The Two Month Mark

After the first month of surgery recovery being a drag, I was pretty hopeful for the second month of physical therapy. It's been great and I'm practically back to normal!  I've been going to PT two or three times a week for five weeks. I went in there my first time or two miserable and hobbling on a cane in my ugly velcro shoe, with negative or poor radial measurements on ankle/toe bending. As I head into my final visit tomorrow, hustling in sneakers and without limping, I am thrilled to say that I have normal ankle radius and a huge amount of progress there with the toe. Therapy pretty much entails a massage session which has progressed from gentle to deep friction (read: pain, then lots of pain, but then much relief!) and a variety of exercises: seated foot rotations on a round wobble board, balancing for 2 min both directions on a standard wobble board, "lunge" walking by pressing off on ball of foot, using the leg press machine for flat-foot and also arched foot presses, "towel-gathering," yoga poses, and of course, the exercise bike to warm it all up and keep the circulation flowing.
The best part about PT is seeing (and feeling!) the progress... my toe joint needs massage/manual rotations and the exercises at least twice a day, plus the PT exercises, and I've been informed that I need to stay on it for probably a year to manage the pain and "train" the scar tissue to heal in the right direction to retain flexibility and reduce stiffness. If I don't do it, the toe will freeze and this will all have been for nothing. I've been showing my husband how the entire foot/ankle needs a deep massage, not just the joint... hey there have to be benefits to all of this somehow! ; )  Also using my "yoga toes" which are helping with the swelling and stiffness - these things are awesome.

The good news: I AM BACK AT YOGA! My doc-approved return to the gym has closed my medical leave and I'm doing surprisingly well in yoga. The help of a rolled towel behind my foot on moves like down dog or as a rest for those moves when top of foot is flat on the floor allow me to keep up more closely with the poses instead of "taking a knee" to compensate. I'm really surprised at how easy this is, and how it will be a great ongoing therapy tool as my formal PT draws to a close.

After long walks, yoga, or PT sessions, ice is still my best pal. I've been using a comfrey salve to massage the scar tissue to keep it soft and healing nicely, though I've read lavender oil is the real trick. Arnica gel has helped with swelling too, and is really cooling, as is Topricin muscle cream (which I can't seem to find anywhere). 

So my foot is still pretty swollen and I can't find shoes, which sucks. I've been trucking around in size 9.5W Adidas sneakers for a month nonstop and I'm pretty sick of them - and they're so big they're not that comfortable anywhere else BUT the swollen joint, and they make dressing up kind of hard. The quest for cute, wide, solid-soled non-sneakers continues!

Now... when will I do the other foot? 

Week Six, Physical Therapy Begins

Happy New Year!
As I head into the sixth week since the surgery, I had my first PT appointment today. I'll be going in 3x/week for four weeks. I wish I took a foot photo before I got new tape today - the incision has closed up, there are no more stitches or scabs, and I'm working on the scar with Neosporin and massage.
I've never gone to Physical Therapy before, so wasn't sure what to expect. We started off with lots of forms and questions, then measurements of both feet - degrees of rotation I could bend various toes and ankles comparatively. Great idea - it shows exactly how far I have to go; I really can't bend my right foot very far right now, nor can I move that toe much (if at all - after a few attempts at "gripping" it just stops altogether!). So after measurements and a 5-min ultrasonic treatment (a wand with goo rubbed over the joint area to stimulate the tissue and joints), there was some soft-tissue massage... after I was warmed up, the toe-tugging and rotating began. Wow. I was in need of many distractions as it was "not awesome," as I told the therapist. She said she'd take it easy on me on my first day. Then I was brought to a chair and while sitting, was asked to raise my heels up, toes flat. I got busted for cheating and rolling out to the outside of my foot and have some serious work to do there. Next was the toe box on the phone book stretch to loosen up my calf and ankle. Finally I sat with both feet on a towel on the floor, "grabbing" for wrinkles to pick the towel up. Even my good foot wasn't very grabby, but my right foot was barely moving - the other four toes were, but the big one barely budged. Long way to go there too. We ended with a 10-min ice pack and some printed instructions on how I can do all of these exercises at home, five times a day, plus the contrast bathing, and using the ultrasonic bone stimulator that I have from a stress fracture earlier this year. I think I will be spending all day doing PT on myself! So I'm on a MWF/MWF/TTH/MWF schedule the rest of the month.

Oh - she also did this trippy tape thing on my foot - it looks like a jellyfish! The top is the normal thick tape placed over the joint, then trimmed into long fringe and spread around the length of the foot toward the ankle. The theory is it lifts the area to help flush out the swelling.
OK I'm off to do a home-session of PT. Adios!

