8 Months After Cheilectomy

Wow! Eight months! I'd love to report that I am completely recovered and good as new, but not yet. However, the news is mostly good. I have resumed my ballroom dance practices: 1.5 hours Tuesday, 2 hours Friday, 2 hours Sunday, and assorted minutes gliding about my own living room. I experience no significant discomfort, perhaps .5 on a 10 point scale. Strength and control are still coming back, and I am not fully in control of spins with right foot bearing weight. Fortunately, in our new routine I am not required to any fancy ballet-style pirouette turns!

I am actually very pleased with my endurance for dancing. About a month ago I attended four 50 minute dance workshops in an afternoon and then danced vigorously for about two hours the same evening. My dogs were tired as I hobbled to the car. For some reason, my dear foot that performed so marvelously all afternoon and evening throbbed and ached all the way home, and by the time I got out of my car an hour later, rigor mortis threatened. I took Ibuprofen and went to bed hoping rest would bring a full recovery. By the next morning I was back to normal!

So, what is abnormal? The ball of my recovering foot experiences a tightness, a tension, and sometimes a low grade ache. Of course, I'm hoping all of that will go away in time. There's no more stabbing pain in the ball of my foot as I sometimes experienced prior to surgery. Significantly, I've relinquished my expectation for range of motion to match my abnormally-flexible left foot. My recovering foot is able to bend and flex within the normal range, and as I work it, strength should continue to improve.

That's it folks. My next post will be at the one year mark. Perhaps I'll have exceptionally good news to report.

Best wishes to you in your recovery process!

Achievements at 5 months Post-Cheilectomy

Here are my celebrations at this point:

1.  Hiking - I have attempted as many as 3 miles at a time on irregular terrain and really didn't experience much pain or sense of imbalance. I do still resort to icing and elevating at times when I feel uncomfortable pressure, but this is infrequent. I definitely do not feel as sure-footed as before, but I'm hopeful that eventually I'll enjoy greater function than before the surgery.

2. Gardening - It's surprising how tiring that can be!  Wielding a pick and shovel, maneuvering a large wheelbarrow laden with soil, wrestling rocks about, bending, lifting--- these all pose a strain that sneaks up and surprises me each time. My foot gets tired! Still, I can work for a half hour easily. The day that I worked for hours helping to double my current garden space was exhausting. Pressure seemed to build up in my foot and ice and elevation was a welcome relief. I thought about taking pain medication, but decided against it since rest, ice, and elevation are so effective.

3. Balance - Improved! Here I am, goofing around, on the new wall my son installed to expand the garden. That's my damaged foot I'm standing on, so I guess I'm not doing too bad. However, dancing is the real test for balance...

4. Dancing - Ahhhh... I have returned to one of my former loves: international folk dancing. For two Monday evenings in a row I walked, hopped, slid, and performed any number of moves not typical in an ordinary day of movement, and to my relief, I did okay. Pivot turns were tricky, requiring full weight on the pivoting foot to execute a controlled, graceful turn. Eek! I could tell that I need to be more consistent in daily PT exercise of raising up on to my toes with most of my weight shifted to the recovering foot. I have a strength deficit that I'd better work on remedying before my ballroom resumes in a couple of weeks. I also tried a "Zumba Gold" class last week and was able to do most of the moves with some degree of control.

5. Cycling poses no strain at all, whether on my exercise bike or out on the road. I'm currently doing 30 minutes a day of varied intensity intervals in order to get a cardiovascular workout.

6. Jogging - Hah!  Well, I've never been a runner, but I have added a wee bit of jogging to my daily walks. Think small: three or four hundred feet of jogging and a whole lot of walking. It is interesting that jogging really doesn't feel any worse than walking. I sprinkle in a bit of running to try to get more of a cardiovascular workout.

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Weight Gain with Cheilectomy

Ladies and gentlemen, I gained twelve pounds in the three months immediately after my cheilectomy. DON'T LET THIS HAPPEN TO YOU! Gaining weight is as easy as relaxing on the couch with your foot on ice, sipping the consolation drink of your choice. Losing weight, especially after foot surgery, requires persistence and pain.

