen when elevated. BUT the minute you stand up, it will turn an alarming purple/red and start to hurt. At this stage, I can now see that I have ankle bones. Sometimes I have almost fallen, and put my foot down-it is very painful so I think it would be foolish for me to think about weight bearing yet-I still have a good three weeks to go before more Xrays. My right calf is already visibly atrophied.
I was not prepared for how long 60 days would feel, to be on crutches and not being able to drive. Like a marathon, it is mostly mental. The helplessness can lead to self pity, anger, frustration, irritability, loss of appetite and depression if you don't practice staying tough mentally. I wear a wristband to remind me to try to be pleasant and optimistic, and I have to look at it every few minutes. Sleeping in a 7 pound boot, risking your neck just to take a shower, deciding against a glass of milk because it is 15 feet away, HOPPING so much you now hate rabbits, and your crutches, one or both, propped up while you're hopping and then they slide and fall, slopping food and drink all over trying to carry things (by the way, get a backpack!) THESE are the adventures in frustration and madness that await you.
I am also using the EXOGEN device to promote bone formation-it cut my recovery time for a fibular stress fracture 3 years ago from 8 to 4 weeks.
I wish I could tell you my experience was like those folks who were done after a month, no pain after 6 weeks! Wow, that is a miracle. I don't think the difference between them and me is pain tolerance-I mean, I have suffered a lot in races, from blisters to puking and this type of pain, especially the first two weeks was nothing compared to a broken collarbone I once enjoyed. Some of it could be my age-I am 56-but I am still running times fast enough to get into Boston so fitness must counteract some of the age.
Who knows? But that is what happened to me. I keep a log and write in it every day, just like my running log. Screws come out at 6 months-back in boot for a short time. Then, walk,then run.
To those of you who had an All American and took a few Tylenol, and walked at four weeks, I stand (on one foot) in awe. To the rest of you mortals, get ready to do a fair amount of laughing and crying, and not be in charge of when or which.
Hi Bostonrunner (and other foot surgery victims)

I canít tell you enough how much I appreciated your posts. On October 19, I had a sliding calcaneal osteotomy with 1 screw, a FDL transfer (my dysfunctional tibialis posterior tendon was shredded and had to be totally removed so the surgeon used a screw to secure the flexor digitorum longus tendon). I also had a gastroc recession at the same time. No stems cells. My surgeon also has done hundreds of these over the last 10 years and averages about 3 a month with good success rate. However, I did do my own research as well as got a second and third opinion. Going into the procedures, I felt confident that this was something that I needed to do to relieve the pain I was experiencing from standing and walking.

Two years ago I had spent 2 days on a ladder washing windows while wearing shoes with poor support and partially tore my tibialis posterior tendon. Was in a Cam boot for 2 months for healing, nwb. Had pt for about two months, but still had pain while walking. Had custom orthotics made (took me 4 months to get used to) but still had pain after wearing for 8 months. My podiatrist said that I already had flat feet prior to the torn tendon, and the tendon was so weakened due to the injury that my arch was continuing to collapse so much that it was compromising the structure of my foot, thus causing pain. Although I am not a runner and not in the same category of athlete as Bostonrunner, I did lead an active life and walked 6 miles a day prior to the injury. I wanted to be able to return to that ability but could barely get through food shopping without pain. I am 50 years old.

This brings me to my current post op status of 31 days (Iím about a week behind Bostonrunner) My doctor had a different post operative treatment plan than what Bostonrunner had. I had same day surgery at 12:00 and was home by 6:00. He told me that I would be placed in a hard fiberglass cast directly off the operating table for 2 weeks. Then xrays, take out staples (which felt like sharkís teeth in a cast when the foot swelled - I wished he had used stitches) and in another hard fiberglass cast for 3 weeks. Xrays again, and in another hard fiberglass cast for 3 more weeks Ė a total of 8 weeks in a hard cast. Then in a Cam boot walker for pwb with 4 months of pt leading to fwb and with a transition to a shoe. Total recovery, I was told would be about six months.

