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Foot & Ankle Problems Message Board

Foot & Ankle Problems Board Index

Hey guys,

Woo, this is a long one, lots going on!

Well, my surgery was on Monday 11/4; it's now Thursday 12/5.

After getting off to a rocky start (extreme swelling that caused blisters, then 2 BAD falls within 24 hours during the first week, then a bad roll and pop a week after that), I'm happy to say that things have leveled off, at least on that front, and no more accidents have been had thus far (and with any luck no more will!).

After my ten day post op, i rolled my foot in a weird way in my boot and something in my foot popped and vibrated up my leg, and really hurt for a couple days. After being told repeatedly to contact the office with "any changes or incidents" i decided to email them and let them know what was going on - that it was probably just that my ankle joint had popped from the immobilization, but it was really hurting so i wanted to let them know. I was surprised to get a call back the next day from the doctor himself.. until I discovered that he really just called to be insulting. "You've fallen more in 2 weeks than most people do in their entire life" was how he opened the conversation - even though in the email i pointed out that I hadn't fallen, i had merely twisted the cast while trying to lift it up onto a bench. So it was obvious right off the bat that he didn't even really read the email. He went on to tell me (this was 14 days post op from having a BONE not just cut but shaved OUT of my foot and a tendon scraped partially off and moved to another location!) that "most surgeries don't actually hurt, its just psychological" (seriously, who SAYS that - I'm sure there are millions of people in the country who have had any number of surgeries that would disagree!) and "I needed to stop worrying about it because I'd really have to try to do something that would mess it up" and "if i INSISTED they'd x-ray it again at my next appointment". I got off the phone absolutely livid, though i had been very polite and calm to him and had just basically told him he was wrong in saying the pain was in my head and pointed out that my email clearly said i rolled my foot, not that i fell. I proceeded to call my GP, who assured me he would contact him to let him know that I am not a worrier, an attention seeker, etc, and that I actually have a very high tolerance for pain. More on that later.

A couple days after that call (17 days post op) I went to see the PA for my second post op and to get my stitches out. I was told initially to expect some "tugging sensations", but I knew from the past to take pain medicine first. Unfortunately, my surgeon failed to listen to me when I told him at my ten day post op that due to my immune system weirdness and problems, while my body tended to overreact it also overcompensated - and the stitches needed to come out before that as the scar tissue was already heavily forming and drawing them tighter. He completely ignored me. Unfortunately, it turns out I was right - the tech couldn't get them out, and neither could the PA. After tugging on them for 15 minutes they had to literally CUT every SINGLE stitch out of my foot with what looked like manicure scissors - as in cut parallel snips into my skin the entire way down the incisions under every knot. Not cool. The verdict? "You should tell the doctor next time you see him that those were in too tight, and they should have probably come out earlier".

Which brings us to the fact that apparently no one tells the doctor anything. Everyone is afraid of him - if he's having a bad day, everyone is having a bad day (we've overheard quite a lot of talk about what a diva he is while waiting there). Word must have gotten around that i had called, because suddenly the PA who had given me the complete brush off before had all the time in the world for me. He had read my chart. He wanted to know how my immune condition and being off the prednisone to heal was going, and was the reynauds giving me extra trouble? He had the time to answer all my questions. He even wanted to chat about the book I was reading. It was like falling down the rabbit hole; a complete 180 from my pre-op apt with him where he didn't want to listen to anything i said (and subsequently screwed up my post op meds because of it). When i asked about the pain and was it normal? "Of COURSE it still hurts! you just had a big surgery 2 weeks ago! they cut a bone out and did a lot of work in there! It's probably going to hurt for quite a while yet!" - 3 days after the surgeon told me the pain was all in my head. I think they were all shocked that I had dared stand up to him, and suddenly liked me or were willing to take me seriously.

Then I was told that my weight bearing date would be moved up to 6 weeks instead of 8 .. and that the PA would be seeing me again. Wait, said I, we were told that I would be alternating appointments with the surgeon and that he would make decisions. I was given the brush off about his busy schedule and his confidence about the procedure and how that was coming straight from him, and that he would see me at 10 weeks post op for a final evaluation. Since the surgeon wasn't in that day, we figured we would just call and find out what was going on with the misinformation and the changes..

That was 2 weeks ago. The surgeon WILL NOT return my call. I've called 5 times. Nor will he call my PCP back, which is UNBELIEVABLY unprofessional and frankly just discourteous in the medical field (I have a lot of specialists that manage my care; it's unheard of to not return a peer's call when its been clearly marked and indicated that that doctor is to receive updates about the patient). I live over 2 hours away and can't drive, so it's not like I can just go park myself there and force him to see me. Apparently he is having an extended tantrum and has decided that I am unworthy of his time, as I must just want something to be wrong and can't trust that he did an excellent job and nothing could possibly go wrong (this seems to be his general stance - he is god, all other mortals should recognize his magnificence).