I Suck

I overdid it, and have to go to Physical Therapy now.
See, after 22 days in captivity, I tried to bust out all of Christmas in 48 hours, and was on the foot about that long (with elevation breaks, though apparently not enough). I was hosting my in-laws and wanted to have a great meal and festive home! I also had the green light to start driving, which I did, around town, hobbling around a bit in my suspension boot. I thought I was doing pretty well, actually!
My 3-week checkup was just last Wed, and I had another today (Monday) - tomorrow marks 4 weeks. Seems being upright so much through the holiday brought the swelling waaaay back up, and was even cause for concern that the pressure had moved the bone settings, so we did another round of X-Rays (no movement, phew!). When I winced through the Doc's application of the manual rotations I'm supposed to be doing daily, he decided I'm not pushing through the pain enough and is sending me to PT. I start Monday. As much as I think it will totally suck, I know it is best for someone else to administer the pain as I don't seem capable of doing it to myself. He also pulled out a few remaining stitches... then I did one myself later this evening. It was far from the wound and was sticking out through the mesh compression sleeve so I just pulled it out with the tweezers, no problem, no pain. I know, TMI.

Here's the crazy thing about today's visit...
While sitting in the waiting room I heard someone coming down the exam room hall on crutches and looked up with absolute sympathy... to see the DOC in a suspension boot and crutches! Seems he broke his foot and is going in this week to the same place for a similar surgery and recovery effort. He joked we may even be in PT together - which would be great, actually, as I like him a lot. Poor thing, I know how much it stinks!

Here's a foot photo from this morning's appointment... you can see the swelling in a pretty large area around the joint/incision; the bottom/ball is really puffed out too. Ow. Still glad I got that pedicure before all of this...

Contrast Bathing + Mobility

Last Wednesday I was told to start "contrast baths" to help reduce swelling.
So the instructions are to soak in hot water for four minutes, then cold (yep, some ice cubes in there) for one minute, and do this cycle four times for a total of 20 minutes. The alternating hot/cold is supposed to expand/contract the area and help reduce the swelling. Admittedly the thought of getting my foot in to water was pretty awesome, I'd been wondering how funky things were getting under those bandages at the 2.5 week mark...
It felt weird of course, but good. My foot is pretty swollen (now even more so underneath, on the ball of the foot, as I start being able to walk around more). It is big and dark colored and super puffy. It looks like a yam (see photo). So Yamfoot and I soak and air dry together twice a day. I've been applying Aquaphor (except near the incision and butterflies) to rehydrate the skin, which is working great.
I took a shower sans bandage/sleeve and standing on the foot with no constriction was ridiculously painful. To offset it I made a lot of moaning noises that I tried to conceal as Christmas caroling. I guess that will just keep getting easier as the swelling goes down. 

I can pretty much walk on it now, when wearing the ugly shoe, though I favor the right side/heel of the foot and still keep the weight away from the big joint or the whole foot. When I go out of the house (yay, I've now had four outings!) I use my big black support boot that I still have from stress-fracturing my tibia earlier this year. It helps distribute the weight more evenly and makes me feel more protected. But my toes still stick out, and man when the big one gets bumped it's The Worst Feeling Ever. Like yesterday, when I adjusted my foot on the chair under the table across from me and inadvertently knocked my toe - C. told me I turned shades of purple he'd never seen before. Also there is a lot of swelling underneath which is partly why walking is still so uncomfortable - seems the small bones at the ball of the foot were also in bad shape and required some resetting in the surgery. Sheesh. So now if I could just fight gravity and keep the blood from rushing down there and creating pressure, I'd be upright for longer periods of time, but I'm very good about those elevation breaks as needed. I'm about ready to leave the crutches behind, though I'd be willing to use a cane for support. Stairs are still tough.

Today I tried to put on an Ugg slipper... no dice. I'm going to have to go find some shoes a size and width larger than normal to get rolling again. Steel-toed, of course...

The Week In Pictures

Phew! So earlier this week, Wednesday, I had my official two-week and third post-op appointment with Dr. Niccoli. The bandages came off, and the stitches (mostly) came out...

Here's the poofy gauze under the red wrap:

So it's not THAT bad!  It actually looks worse now, three days after this photo was taken... the wrinkly skin shows how much swelling there was post-surgery. The brownish stain is the disinfectant stuff they put on under the bandages. I should have gotten a way closer up pic of this.

