Physical Therapy--No Pain, No Gain

I'm now 10 weeks post-surgery.  At about four weeks out, Dr. B had looked at my toe and said, "You need to start working that toe--it's going to freeze up on you."  So he showed me how to do my own physical therapy, stretching it downward at the joint at the base of the toe with my hand.  I've been trying to do this for weeks now.  When I first started, I would sit there stretching, with tears running down my face, because it hurt so bad, even on pain meds!  Poor Jon, sitting across the room from me, felt horrible.  In time, it became less painful, but not much more flexible.  Finally last week, I called Dr. B's office and asked for orders for physical therapy.  I had a feeling I didn't really know what I was doing, and also wanted to have someone else look at the fourth toe, which is still very sore (hurts with every step) and pretty swollen.

Today, because we got a snow day from school, I was finally able to make a call for a PT appointment. The receptionist said, "Can you come in now?"  Craig, the physical therapist I had seen a few years ago, happened to have an opening.  

I'm so glad I went!  When he evaluated the foot and took his measurements, it was clear I have a long way to go to restore an acceptable range of motion to my toe.  And Dr. B had only told me to flex the toe downward, but Craig pointed out that it's the upward motion (like standing on your toes) that I need in order to walk correctly, because I should be extending through and pushing off that toe with each step.  Right now, my toe doesn't even extend enough to allow for that.

So he had me do four things, all of which hurt immensely, even though I had taken a precautionary hydrocodone!  

1) Stand and lean my hands against a wall for support, then lift the heel of my foot so that the foot was positioned like standing on tiptoes (although no weight was on it, just being in that position caused lots of pain), 

2) spill a cup of marbles on the floor and pick them up with my toes and put them back in (ouch),

3) put my foot on this device he had with a spring-loaded lever, and flex my toes to pull the lever back (yep, ouch),

4) then Craig spent about 15 minutes manually stretching my toe both ways.  He got busy doing this and then started chatting with one of his regular patients who had come in and started her exercises.  So he's mashing away on my toe, pretty oblivious to my wincing and breathing, and squirming in pain (or just pretending he wasn't noticing).  When he looked back up at my face, he gave me this questioning raise of the eyebrows.  So?  I just expelled all that breath I had been holding, and said, "I can assure you I have NOT been doing any stretching of that sort at home."  I thought he was going to just go ahead and snap the toe right off, he was pushing and pulling it so hard!  It was so red when he finished that I had to take a picture for the blog.  And here's a pic of the deceptively cute little pink marbles--demons!

I'm really glad that I'm going to PT now . . . it makes me feel more confident that I'll be able to have full function of that toe when I'm done.  And I talked to my therapist about the fourth toe as well, since it is still so painful, and I showed him the one on the other foot to get his opinion about whether it had been a good idea to get it done.  He said yes, and it will eventually heal well and not bother me anymore, which was a relief to hear.

When the shoe's on the other foot . . .

Check it out!  Five weeks out, and I was actually able to cram my right foot into my regular shoe!  I went to the store in it, came back, and took it off promptly, but it was a good first run.  It's still too tight and pressing on sensitive incisions to be comfortable, but it's definite progress.

4-Week Checkup!

I saw Dr. B today for a one month check-in to see how the healing is going. They took new x-rays. The verdict: the bones look good, the incision looks good--go ahead and walk on it! Yay! He said I could also start putting Vitamin E oil or Mederma on it so that it will heal with a minimal scar. I'm so glad--I've been itching (pun intended) to rub something on it. It gets so tight and dry and is begging for some treatment.
Then I directed his I'm-pretty-proud-of-my-work self to that poor little fourth toe that he turned. It still looks the same as it looked right after surgery 4 weeks ago! There's a big old blackened area that just hasn't changed, and the skin around it is looking kinda gray and turning tough. Gangrene??? Just kidding, but it really doesn't look good. He took a look at it and hemmed and hawed and threw around some medical terms: "Yes, well, uh, this here is vacuum edema and this part of the skin isn't getting circulation, that will eventually slough off . . . , but I can get some of that scab off for you" (pointing to the black part).
"Okay," I said, "yeah, that would be great."
So he rooted in a drawer and came out with a little scalpel and said, "Hold really still--this is very sharp!" and proceeded to DO SURGERY without anesthesia! I immediately reverted to my Bradley method of childbirth breathing (it's well ingrained, thank goodness). Well, the scalpel wasn't cutting it (pun intended), so he got a clippery thing and started pruning away. All the while I'm cringing and breathing and thinking, "That's what I get for questioning a surgeon's work!" The surgeon's solution is always to cut, no?
Actually, when it was all said and done, I was glad he gave it some attention. He had the nurse clean it all up and dress it with Neosporin and a Band-aid. Hopefully, it will start healing more quickly now.
Walking update: putting weight on the foot in my surgical shoe is going well! The foot tires quickly (and my calf muscle is killing me from non-use!), but it's exciting to see such progress. Wonder how long before the swelling goes down and I can stuff it back into a regular shoe?
Here's an updated picture--I'll spare you the fourth toe for now. Check the incision now, because I'm going to be massaging it with Maderma everyday to create a magical disappearing scar!

