The Next Step

I actually can’t believe that it has been just over two weeks since I had my big surgery. The recovery process is going quite smoothly now. I haven’t had any pain in a while and very little, if any swelling when I have my foot down. My mobility is still limited, but I don’t get as tired when I move around. I have also been exercising my right leg with leg lifts and bending my knee. I can tolerate having my leg straight which is helping my Achilles and calf muscle stretch.

Last week I had my two week follow-up appointment in Worcester. I had my cast cut off and X-rays taken. It felt kind of strange to have my foot without the cast on and my foot kept on twitching. My mom was able to take some pictures of my foot still with the sutures in. The next step was for the surgeon to remove the sutures. All of the incisions looked like they were healing well. The doctor looked over the X-rays and explained that the alignment from the procedures still looked perfect. The most important thing he stressed was not to put any weight on my foot. So far, I haven’t had any problems with that.

The plan is that I will see the doctor in another two weeks. I will get my current cast cut off and be given the okay to wear a walking boot. I won’t actually be able to walk yet, but it will give me the chance to move my foot several times a day. By increasing the mobility of my foot it will prepare me for when I will be able to walk.

Enjoy the pictures!

9 Days Later…

It has been nine days since the surgery and it is amazing how much progress I have made in such a short time. I will give you a brief recap of my experience in the first week.

Friday, September 12th – Surgery Day

My parents and I arrived at the hospital at 5:30 in the morning and were pretty anxious to get things going. I was admitted and brought to my own room to prepare for the surgery. The nurse came in and gave me the low down ,to change in to the johnny, and provide a urine sample. About a half hour later the nurse came back to put in the IV line and a hospital representative verified my insurance. I soon left my parents to be transferred to the holding room before the OR. The anesthesiologist came over and administered the nerve block at the knee. They also gave me oxygen and a slight sedative. By 7:30 am I was in the operating room. The surgery took 5 hours and everything went according to plan. I woke up in the recovery room (PACU) and had no problems coming out of the general anesthesia. Later, I was sent to a private room where I would stay the night. I didn’t have any pain until that night when the “72 hr” nerve block wore off. I had about a level 8 pain and the Percocet given to me was not helping with the pain. The doctor gave the okay to give me morphine which just made me sleep, but didn’t actually lower the pain level when I awoke. To help with my circulation while lying down the nurse hooked my good leg up to a circulation cuff that inflated. It was a rather sleepless night with the pain and a bad migraine I had acquired from all the beeping. The circulation cuff had an alarm that kept going off because the tubing was not hooked up properly.

Saturday, September 13th – Going Home

I got through my stay in the hospital by just waiting for the new dose of pain medication and watching Spongebob Square Pants. I had a healthy appetite and was drinking plenty of water. I got a visit from a physical therapist who took me out for a test run on my crutches. I passed my test with flying colors. I have had a lot of practice with those bad boys. Later in the afternoon my pain escalated. A resident podiatrist came by and took off the bandages to see if that would relieve the pressure from the swelling. He took off part of the splint that was causing the pain and put the bandages back on. Once the pain was back under control I was cleared to come home. I live about an hour and 15 minutes away from the hospital. It was a long drive home without my foot above my heart. I had it on several pillows on the backseat, but when I got home the pain was off the chart. We called the doctor to see what we could do at home. He told my mom to loosen the ace bandages. This actually did help get the pain back to a manageable number. The only unfortunate part of loosening the bandages and having the splint compromised at the hospital my ankle was no longer at a 90 degree angle. The reason behind the 90 degrees is for my Achilles tendon to keep it stretched from the lengthening procedure.

Sunday, September 14th

I laid around all day with my foot above my heart. Moving every once and awhile to find a more comfortable position. I only got up to use the bathroom with assistance by my mom. I didn’t feel very awake because of the pain medications.

This was the first time that I was to administer Lovenox (an anticoagulant: to prevent blood clots) at home. Honestly, the needle doesn’t bother me. It only pinches for a minute and then its over.

Monday, September 15th

I went to Worcester to see the doctor to address the issue of my splint. He took of the surgical dressings and pressed my foot into the correct position. Stretching the Achilles was extremely painful, but I kept concentrating on my breathing. The pain got better when he put on a hard cast. There was a little more room for any swelling.