I have no excuse. I knew that, basically, if I ate more calories than I burned, I would gain weight. I also knew that my caloric expenditure would plummet with the foot surgery. I definitely did not pause to do the math. Here are the hard facts: Before the surgery I consumed a given quantity of food, and after the surgery I continued to consume pretty much the same amount. Before the surgery, I was dancing fairly vigorously at least three hours each week and either cycling, walking or jogging almost daily--- burning at least 3,500 kcal each week. Does 3,500 kcal sound familiar to you? For years, doctors, dietitians and fitness professionals have used this rule of thumb: cutting food intake by 3,500 calories will result in a 1 lb weight loss, and conversely, increasing food intake by 3,500 calories (or reducing 3,500 calories of exercise) will result in a 1 lb weight gain. Doctors, dietitians, and fitness professionals now know that it's a bit more complicated than that, but you get the idea. According to this old weight balance dogma, it was a no brainer that I would gain about one pound each week just from the elimination of vigorous exercise. On top of that, I'd gain even more pounds from the severe reduction in basic movements associated with daily living. Actually, it's a wonder I didn't gain more than twelve pounds!

Friends, don't let this happen to you! Do the math. Really. Calculate how many calories you are not burning in hard physical work or exercise during your recovery, and reduce your intake by at least that amount. Easier said than done, I know. I love cream in my coffee, a glass of wine with dinner, chocolate, and second helpings.

I know you're hurting and you want to reward yourself. You deserve to reward yourself! Just don't do it with food!

Chiropractic Care for Cheilectomy: 16 Weeks after Surgery

Chiropractic Care?

One hundred twelve days (16 weeks) after my cheilectomy, my friend, Suzanne, suggested that I go to her chiropractor, a very nice man who also does amazing work with extremities. That sounded a bit weird. I have not been a big consumer of chiropractic care, but I felt abandoned by my physical therapist, and I trusted Suzanne. What could it hurt? Both the surgeon and my PT had said that basically, I might experience pain, but I won't hurt the toe joints or the repair.

Ten days after PT graduation the nice chiropractor manipulated and popped some of my toe joints. Nothing alarming. Then, he sat on the floor for a closer examination. His conclusion? Bad news. This may be hard to explain because I can't fully visualize it myself. He said that there seemed to be an imbalance in the way ligaments are pulling on that right big toe, and it is likely to lead to the development of a bunion on that foot if left uncorrected. He suggested that I seek out a good podiatrist who could fit me with an orthotic. Really??? NOT what I expected or wanted to hear. He may or may not be right. If it truly takes six to nine months to recover from this surgery, then it makes sense to me that it's just too early to tell. I plan to revisit his suggestion many months from now when my foot is fully healed and I know what my new normal really is. Four months into recovery is still early. Meanwhile, I'll go back to him a few more times. The work he did actually manipulating my foot seemed to be beneficial, and I'll take all the help I can get!

Last PT - 14 weeks, 3 days after Cheilectomy

Physical Therapy--- Over?

Evidently, at 14 weeks, 3 days after my cheilectomy, I had made enough progress for my physical therapist to say goodbye. My big toe strength and range of motion in extension and flexion were back within normal limits, although not even close to my other big toe's range of motion.

I had mixed feelings about "graduation." I still experienced pain with movement. I couldn't walk more than 3 mph, couldn't do basic ballroom dance steps. Range of motion was not where I wanted it to be. It had been very beneficial to have someone with strong, knowing hands manipulate my toe joints, pushing them beyond my usual limits, giving me guidance, encouragement, and homework. Okay, to be honest, I felt a little abandoned. Suddenly, I was left to my own devices, encouraged to continue all of the daily stretch and strengthening exercises that had brought me this far. I was to trust the process, be patient and persistent.

I could do that, but I wanted more help with this seemingly never ending recovery process.

Slow Progress - at 11 weeks 5 days after Cheilectomy

Delusions of Quick Recovery

I am frustrated with the speed of my recovery, and I have to admit that I brought this on myself.  My surgeon told me flat out that most of her patients are not even happy they had the surgery until 6-9 months post op.  She also told me of one patient (only one), a marine, who was back to full duty in three weeks.  She was very clear with me that he was by far the exception.  So what expectation did I set for myself?  What I'm realizing is that deep down, I figured that if he could do it in three, I could do it in six.  Weeks.  Not months.  I was hoping I'd be able to rejoin my dance team for the June and July performances.  Nope.  Not even close.  I'm unhappy to report that 6 - 9 months is probably a more reasonable expectation.  Perhaps I need to stop dwelling on all the things I still cannot do and focus on evidence of progress.

I can walk, with pain, at a pokey 3 mph pace.  I can ride my stationary bicycle at a calorie-burning pace.  My toe, foot, and leg strength seem to be improving; the PT toe raises are less painful and easier to do.  My range of motion has certainly increased.

No quick recovery for me, but I am making steady progress and have cause for gratitude.

First Ballroom Shoes, a Painful Experience at 9 Weeks, 2 days Post-Surgery

Not Happy!