So my PCP (who is a one doctor purposely small practice and one of those very good PCPs who does a lot himself and does tons of research and building of his knowledge base and diagnostics, instead of forking over every problem to a specialist) has consulted with another surgeon he knows, and I'm now supplementing my after care with their advice. We all concur that it is safe to begin weight bearing at 6 weeks, due to smaller amount of tendon than expected that was transferred, so at least the surgeon didn't just say that to get me out of his practice faster. My PCP/the consulting surgeon have cleared my to sleep in a night splint for plantar fasciitis instead of my cast or my boot, starting Monday (5 weeks post op) because I have extensive disc damage in my lower back (4 herniated discs, two of which actually bulge, and congenital spinal stenosis), and the sleeping with the cast is proving EXTREMELY troublesome. My back was actually on it's way to healing, but the immobility combined with having to sleep on my back with my foot in a 6 pound boot, have caused SERIOUS problems. I am actually back on low dose narcotics - but for my back, not my foot. My PCP wants to start a few weeks of constant prescription anti-inflammatories, but I am trying to wait until 6 weeks, so we are playing it by ear. Him and the other surgeon both maintain that 95% of the healing as far as ROM and tension on the tendon go has already happened so I should be fine starting them, as well as starting to flex my foot more and work on the ROM. (and that this is also why it won't hurt me to go to a lighter night splint). Before anyone is too horrified, please remember that I didn't actually have any work done on my ankle or any bones cut or fused, just a superfluous one removed and the piece of the tendon relocated, so most of my foot is still stable, I just can't hyperflex it or turn it sharply, and it needs to stay in a dorsiflexed position so the tendon doesn't lock. At this point I am planning to start PT for flexing and ROM in about a week, to get an appointment or two in before weight bearing begins.

The surgeon's PA had said at my last appointment that the surgeon expects that i will go from PWB to sneakers in a span of 4 weeks. I feel like that is wildly optimistic, but who knows; the bone was only about the size of a woman's index finger nail, and the tendon transfer was on the lower (so better prognosis) side, so maybe that'll work out. I'm not going to break my neck to get it done though and possibly cause harm or set myself back long term, especially for someone who has decided I'm not even worth their time.

As for the foot itself, I have a lot of random intermittent pains in the side of my foot/ankle around where the PTT comes down, as well as HORRIBLE but brief stabs of pain sometimes when I move my foot slightly around where the bone was moved and the tendon was attached. After showing my PCP the areas that were hurting, he said it was all perfectly normal and nothing to worry about; something about a neural sac in the area, plus bone and tissue disturbance, plus still blood that is trying to be absorbed back into the body, plus tendons and joints that have been held in an unnaturally tight position for quite some time now. Overall the pain is completely tolerable as long as I don't overdo (I only started the narcotics yesterday for my back; for a good week i had only been taking about 2.5 oxycodone at night, so I'm fairly confident the pain has improved.). It swells fairly badly when left down on the floor still for more than 30 minutes, but honestly not as badly as I expected, and it has been improving. It's more that it FEELS like it is swelling, and becomes very tight and tingly and mottled. My (not crappy) doctor says that the more I leave it down the more it will become used to functioning that way again and that for a week before weight bearing I should make an effort to try to leave it down for longer periods of time, to retrain my body. My doctor also had this procedure done himself in both feet when he was fairly young (and he's in his mid 50s now), so between that, the fact that I trust him completely, and the fact that he has consulted with another professional, I'm feeling pretty good about the advice. At least I'm GETTING advice somewhere.

Unlike a lot of you, I was under orders to remove my cast/boot daily and rewrap/gauze it starting at day three because of my pre-existing health problems, and was cleared to shower with it in the tub (while sitting) at 2 weeks. So I have really gotten to see the healing process very closely along. The foot looks fairly normal at this point - a big improvement that seemed to happen all at once about a week and a half ago. There is still a band of swollen tissue on the side/bottom of my foot, likely around one of my tendons, but i feel that is to be expected. otherwise my foot and leg look completely normal, other than the terrible, terrible sad muscle loss happening in my calf (another thing my surgeon COMPLETELY glossed over). The scar from the incision on my foot is VERY hard, but has even started to lay down some, and almost all of the scabs have finally fallen off. I practically never need to elevate over my head anymore - I survived an hour and a half in a motor cart at Costco - the first 30 minutes were dreadful and then it sort of just calmed down and accepted it. Later, After 20 minutes of having it truly elevated it was back to normal. So I feel that it is encouraging. I guess the true test is once weight bearing starts, but that's still almost two weeks out.

I am excited to be able to start PWB before Christmas, as I am very sad to not be able to do much right now, as the holiday season is very important to me. I'm still sort of a depressed mess, but I think that's mostly due to my jerk of a surgeon and the amount of valium I am having to take for my back, which is very depressive to me. I am, at least, feeling much more optimistic after the hour I spent with my PCP. I am also looking forward to being able to distribute my weight and move around a bit more not only for my back, but because my non operative foot actually has a AN that is twice as large as the one that was just removed, but has never been symptomatic as was never injured. Until now, when it is taking a lot more stress and pressure as I hope around on it. While we know it will probably need to be fixed at some point, after all of this I'm not at all keen on any more surgery and will likely put it off as long as possible - maybe in 30 years they'll just have nanotech that can go in there and fix it for me ;)

So.. that's my story so far. I would caution everyone to remember that even if you search out a surgeon who is a board certified ankle and foot specialist who works in a sports medicine practice and manages athletic team care and has all the bells and whistles and accolades and pedigrees, it doesn't necessarily make him or her a good doctor. In fact, I think that was part of the problem here. To him, this surgery was VERY small potatoes. The most routine thing that he does, so in his mind I shouldn't even have any more issues or need anymore care. This guy seems to purely want to cut people up, do amazing and fantastic repairs, pat himself on the back, and that's it. I have confidence that he did an outstanding job on the work itself and honestly have no reason to think otherwise, but the aftercare has been obviously woefully poor. Unfortunately, we didn't get a flier that said that before hand, so now I'm just doing the best I can with what I have to work with.

Hope everyone is doing well/staying healthy!

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