Tuesday, September 16th – Sunday, September 21st

Throughout the week I kept telling myself to stay positive because each day will get better. It was relatively touch and go the first couple of days, but slowly things really have gotten better. I am currently off of my pain medication as of day 7 and feeling well. The swelling has also lessened. I can actually sit up in the recliner, while still having my foot elevated. My foot also doesn’t surge with pain every time I have to get up to use the bathroom. I have even graduated from the sponge bath! Having a modified shower feels so much better.

The hardest part of this first week was finding a comfortable position. I found it hard to find a balance between blood circulation and elevation. My advice is to just keep re-positioning and adjusting the elevation. Most of all I would say is to be patient. It doesn’t feel like it, but things will get better. I have been able to sleep a little bit more. And with more sleep it makes it easier to handle my emotions.

Image from a card I got in the mail

The Final Countdown

On Monday I went over to the hospital for my pre-admission testing. It is really a physical that takes all of 10 minutes. Since I am young and healthy it really is just a formality to make sure everything is in order. Specifically the doctor checks your blood pressure, heart rate, pulse oximeter (blood O2 saturation), temperature, listening to the heart and lungs, palpation of abdomen and reflexes. They did take a small amount of blood to test my thyroid levels as a precaution. The nurse came back in and gave me a folder of information explaining how to prepare for my surgery. She explained that I will get a call the day before my surgery to let me know what time my surgery is scheduled and when to arrive. (Right now I’ve got my phone at full volume and within an arms reach just waiting for more information.) In preparation for the surgery I am required to take a shower with Hibiclens (anti-bacterial body wash) the night before and morning of the surgery. This is to prevent Methicillin-resistant Staphylococcus aureus (MRSA) a bacteria that is resistant to many antibiotics from entering the hospital. Included in my folder was a copy of the pain assessment scale. I found a more accurate pain scale on Google that uses Lego people.

Hospital pain scale

Lego Pain Scale. Too Funny!

In the last hours that I have before the operation I have just been getting things finalized around the house. I cleaned the bathroom thoroughly, changed my bed sheets, and have pillows ready to elevate my foot. There isn’t too much more I can do to prepare. It’s strange to think my right foot will be forever changed. Everything will be different after tomorrow and it will be amazing to see its transformation. I can’t lie and say that I’m not freaked out. I’m extremely nervous, but I completely trust my surgeon. It is comforting to know my family and friends will be there for me through this entire process. The next time you will hear from me will be on the other side of surgery. 😀

My pre-surgery footprints in the sand (Notice how flat they are?)

The Inside Scoop

What exactly is a calcaneal osteotomy, you might say? You are not alone, I had no clue what those words meant right away.

In simple terms, a calcaneal osteotomy is a procedure used to correct the deformity of the foot and ankle through a controlled break of the calcaneal bone. Oh and by the way the calcaneus is just your heel bone. There are four different types of calcaneal osteotomies: Evans, Dwyer, medializing and lateralizing. The two that are most important to understand my case are the Evans and medializing procedures. The Evans calcaneal osteotomy involves an incision on the outside of the foot that exposes the calcaneus. The bone is then broken and a porous titanium implant is inserted. The implant is then secured to the bone with a plate and several screws. This procedure will elongate the outside edge of the foot. The medializing procedure is performed on the very back of the heel. The bone is cut and shifted several millimeters towards the inside. At this point the surgeon will insert one or two screws to reattach the bone. 

My foot is pronated and neutral is the goal

It is common to have complimentary procedures done at the same time. The surgeon recommended that I have an Achilles lengthening and fusion of the talonavicular joint in the midfoot. Most people are familiar with the Achilles when athletes rupture the tendon. In this case, the surgeon with make two incisions into the Achilles and stretch the tendon to tear it. This procedure is to correct a tight Achilles tendon and allows more motion of the ankle joint. The last procedure is the fusion of the talonavicular joint which is where the surgeon will use two or three screws to connect the talus and navicular bones. These screws will immobilize the joint, but will create stability in the foot and create an arch. Due to my age the fusion of all the joints in my foot is not recommended. 

The surgery will be performed under general anesthesia and a nerve block behind the knee. If everything goes according to plan these four procedures will take about four hours. 