I finally tried putting on my dusty old ballroom practice shoes, hoping to try out a few moves.  To begin with, my right shoe was uncomfortably snug because of the continued swelling around the big toe joint.  As for trying out a dance move--- perhaps a mellow little Night Club Two-Step--- dream on!  The first picture that I took of my feet made me realize how abnormally I was standing as I tried to avoid putting weight on the big toe.  In this second picture, you can still see my right leg curving outward in pain avoidance!  I just couldn't put weight normally on my right foot, much less dance on it. I am so disappointed, even though I know that this is unreasonable.  No one said I'd be good as new in a mere two months.

I want to rejoin my dance team!  I want to resume my usual breakneck stride! I have been riding my indoor bicycle vigorously for 30 minutes each day, but I'm unable to walk at a calorie-burning pace, and clearly ballroom dancing is still unattainable.  I've gained eight pounds in two months!  Not happy!

And all of this complaining is not making me any happier!  Enough already.  I'm going to do my PT exercises and attempt to count my blessings...  (Still scowling.)

Picking Up Glass: PT 45 Days After Cheilectomy

Heavy Lifting

Try doing a couple sets of these... Pick up a squashed glass marble with your big toe (and a bit of help from its neighbor toe), and then drop the marble into a new pile. Move all of the marbles to the new pile. Now, do it all over again. And again. That's it: one of my three PT exercises for the time being. The other two exercises are more focused on stretching the big toe tendon underneath my foot. 

It isn't the joint or my incision line that are causing me trouble these days. It's that rascally, stiff tendon down under. I'll also be rolling the sole of my foot over a tennis ball and---yup, you guessed it--- if it doesn't cause some discomfort, it probably isn't helping much!

First Brisk Walk: Day 39 after Cheilectomy

Thought it was time to try a real walk down the road... I walk around school often throughout the day, but never very far or fast. So, this evening after some PT exercises and manual stretches of the sole of my foot, I put on my athletic walking shoes and set out, hoping to get a little exercise. It was not what I'd call a workout---at least not a cardiovascular workout. Three miles per hour, tops, was the best I could manage while trying to maintain normal weight transfer all the way through that final painful push off the big toe. It is so difficult to choose pain! How much easier it would have been to just limp, but that won't get me anywhere. If pain leads to gain, I guess I choose pain. 

No Pain, No Gain in PT: 38 Days after Cheilectomy

No pain, no gain--- absolutely true with regard to this recovery process.  Melissa, my PT, gripped my foot, wiggling and wrenching it until every muscle, ligament, and tendon screamed for mercy.  I kept my mouth shut lest I be told again to put my big girl panties on. Truly, I saw red, visualizing a zealous chef snapping chicken bones with her bare hands. I spent long agonizing minutes with my great toe bent back while Melissa massaged and manipulated the stiff, shortened structures in the sole of my foot.  Massage sounds so tender, but tender it was not.  Like last time, I was shocked to survive the torture, stand, and walk better than before. I even tried standing on my toes for the first time. Pretty amazing! Here's a photo of my foot executing an impressive bend.  Not without pain, but wow!  Just Wow!  

2nd Post-Op: Day 33 after Cheilectomy

No Pain, No Gain

Pain is usually a warning signal--- our bodies telling us to slow down or stop an activity. My surgeon, Dr. Kessinger, confirmed today, though, that for my great progress to continue I must endure the pain of forcing my toe to the outer limits of its current range of motion. She said that if I'm not challenging the joint and nearly in tears, I'm not doing enough. I'm not fond of pain, but I guess I've been doing okay. It's been 4 1/2 weeks since the surgery, and she said that my toe function and range of motion is similar, on average, to patients after nine weeks. Celebration!

I also picked up some interesting and useful information from the nurse. I learned that the smaller joints in the body such as in the hands and feet take the longest time to heal. When I asked about the value of massaging vitamin E into the scar, she explained that vitamin E or Vaseline would be equally fine, because it's actually massaging the scar that helps to heal the suture line and minimize scaring. Finally, she informed me that sun is the enemy of scar healing; she urged me to wear sunscreen on my scar, treating my scar like a newborn with tender skin that must be protected from harmful rays.

Ah, if only my physical therapy exercises were as easy as putting on sunscreen!

Physical Therapy, Day 28 after Cheilectomy

Productive Pain?

