AM Report
I found a pair of shoes that I can actually wear comfortably! This is great, because the Aircast boot limits ankle movement and the flexing motion at the the toe joint that is necessary for recovery. In order to slip them on, I needed to adequately cover and cushion the incision. I used a couple of waterproof bandages lengthwise that I knew would seal really well and be unlikely to be scraped off, and added one more over top, sideways. Then, I carefully slipped my foot into my craziest, elastic-banded shoe. If I could have done a happy dance, I would have. Couldn't believe it worked! In case you're wondering, they're Skeechers that come with an amazingly cushy memory foam insert. Now, we'll see how the day goes...
PM Report
Excellent! Can't believe my luck. The elastic bands put the slightest bit of pressure just off the edge of my scar line (I think, since it's all under the bandages). I walked slowly, trying to walk normally. Easier said than done, for sure. I kept catching myself executing a stubby little shuffle in an attempt to avoid the pain of extending that joint. Spent the day at a big family April birthdays event. I found it more difficult to stand in one place than to walk slowly, but I didn't have to do either for long. There was plenty of time to ice and elevate, but I probably didn't do the PT exercises as often as I should have. Those exercises are tricky: sliding the joint around and trying to manipulate the little sesamoid bones underneath. Attempting to walk somewhat normally in shoes felt as therapeutic as the exercises (meaning productively unpleasant).
My monumentally talented physical therapist, Melissa Mercogliano at the Center for Orthopedic and Lymphatic Physical Therapy (COLPT), put her hands on my foot and manipulated the joint in ways I honestly did not know were possible. And gently, too. No tears. A little swearing. A bit of pain. I learned how to gently slide my joint back and forth and from side to side. I learned about those little sesamoid bones that cradle the first metatarsal bone, helping to absorb weight placed on the ball of the foot during all weight-bearing activities. Rehabilitating my foot will involve freeing up those little bones; they had seized up over time because of the bone spurs above that were restricting full extension of my big toe. It helps to have a good foot for comparative purposes. Fortunately, my left foot has excellent range of motion and perfect little sesamoid bones. Who knew? I can always count on physical therapy with Melissa to be educational! You'll find her office on the web at: colpt.com.
The rest of the day involved helping my parents sort and move. I was mostly useless, but I find I am able to stand and walk a bit longer each day before I'm driven to ice and elevate. A one point I may have been on my feet for 20 minutes before diving for a chair and an ice pack.
"Gotta get that toe moving," said the nurse on the phone. I had called the surgeon's office, wondering why there's no mention of using triple antibiotic in any of the post-op instructions. The nurse explained that the doctor wants the wound to dry up and scab, and ointments would slow that process down. Okay--- so far, so good, but it seems odd to not use some sort of antibacterial ointment.
Today was a day of self-induced pain, though, as I stretched the toe as directed by my surgeon, bending it up to the point of pain and holding for twenty seconds, and then pulling on the toe, pushing down to the point of pain, and holding. I'm doing it right if I'm nearly in tears. Ouch! I put myself back on pain meds to survive this torture. It was great, though, to shuffle about the house bare-footed in between sessions of torture followed by elevation and ice. I can't be upright for very long, though, before unpleasant pressure builds in the foot, and then it's back to the couch again...
Lovely day for a drive... As you can see, I've been elevating constantly---even in the car.
I was very eager to get my first look at my foot, and it actually turned out much better than expected. Less swelling, less bruising, and a neat, straight incision that appears to be healing nicely.
My surgeon kindly showed me some special ways to torture the healing toe. My goal after all is to restore range of motion and get back on my adult performance ballroom dance team. Clearly, this will not happen without pain. My new motto: grimace and bear it! Evidently, I will be icing for quite some time. As I understand it, the enemy is not pain, but immobility and inflamation. Ice and Ibuprofen: my new friends.
Finally, into the boot! What pleasure it is to walk! My husband and I stopped at a little cafe and had brunch in the sunshine; pretty good for April in Washington. Later today I will try on some of my shoes and see what might work. The surgeon, Dr. Kessinger, said that I can wear normal shoes whenever they feel comfortable. Athletic shoes may be my best bet. The boot is wonderful after hobbling around on crutches, but the boot allows no flexing of the toes. I would like flexing while walking to supplement my other exercises.
No Drugs
Night time medication doses of hydrocodone and Ibuprofen sat on my night stand all night long, but I didn't need them at all! I guess I'm done, except for the doses I plan to take prior to physical therapy. It's a relief to no longer need narcotics on a regular basis!
No Crutches
What a pain! Literally. I am no expert at locomotion with crutches--- probably doing something wrong, but I have bruises on the front of my armpits and my right shoulder was starting to hurt. That's all I need: an overuse injury related to use of crutches! I know Dr. Kessinger said no weight bearing until the post-op appointment, but I decided to be careful and listen to my body. I've been hobbling around only when absolutely necessary, putting weight only on the heel and outside edge of my right foot. I still spent the majority of the day (95%) with my leg elevated, and I applied ice packs fairly often. So far, so good! Tomorrow: post-op appointment with the surgeon. I am looking forward to seeing what my foot looks like 5 days after surgery!
Monday... How delicious to be clean again! Rather than wrestle with plastic bags and tape to waterproof my right leg, I opted to fill the tub and lounge with my right leg hanging out over the edge of the tub. I was able to wash my hair and enjoy the hot water. I know from reading other blogs that many are already in a boot at this point. My surgeon, however, requested no weight bearing or dressing removal until the post-op appointment on Wednesday. I suppose the dressing will be removed and then replaced by my physical therapist later today.
I've been increasing the interval between pain meds, and I hope that tonight will be the last night for hydrocodone/acetaminophen.
Postscript: Showing up for physical therapy with a foot swaddled in yards of bandage was an unusual event, and my wonderful physical therapist and friend, Melissa Mercogliano, felt uncomfortable removing the giant cocoon without specific okay from the surgeon. So, what we were able to do on this first visit was limited. By the time the call came back from Dr. Kessinger's office I was at the front desk lining up future appointments. Word to the wise: don't make any assumptions and sometimes, don't trust your instincts. I had wondered about showing up to PT prior to my first post-op visit when the written post-op instructions specifically said that the bandage would be removed at the first post-surgical visit; I had made a phone call to surgeon's office to clarify, but I didn't think to ask about the intervening PT appointment or think to ask, "But, what about the bandage? Who removes that?" I trusted that while all of this was unusual to me, it all would be old hat to all of the medical folks involved. Not so!
That must have been some powerful pain blocker administered by Dr. Kessinger! I felt no discomfort at all for the first 24 hours after surgery, but by Saturday evening, pain sliced into my consciousness. Since then, I've been leapfrogging the medicines as directed: hydrocodone every 4 hours or so and 400 mg of Ibuprofen every four hours, but taken two hours into the hydrocodone cycle. Overlapping medications to keep pain at bay. That, and ice packs. Oh, do those feel good! Remember "RICE"---rest, ice, compression, and elevation? I'm doing all of it except that the bandage provides only slight compression.
Tomorrow will be my first physical therapy appointment. I am very curious to see what my foot looks like. Swollen? Probably. Discolored? Probably! So far, I'm doing pretty well, I think. Of course, I'm hoping for a super speedy recovery. My surgeon said that she had one patient, a marine, that returned to full active duty three weeks after the surgery, but that he was not typical. Most of the time it takes six to nine months before her patients are glad they had the surgery. Clearly, recovery experiences vary considerably!