However, things are not altogether going as planned. At 24hrs post opt, nerve block wore off and the pain was unbearable, even with Percocet. I have had ear surgery, major abdominal surgery (was hospitalized for 5 days) and bore 2 children (first one was 52 hours labor) and I have never experienced this kind of pain Ė a 10 on a scale of 10. Was on Percocet for 2 weeks but my doctor said that I should not be experiencing that much pain after 2 weeks, which made me paranoid that something was wrong. Swelling increased the pain as the staples dug into my skin and the cast felt like it was strangling my foot. At 2 weeks, the staples were removed, xrays showed good healing, and according to the doctor, the foot looked appropriate for this stage. I was relieved and got some pain relief with the staples out in the new cast. Went off the Perkoset and experienced awful withdrawal symptoms. However, the next 7 days in this new, tighter cast proved to be a torture chamber. Every night my foot and leg would swell to the point that my toes were engorged and bright red and the skin on my upper leg would bulge over the top of the cast (by the way, I have skinny legs with very little fat) It would take six hours of icing the cast to get the swelling down and I usually could finally get to sleep at about 3 or 4 in the morning. Every day I kept the foot elevated (nose above the toes except for when I went to the bathroom Ė I couldnít even shower) and I was on 3 Ibuprofin every 4 hours for pain and inflammation. I kept thinking each day that I would turn the corner and this would stop, but it didnít. On the 8th day I could not get the swelling down, called my doctor and he told me to go to the ER and get the cast taken off Ė he suspected a blood clot. When the ER Dr cut the cast, it sprung open and I got immediate relief. The foot and leg were bright red and there were bruises all down my shins from the cast pressure. The ER Dr thought that the cast was just too tight. He tested for a blood clot but it was negative.

I was sent home with instructions from my podiatrist (who was in communication with the ER Dr that night via phone) to use the Cam Boot, elevate, let the swelling go down and see him in 5 days. I noticed that my foot was numb on the top of the one side from the pinky toe down to the osteotomy incision. My heel also had several numb areas. Within a day I started to get pins and needles in my toes and heel, which escalated, into sharp, horrible, electric shock feeling pain. Called my Dr and he said I was experiencing transient compression neuropathy (due to the cast pressure from the swelling) and told me to take Perkoset for pain and the numbness and pain should dissipate in a couple of days. When I saw him on the 5th day, the pain had reduced to mostly a strong ache with occasional sharp electric pain periods. The numbness was the same. He said that would go away more when the swelling went down. (To date it is still numb) He wanted to put a new cast on but I just burst into tears. He kept saying that this was so unusual, but it was important to continue the course of treatment in a hard cast (foot needs certain position to heel properly) in order to get optimal results at the end of 8 weeks. After some discussion and some reluctance on his part, he agreed to let me use the CAM Boot walker for the next two weeks and then at the next appt he would xray and put a hard cast on again for another two weeks.

Needless to say, I am terrified at the idea of another hard cast. I have never had a hard cast before and didnít know what to expect. On the other hand, my journey with this experience has been so bumpy and I am so afraid of not following the optimal course of treatment for fear of making recovery more difficult when I start pwb and fwb. In addition, I am very concerned about the numbness on my foot and fear that it may get worse in a hard cast if it is compressed again.

What really struck me about Bostonrunnerís experience is that most of his procedures are similar to mine (did you have a gastroc recession prior to your current surgery or at the same time?) and he never even had a cast at all!!! Just bandages the first two weeks and then a boot for 60 days. Is this boot the same as the Cam Boot Walker that I am currently using? It would give me great peace of mind to know that continuing with it instead of a hard cast would also give good results. Is there some way that Bostonrunner could let me know who his doctor is so I could possibly have my Dr consult him? Also, what is an EXOGEN device?

Thank you all so much for taking the time to post Ė it has been a tremendous help to me!
It is incredible that you were able to begin pwb so soon. I agree that pt does help. I began pt before I was weight bearing and it really helped to loosen up my foot/ankle. I also had deep tissue massage which also helped with the calf muscles. I am 16 wks post op ptt repair, fdl tendon transfer, kidner procedure, calcaneal osteotomy, achielles tendon lengthening and there was one other procedure which I cannot remember. I am wearing NB sneakers with an ASO. I was given the go ahead to start wb as tolerated at 8 weeks. It was difficult without crutches and I had to rely on crutches for some help for awhile. I have just returned to work today and it really was much better than I thought it would be. I work in a hospital and am on my feet all day. I am sure by the end of the week my foot will be tired but all-in-all, I could not be happier with how my foot responded.
[QUOTE=Missyluke;4653078]It is incredible that you were able to begin pwb so soon. I agree that pt does help. I began pt before I was weight bearing and it really helped to loosen up my foot/ankle. I also had deep tissue massage which also helped with the calf muscles. I am 16 wks post op ptt repair, fdl tendon transfer, kidner procedure, calcaneal osteotomy, achielles tendon lengthening and there was one other procedure which I cannot remember. I am wearing NB sneakers with an ASO. I was given the go ahead to start wb as tolerated at 8 weeks. It was difficult without crutches and I had to rely on crutches for some help for awhile. I have just returned to work today and it really was much better than I thought it would be. I work in a hospital and am on my feet all day. I am sure by the end of the week my foot will be tired but all-in-all, I could not be happier with how my foot responded.[/QUOTE]

Thank you for your comments Missyluke. Good for you...it is a big deal going back to work! My PT therapist was really good. She never told me what I was supposed to be able to do. She would give me tests to see what I could do and then push me a little more each time. I went 2 times a week for 5 weeks. I am fortunate in that I work out of my house so I could get back to work bit by bit. I also had lots of help from amazing friends and a great husband. Can you tell me what a kidner procedure is? I have to go to a trade show at the end of January and am hoping I will be able to handle it. Although my progress has been on the fast track, I have worked really hard at recovery and being really good to my foot. I am also working at building up my other foot, leg and hip for the next surgery. My hip on the opposite side of my current surgery foot is problematic and weak so I have to work it at the same time. It will be a long year, but it is very encouraging to hear that people are happy with their results and getting on with their lives. I am looking forward to being able to walk without pain!!
Hi Bostonrunner and other surgery victims.