Some of the stitches weren't ready to come out. I was so squeamish about it - it definitely wasn't great, and I thought it would be much worse. I appreciated the nurse holding my leg down and forcing me to sit still! The doc put butterflies on the length of the 3" incision. I so greatly welcome this safety backup, because I always think it's all going to split wide open when the blood rushes down to it...hey, when you go through this crazy foot surgery, you think about this kind of thing.

Then this tight mesh compression sleeve was put on (Spanx for feet!?) and held in place with some blue bandage and I was sent on my way with a bunch of new instructions:
Increase the manual rotation exercises
Start resistance exercises using the sleeve to "raise" and "lower" the toe
Start "contrast bath" 2x/day (alt hot/cold soak! hooray!)
Green light to start taking normal showers!
Continue the diuretics to help reduce swelling

Ultimately I am making good progress. I was still fatigued, having pain, not getting around much and not feeling that great right up to Day 13. There was a big improvement jump the next day - hitting the two week mark was a big one - massive improvement in mobility, strength, pain, swelling. So if you ever have to do this, believe it that sitting still for the first two weeks is the right plan.



If you're still reading this, and want to see the super gross pic, here is the foot on the one-week bandage change visit:

Week Two: Hanging In There

At last Wednesday's foot checkup I was started on some prescription diuretics to help with the swelling. I was warned to stay extremely hydrated, as these things would be pretty intense. I followed doctor's orders, and he was not kidding... I don't know that I've ever consumed so much water but I can't seem to keep up with it... this stuff makes me light-headed and nauseated. I have also had some other pretty intense pain waves the past few days and have requested a refill on the Percoset. I know it's all part of healing, but I'm pretty wiped out from this constant feeling of fatigue and queasiness. It's making me moody, which isn't good for anyone. Sorry it can't be just my foot hurting without my stomach and head participating!
I'm getting around on the crutches better as I can now bear a bit of weight on my right foot, but can't be upright for long because as soon as the blood rushes down there I'm in trouble, so I have to get my leg elevated for a while before trying again.
I get my stitches out on Wednesday and am hoping this will be the end of the diuretics too!?

On a positive note, yesterday a friend drove me to another friend's home for a holiday hang-out day; it was the right environment for me to get out of the house. I wanted to put my head out the car window like a dog to get the fresh air and take in all the holiday decor that has come up around town during my last two weeks in captivity! It was great to have my same chair/ottoman setup but be surrounded by great ladies and a festive holiday home! I was completely wiped out upon return, but it was worth it. There are two holiday events happening on Wed and Thu evenings this week, but I think I can only manage one of them... fingers are crossed. 

One Week Checkup

Fabulous... first shower! I have this ridiculous thick plastic bag with a rubber sealed ring around the top that is for keeping the dressing dry... now that I can stand up I thought it was time to give this "leg condom" a whirl. Seriously, when you are recovering from anything that keeps you in bed for a while, a shower is one of the best things to make you feel better. (This photo is courtesy of some medical supply site, btw, that's not me...)
I also got myself put together (hair dryer, contact lenses, makeup, street clothes) for the first time, it really made a world of difference in my approach to the day. You have no idea how sick I am of wearing my glasses!

I had my one-week checkup with Dr. Niccoli this morning. I kept my promise to his nurse that I would not pass out this time, though I did get a little squeamish when she was removing the bandages. Wound ooze is just disgusting. Things seem to be progressing well but to battle the swelling I am going on some prescription diuretics, which means I'm going to be drinking gallons of water a day to stay hydrated, so that should be interesting. The wound is so gross... I took a photo of what I can only call "Franken-foot," but it might be too icky to post here. It looked like a couple stitches popped so he put on some butterflys and wrapped me back up. Yes, I cheered like a little kid  when I  was given the option of colored bandage, of course choosing Christmas Red:

I loved C's idea of putting a Santa hat and beard on it, though I have some other ideas for bedazzling this thing. Then again, really, maybe the red is more than enough!? I love it!

So I get the stitches out NEXT week, at the two-week mark. I still have to stay off it, I have to increase my "toe rotations" to 100x/day at a wider radius, and I have permission to move toward walking on it without the crutches. Seeing as how I just figured out the crutches last night/this morning (I hustled across the parking lot this a.m., it was a beautiful, funny thing) I think that will be a goal later in the week. I got home and before long took a spill doing my special inchworm-moonwalk maneuver; I paid dearly in pain, and am thankful for the reminder to slow down.

I also got the "use your best judgement" (read: veto) on going to the Metallica show this weekend, which is a huge bummer. Unless I can dig up a wheelchair, it looks like I might be out.

I'm going to have to start doing some holiday decorating and getting a bit more festive now that my foot has gotten into the Christmas spirit!