Physical therapy is not for the faint of heart. It hurts! I learned this years ago while recovering from rotator cuff surgery. On Thursday, one day shy of four weeks since my foot surgery, my physical therapist friend, Melissa, grasped my foot with a vice-like grip and kneaded my muscles and bones and fascia and scar tissue for 45 minutes with force that left me grimacing and struggling not to moan. In a mistaken plea for advice, or perhaps sympathy, I asked if perhaps I should take a couple of Ibuprofen before the next visit, to which she promptly told me, with a distinctly unsympathetic twinkle, to "put your big girl panties on." Direct quote. Hmphhf! Clearly, pain is part of the process, but sympathy is not. I was shocked at the force with which she kneaded my incision line, as if working some really hard, old plasticine clay in an attempt to get it to loosen up. If I didn't trust her so much after years of successfully rehabilitating other body parts, I might have run screaming from the room. Evidently, sustained force is required to break up scar tissue. After 45 minutes of pinching, crushing, squeezing, wiggling, kneading, stretching... I stood up. Walked. And the shocking thing was, my gait was more normal than before. She didn't cause permanent damage, but actually made it better!

Big Toe Boogie & First Pedicure: Day 29 after Cheilectomy

Big Toe Wanna Dance!!

As I mentioned before, I'm hoping to return to my ballroom dance team as soon as possible. I've gained a lot of range of motion since my April 1st surgery, but my right toe is far behind my normal left toe. I need a lot more range of motion, and I also need to be able to load that joint. My new PT exercises seem to focus on this: applying weight appropriately as I roll forward from the ball of the foot to the big toe and actively push into the floor. Oh, how we take these simple movements for granted when everything just works.

Here I am in the passenger seat where I caught my big toe doing a boogie on the dashboard, flexing and extending like a champ. Of course, I still can't bend it up very far. I'm only four weeks into the recovery period, so I guess it's early still.

So here's my first ever dancing toe video: 15 seconds of cuteness. Yeah, I know, my toe has grown very narcissistic! Still, I thought folks out there considering this surgery--- or recovering from it--- would like to actually see another kindred toe in movement. Best wishes to you and your dancing toes!


First Pedicure  

Hot water, massage. a little pampering... What's not to love? Actually, not much. None of the foot scrubbing, massage, and manipulation was painful except at an area removed from the actual incision line. The painful area had been visibly bruised in the weeks following surgery, but the bruises are long gone. However, a tender area remains. It's evident that this foot underwent some serious trauma, and it's going to take a while to bounce back.

By the way, shown here is now my favorite sandal to wear. Comfy Birkenstocks protect the joint but also allow more motion than my other pair. Movement may not feel fantastic, but it's what the joint needs for recovery. Actually, at this point in time, my stride feels pretty good, as long as I don't race around. A slow to normal walk feels pretty dang normal. Nice! Now, the PT exercises are another story... Not nice.  Not.  Not nice... but necessary.

Working Full Time: Days 25 - 26

Working Full Time

On the one hand, it's been easy to return to work after only three weeks: driving a half hour each way, standing, sitting, walking through the school. There are several shoe options that feel fine. On the other hand, the strain creeps up on me. Welcome relief comes when I elevate my foot on a stool under my desk and ice it several times a day. Yesterday I had a couple of minutes of intense pain when I somehow snagged my right big toe on the low horizontal crossbar of a classroom stool, bending my toe sharply and unexpectedly upward. Yeeowww! I collapsed in a chair and sent a student of another staff member to our staff room freezer to fetch a fresh ice pack. Later in the day my foot was noticeably more uncomfortable and light shade of reddish-purple. I iced and elevated more through the evening at home and my foot seemed to bounce back to normal; well, my current normal. I have high expectations for my new and improved "normal" a few months down the road.

Back to Work: Day 24 after Cheilectomy

It had to happen eventually... back to the salt mine. I really can't complain: two weeks of medical leave followed by one week of vacation, half of which I spent in Hawaii. I'm a teacher. In my own classroom with my fabulous 5th graders, most of the time I'm able to stand, sit, walk, wiggle, fidget, shift, sashay, and elevate my leg as necessary. I did have to forgo my customary speed walking, and I tried to reduce the number of trips to the workroom. 

The only real stress on my foot occurred during those relatively quick conversations while standing with other staff in the hallway or workroom, before or after school and during recess. Two or three minutes of standing is all it takes. My attention would be drawn to the blood pooling in my foot and the whisper of a throb developing, at which time I would "jog" in place or hoist my right leg up on the nearest desk or table. Ahhhh... Flexibility is a plus. I wore the Birkenstock sandals, shown in a previous post, that provide such wonderful support for my entire foot and also protect my toe joint from excessive motion and sudden pain. 

I managed to do some toe PT twice during the day: once during lunch, and once during afternoon recess. This basically consists of rocking the big toe joint gently from front to back and from side to side. Next, I apply pressure outward on my toe, pull it down and hold, followed by pressure outward, pull up and hold. Ouch. Finally, I try to manipulate the sesamoid bones that continue to be uncooperative. After each torture session I strapped on one of my favorite ice packs for a little while. 