Stinginggggggg!

My foot has a new trick--the incision stings and burns and stings some more!  I googled it and also called my surgeon's office and found out this is good news.  It means the nerve endings around the surgery site are "waking up" and regenerating and healing.  For something good, it sure does hurt!  I thought I had an infection at the incision site; that's how intense this new kind of pain is.  Glad to know it's actually just part of the process.
Here are updated pics--Day 18 out from surgery.

Good foot day!

Today is day 15 out from surgery.  For the first time, my foot seemed improved.  It seemed to have turned some corner overnight.  I was able to put some weight on it (heel only) and walk for a while with one crutch, rather than tooling around on my knee-walker.  It felt good to see at least some improvement.  And no pain meds today of any kind!  I think there has been some reduction in swelling, and that made the foot hurt less all around.  I hope this means the bones are healing well.

The evil sock demon strikes again . . . or does he?

Had a funny moment in the laundry room today, as I stood on my scooter, hanging and folding a dark load of clothes out of the dryer.  I was getting more and more frustrated . . . why are all of my socks coming out missing the mate?? Ugh, there's another one!  What happened here?  

Then I remembered--I've only been wearing one sock all week!  :)

Starting off on the (new) right foot

Today was stitches out day, day 10 after surgery.  I coudn't wait to get all that bulky dressing off and to see my new foot!  My friend took me down to the medical center area to Dr. B's office.  Dr. B works in a large practice of orthopedic surgeons (48 surgeons at that location, with 19 other satellite locations!).  So when you enter the waiting room there, it's this huge space filled with people on crutches, in wheelchairs, on knee-walkers, and in casts.  I told my friend, "This is where all the broken people are."  When I got called back, they took me to a place called "The Cast Room."  What a funky place!  One wall is lined with high patient tables; there's a large island in the middle with all sorts of cast saws, wrap material, cutting instruments, and miles of gauze and Ace wrap ready to be unrolled and applied to the broken people.  So they called me and two other guys back all at the same time and lined us up on tables.  Three eager Cast Room Guys in scrubs immediately reached for their saws and shears.  It was a bit of a grisly scene as they sawed and cut us out of our casts and, in my case, surgical dressings.  Long Frankenstein-like surgical sites were revealed, all stitched up, bruised, and puffy with swelling.  It was definitely not for the faint of heart.  (Neither are the pictures when you scroll down, by the way, so consider yourself forewarned.)

When I first saw my foot, I was a bit shocked, because it didn't look anything like my foot.  It was a completely different shape.  A bit surreal to see that unfamiliar thing attached to my ankle and positioned where I normally see my foot. It took me a while consider it mine.

Next, Cast Room Guys cleaned up the feet of my Cast Room Buddies and me and then wheeled us one by one to get x-rays.  When we returned, in came Dr. B, escorted by his nurse.  He stopped at the first table, checked out his work, chatted with the patient, gave instructions to the attending Cast Room Guy, and moved on down the line, until he had seen all three of us, quick as can be.  Now that's efficiency!  Then Cast Room Guys taped and bundled us all back up.  The other two needed to go back into casts, so the wrapping and wetting and forming was interesting to watch, while I just got two band-aids and a spacer and some surgical tape.  Big complaints from the other two tables at having to go back into casts while I got to go home in such an unencumbered foot.  I win!  :)  Feels GREAT to have my foot out of that dressing and ACE wrap.  Okay, enough chatter, I know you've been waiting for PICTURES!  Here they are:

Cutting off the bloody dressing--yuck.

My first glimpse. Whoa. Doesn't look too good, but both Dr. B and my Cast Room Guy commented on how great it looks! I guess that's all a matter of perspective. I do think it looks like good work, although I'm a bit worried about that space between my 1st and 2nd toes. Dr. B told my Cast Room Guy, "Put a spacer between the toes to maintain the first toe's position, but not too thick.  It looks like it might be a little over-corrected." Yeah, that's what I thought. But I'm sure it will look amazing in a few months!

So much bruising! Dr. B asked me to flex my big toe up and down.  "Sure!" I said, confidently. But when I tried to move it, it wouldn't go anywhere.  He said I've got to get it moving or it will stiffen up on me.  So he showed me how to move the joint, using my hand to force some flexing and extending. It hurt!  Sigh, physical therapy time--no pain, no gain.

The best view of my incision. Going to take a while before that looks good!

I'm worried about that 4th toe--he doesn't look happy at all!

The Cast Room--view from my exam table.

Taking out the stitches--youch!

The "before" x-rays, taken in September. Notice how the big toe bone has 

drifted off to the left, away from the small round sesamoid bones.  In the 

next picture, it's back in correct alignment. 

Sporting some new hardware.

Wow, I've never seen anything like that in all my research about bunion surgery.  I've been worrying that if I put weight on it, I might dislodge the newly fixed bones.  Now that I see the hardware, I don't think it's going anywhere, no matter what I do!

Funny how differently my feet are shaped now