I havenít posted in quite some time but I really have appreciated reading everyoneís progress. There seems to be a broad range of treatment protocol and recovery times for similar procedures. The nice thing about this board is that we can encourage each other. On October 19, I had a sliding calcaneal osteotomy with 1 screw, a FDL transfer (my dysfunctional tibialis posterior tendon was shredded and had to be totally removed so the surgeon used a screw to secure the flexor digitorum longus tendon). I also had a gastroc recession at the same time. I had a hard fiberglass for the first three weeks, but had to switch to a Cam boot for the next five weeks because the cast was too tight and caused numbness do to nerve damage (was supposed to stay in the hard cast for the full 8 weeks). At 12 1/2 weeks post op, I still have neuropathy (numbness and pins and needles) from my osteotomy incision to my pinky toe on the one side of my foot.

However, the rest of my recovery seems to be progressing. I started pwb and pt at 8 Ĺ weeks and gradually went to a sneaker by about 10 weeks (no aso brace but still using crutches) My Dr. said to wear a sneaker when I could tolerate it (didnít really give me any guidance or restrictions) and gradually progress to full weight bearing. By 11 weeks I traded the crutches for a cane. I stopped using the cane about 5 days ago and now am full weight bearing. Since starting physical therapy, I have really pushed through the pain to maximize recovery. I also religiously did all of the exorcises the physical therapist gave me to do at home. I still have pain when I walk, but at least Iím walking. I can only walk for about 10 minutes at a time before needing a break. Before my original injury two years ago I walked 6 miles a day. Although Iím 50, I hope to be able to do that again. My physical therapist says Iím doing well. I havenít seen my podiatrist since 8 weeks, but I am supposed to make an appt with him after completing 12 visits of pt, which will be in about a week.

There are a lot of factors that can play into recovery progress Ė how long the problem existed before surgery, age, activity, weight, health, stress, etc. Just remember that this is not a race. Those of you who are in earlier stages Ė this too, will pass. It is a very, very difficult, painful recovery, but it does get better, I promise.

How are you doing, Bostonrunner? You havenít posted in a while. You are about a week in front of me and I hope things are going well for you.
Frankenfoot I am so sorry to hear of setback. I had surgery in August (ptt repair, kidner procedure, fdl tendon transfer calcaneal osteotomy and achielles tendon lengthening). It is so hard to know what swelling and pain is normal during the recovery process. It really gives me something to think about as I sit here at 4:15am with heat/ice on my foot before getting ready for work. I work on my feet all day at the hospital and have been stubborn on taking whatever is assigned to me. Yesterday I had a particularly hard assignment and ever since have been dealing with aches, swelling and some sharp pain (arch, incision sites and leg). Makes me think I need to not be so stubborn. I can understand how depressing having to go through all this again can be. Hopefully, this time around things will be different and recovery will go well.
[QUOTE=frankenfoot;4675729]Hi Girlygirl...thanks for your comments. Please refresh my memory...when did you have surgery and what did you have done? Take good care of yourself! Hope you figure the pain out. I got my stitches out yesterday...I will have a very interesting scar. My doctor wants to be exceedingly careful with me this go around. He has been doing more research and really has not found much to explain why this happened.[/QUOTE]
I had surgery Sept. 9th, 2010. I had a ptt repair, fdl tendon transfer, sliding calcaneal osteotomy with 1 screw and achielles tendon lengthening with gast. recession. I have not healed quite as quickly as some on these boards. I am very athletic and I think my doctor expected me to heal quicker than I am. I had my screw removed yesterday. It didn't feel to bad until about 10 pm last night, then the numbing medicine wore off and I had to take pain meds to get thru the night. I feel much better today and am elevating and icing it. I am praying that this screw removal will alleviate the pain I was having in my arch and my heal when I would walk. I go back in 8 days and get the bandage removed and stitches taken out. I got to take my screw home. It is bigger in dia. than I had thought and I could see why it could cause a lot of discomfort. I think my doctor thinks its more phycological, but I think we know our bodies and when it hurts something isn't right. I am like you, I had a lot of pain prior to surgery and got used to being in pain all the time when I would walk. I haven't gotten to the point yet that I can say, I am glad I had this surgery done. I hope to be saying those famous words soon. Please be careful and rest up.





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