Everyone is surprised at how good my foot looks, me included. Visually, the healing is remarkable. As for regaining normal range of motion, time will tell...

First Hot Tub: Day 23 after Cheilectomy

First Hot Tub

Whatever made me think that this might be painful? I suppose because applying cold has brought so much relief over the past three weeks, I assumed applying heat might hurt. Nope... Bliss! I performed the required PT manipulations while in 102 degree water. Perhaps the heat will help me relax more and stretch this stiff joint. I'm planning to fit in a bit of home-style hydrotherapy every day. When I got out, I did ice and elevate. Not that my foot was craving cold; it just seemed like the right thing to do. I'm going to ask my physical therapist about the benefits of hot and cold at this point of the healing process. (Postscript: The PT assistant who massaged and manipulated my toe and foot for 45 minutes today said to limit the time in the tub. Heat contributes to swelling, and can be the enemy of healing. However, a brief period in the tub to relax and do the exercises followed by ice and elevation would be beneficial.)

First Cycle: Day 22

First Stationary Cycle after Cheilectomy

Riding my stationary cycle for 20 whole minutes felt great! That's a relief since I need to increase my minutes and ride daily; I have a few pounds to take off and some muscle mass to regain! I wore the Birkenstock sandals pictured on Day 13, Sandals in Paradise. Perhaps my athletic shoes will feel okay now. I'll try those tomorrow. The Birkenstock sandals are exceptionally comfortable, probably because they do not allow much movement of my repaired joint, and there is absolutely no irritation on the incision and suture areas.

Treacherous Walk: Day 19 after Cheilectomy

A Hike Over Lava

This was one exhausting walk! Aside from the fact that my level of aerobic conditioning has plummeted, the terrain was rugged and irregular: jagged lava chunks from gravel to rocks too heavy for me to lift. Treacherous! It took some serious concentration to walk the mile or so to get to Makalawena, one of the most beautiful beaches on the Big Island. I was as fast as a herd of turtles, and my foot hurt, but I kept telling myself that just as physical therapy causes productive pain, this pain would also be productive as long as I did my best to approximate a normal stride--- stride through the pain--- and make sure I didn't trip and injure myself. I tried to think of it as a walking meditation, which helped a bit: observing the pain with as much detachment as I could muster. The reward was nearly four hours at the beach, swimming and relaxing.

 It still seemed reasonable to maintain a dose of healthy paranoia and protect myself from dangerous bacteria by coating with both liquid and adhesive waterproof bandages. My suture holes looked well-sealed, but I hadn't examined them with a magnifying glass. Better safe than sorry on this, my second to last day at the beach!

Chillin' in the Shade

After trudging across fields of lava, bludgeoning barefooted across this beautiful white sand, swimming in the surf, and then slogging back to my beach chair, I was beat! Thank goodness we had hours to recuperate before the long, laborious march back to the car. Later, icing and elevating never felt more delicious!

Shower Pressure: Day 18 after Cheilectomy

Shower Pressure

Not talking about the pressure of water pummeling my head as I rinse the soap out of my hair... Talking about the column of pressure created by gravity and the fluids in my body pushing down, pooling in my feet. Every time I take a longer shower---seems to take forever to wash this mop of hair--- I feel uncomfortable pressure. Have I been imagining it, or does the color look different? Today I really looked and then grabbed my camera. My right foot is a distinctly reddish purplish color. No wonder. That explains why ice and elevation always feel so good after a shower. That explains why moseying around a museum is much more difficult than a saunter down a lava tube. That explains why standing to stir soup makes me dance in place. My body needs the pumping of muscles to counteract the effects of gravity. I wonder how long I get to put up with this....

First Hike: Day 17 after Cheilectomy

One Week Since Suture Removal

Today is the one-week anniversary of suture removal, so here's a comparative photo from one week ago. Lots of change in one week!

First Hike

Well, this won't impress the mountain goats among us, but on Kilauea, Hawaii I hiked intermittently at least one mile over crunchy compact and irregular dirt and lava gravel trails: through the Thurston Lava Tube and back and to numerous look-outs along the Chain of Craters Road.

I focused my attention on trying to apply weight to the ball of my foot in a normal stride and trying to avoid rolling the foot outward to avoid pain. I am not good at welcoming pain, however beneficial it may be. Although bruising on the top of my foot is nearly gone, that is still where I feel the pain of my sandals, hence the flapping straps to relieve pressure. The majority of pain is centered on the ball of my foot. Perhaps today's challenges will help it release and perform normally.