How It All Began

I was born with flexible flat feet and never had any idea that it would affect my life so much. I first started having pain with my feet in elementary school when I was in competitive gymnastics. I remember being very passionate and proud of my skills, but the pain from tumbling was wearing my spirits down. I “retired” from gymnastics after 7 years. I tried going to a certified pedorthist for orthotics. They were semi-custom orthotics and seemed to help initially, but didn’t hold up long. At this time I was also breaking through sneakers every 6 months. In high school I decided to join the swim team, softball and soccer. I was determined not to give up my active lifestyle because of my pain. I lasted maybe 3 weeks in soccer. That proved to be way too much running. Shocker! I managed pretty well in softball and swimming. The moment that changed everything for my feet was when one of the swim Mom’s recommended I see a local podiatrist after seeing my feet.

I made an appointment immediately in hope of some answers. The first thing the podiatrist and his team did were to examine my feet while walking and lying down during his clinic hours. They determined that I needed custom orthotics that would be rigid and supportive for my extremely pronated feet. I was also given some basic physical therapy stretches to do at home. These orthotics helped and there were some adjustments that were needed to control the heel. The orthotics made it easier to walk and stand for short periods, but I still found that I was getting pain in my feet, hips and back. At this point my doctor suggested that I get AFO walkers to stretch my tight calf muscles. This required me to wear these custom “moon boots” (as I like to call them) for 3 months for 23/7. It was a tad bit difficult being 16 and having to wear these boots at school. I also needed to go to the local hospital every week to get adjustments on the boots and to see my progress. After the boots came off I kept stretching daily and approximately 6 months later the pain came back in greater intensity. The next course of action recommended by my podiatrist was to have surgery.

I had my first surgery on my left foot for a titanium subtalar implant and Achilles lengthening. This surgery actually went really well and I took the recovery process slowly. The hardest part of recovering was going to physical therapy and learning how to walk heel to toe again. It was challenging to allow myself not to limp because I was afraid of injuring my Achilles. Considering everything, I did well with the recovery. 3 months later I had surgery on my right foot. This time the surgeon only put the subtalar implant in without the lengthening the Achilles because she determined my dorsiflexion angle was sufficient. Without the Achilles lengthening my recovery time was quicker and easier. This second surgery was over the summer and I found it challenging to be stuck inside when the weather was so beautiful.

About a year after these surgeries my feet seemed to have settled back to normal. Well as normal as they could be. I mean I still had the chronic pain, but it was definitely not as severe as before the surgery. The next year I went off to college and joined a rugby club and a horseback riding club. That seems pretty crazy thinking back that I would have chosen those two sports to participate in. The two sports could not have been more opposite in style and discipline. As time went on I was getting increasing amounts of sharp pains in the subtalar joint where the implant was located. That was concerning, but what really troubled me was the surge of new pain I was getting in both knees. I saw my local sports medicine doctor and found that I had patella femoral syndrome. PFS is a common condition especially in female athletes, however, I was having problems because of the way my feet are structured. I went to physical therapy and that did help with the majority of the pain. The main reason I stuck with these two sports as long as I did was because of the passion I had for horses and the camaraderie of the team and the adrenaline rush from playing rugby. I stopped playing rugby when I suffered a concussion.  Soon after I had to stop horseback riding when I had a strange foot locking experience that prevented me from bearing any weight on my right foot. 

After all of these years of different treatments for my feet I had become very interested in podiatry and was pursuing a career in the medical field. Over the summer I was accepted to a pre-health internship at New York College of Podiatric Medicine. At this internship I was able to talk to several podiatric doctors about my particular situation. One doctor in particular thought that if I was in that much pain still that I should consider the possibility of a calcaneal osteotomy. That was the first time that I had ever heard of this procedure. Of course my curiosity was peaked and I needed to learn everything about this surgery. After returning home I talked to my surgeon and other orthopedic surgeons and they determined that I would need to take out the implants to see that would help with my pain. Then if it didn’t help, I would consider the calcaneal osteotomy. During the spring of 2013 I took a semester off of college and was able to have two more surgeries to remove each implant. Both surgeries and recoveries went relatively smooth besides an infection of the incision site that was caught early.

It has been a little over a year since I have had both implants removed. Since the implants were taken out I still have pain in my feet, legs, hips, back and knees. I do have some new kind of sharp pain that is particularly concerning because it is my posterior tibial tendon. I saw my podiatrist to see what was going on. I thought maybe I would just need my orthotics refurbished. No that wasn’t it. We had a lengthy discussion of my options and recommended an appointment with a surgeon. It was finally time to go all in and start the wheels turning for the calcaneal osteotomy.

Imprint of my flat foot

“Moon Boots”

“Moon Boot” side view

Left and Right Titanium Subtalar Implants