5 months on

Five months on from surgery and things are very well with my toe.

I saw the orthopaedic surgeon a month ago for the second follow up consultation. He was impressed with progress and does not feel the need to see me again unless something untoward happens, which I think unlikely.

I can walk any distance. There is only a slight soreness in the joint which I am for the most part barely aware of.

I'll write another post in twelve months to flag progress, assuming nothing worth writing about happens in the meantime.

The colour in this photo is quite washed out - my foot is really a healthy pinky-red hue. The scar is still quite noticeable, but has faded. As you can see, it has fully healed.

The advice I give to anyone undergoing this surgery is:

• Follow your surgeon's instructions, especially in the first couple of weeks when the joint is traumatized and the major healing takes place. Yes, it is a drag just laying around with your foot elevated, but it is only a short time really and being diligent about this will pay dividends.
• Do lots of walking when you are able. But avoid impact activities like jumping and running. I've just gone to a lot of trouble and expense to have this joint repaired and I want it to last - I'm not going to wreck it again.
• I didn't have a physiotherapist and my surgeon did not feel the need to recommend I use one. My toe has healed quickly and well anyway. You may also want to consider whether you need this additional expense. Just walk.
•  Wear sensible shoes with fairly rigid soles.

Week 8

Week 8  April 30. 2017

For the most part, I forget I have had the operation. The pain in my toe has subsided to the point where it is about the same as it was prior to surgery. I am now hopeful that it will quietly fade away completely.

I will continue to post updates at irregular intervals, but there really isn't much to say now.

Week 6

Week 6 - Wednesday 5 April 2017

Not really much to say beyond the last entry. I've been going to the gym regularly, cycling and walking. The wound has healed nicely. No swelling. No pain in the joint when I'm not walking on it.

The only discomfort I have experienced recently is in my left hip (which I mentioned previously) when laying down. This may be due to my awkward gait when favouring my left foot, which probably put strain on the hip joint. Now that I'm walking more normally it seems to be settling down (possibly bursitis - I'll talk to my doc about it if it persists). Otherwise life is pretty much back to normal.

The toe hurts a little more than it did before the surgery (maybe 2 to 3 on a scale of 10 when walking), but I feel there is slow, but steady improvement. The surgeon said full recovery takes months, so patience is the key.

I'll just make occasional entries now as there really isn't much to write about.

Week 5

Week 5. Monday. 27 March 2017

Just in from cycling to St Kilda, where I enjoyed coffee in a cafe beside the beach.

The toe is a little more painful to walk on than it was before the surgery, but I can feel incremental improvement. I no longer limp.

In the evenings I sit and work it with my fingers to improve flexibility - the joint doesn't have full range of motion, but is getting better.

I am going to the gym regularly, but, as I mentioned in a previous post, I do not run and normally avoid exercises that cause excessive jolting of joints anyway.

The wound is healing well. I kept a plaster over it until a few days ago, mainly to stop it abrading against the sock as I walked, but have done away with that now. No swelling. I often forget I had the operation.

Week 4

Week 4. Monday. 20 March 2017.

Exactly 4 weeks have passed since the surgery.

I returned to the gym yesterday, also went today. I mainly work out on the stationary bikes - which is easy on the toe as it isn't required to flex.

As an aside, I have never been into running - I believe the jolting puts too much stress on joints and that excessive running is not a natural form of exercise. Our hunter gather ancestors probably only ran when they had to (to escape predators or chase down prey) and would be aghast to know people these days run miles for entertainment. I can't believe it when cheilectomy patients write that they can't wait to start running again. As for me - I'm going to get maximum mileage out of this surgery by not abusing my foot. I prefer walking up hills to get a bit of puff going.

Enough rant - back to the post. Last Thursday I cycled about 20 kilometres to St Kilda for coffee. No problem. As I said before, the foot is fairly flat on the pedal which minimizes flex and pain.

I've also been doing quite a lot of walking - several kilometres each day. The toe is painful, around 3 on a scale of 10, but I can tell it is improving. I still have a very slight limp and this is enough to continue to cause me some pain in the thigh and hip from walking slightly unevenly.

The wound is healing well (see photo - taken yesterday). It is a little soft in a couple of places, so I have decided to keep it covered with a plaster for a few more days rather than have it abrade directly against a sock.

The toe doesn't have full flexion by any means, but I wriggle it around in the evenings. I am confident it will gradually improve.

Week 3

Week 3. Monday 13 March 17

End of the third week - 21 days since surgery.

I have been walking at least half an hour a day, plus wandering around the apartment.

At rest the foot is fine - only slight tenderness on the site of the surgery.

Walking there is low level pain in the toe joint, enough to make me limp a little, but nothing more than I would have expected after surgery. I also have some pain in the leg and hip joint, which I expect is a result of the unnatural stresses caused by limping.

Day 19. Coffee at the market

Day 19. Friday. 10 March 2017

Here's a picture of my foot taken this morning. The nurse put the dressing on when the bandage was removed and sprayed it with waterproofing.

This morning I walked something less than a kilometre to Chapel Street, then caught a tram a similar distance to the Prahran market. I am limping and still wary about the foot, but gradually becoming more confident. The joint is stiff, but I am confident it will slowly loosen up with use. It is a little sore when walking, maybe 2, sometimes 3, on a scale of 10.

I regularly have coffee at the market and a had a bit of a chat to the cafe owners, George and Lea. Then limped around doing some shopping before catching a couple of trams home. That will do for today.

Prahran market

 

Day 18 - resuming a near normal life

Day 18. Thursday. 9 March 2017

Having a coffee at a cafe is something I do regularly. Sitting for half an hour with a book or watching people wander by is one of life's pleasures. I know those $4.50 a day coffees add up, but I think its a cheap delight. I'm not, at any rate, much into restaurant eating - and one restaurant meal can gobble up as much cash as a fortnight of cafe crawling.

So I was chuffed to be able to have a decent coffee in a cafe after 17 days of medical imprisonment at home (with the exception of the weekend jaunts with my wife). A sign that life is returning to normal.

I am wary of the foot, and tend to limp a bit. I expect that will pass before long as I become more confident and the healing progresses. There is no pain, though I am aware of sensitivity in the area of the wound. I haven't been game to really try bending the toe yet, but that will come.

Yesterday the surgeon said he has moved away from recommending people see physiotherapists. He said he just wants me to start walking. Half an hour to start, then gradually increasing as I feel comfortable. In his mind, the natural process of walking around will do as much good as physiotherapy. He's a nice guy - Paul Rice - I'd recommend him. Must be pretty qualified as he's ceased being called Dr and has returned to being called Mr (that happens to some highly qualifed Docs).

I am a doctor, by the way, but I'm not a physician. I have a Ph.D. in geology. I also usually get called Mr, but in my case its because that's what people call you by default and I can't be bothered correcting them - you sound like a bit of a wanker if you do. Even my mother still writes Mr on my birthday cards after 30 years of me being a Dr - but she just forgets. 

Day 17 - Bandage off

Day 17. Wednesday. 8 March 2017

I feel like I have had this thick bandage on my foot for 2 months, not 2 weeks.

Late afternoon Wendy drove me to the hospital and the bandages were cut off. Much less ghastly than I had expected. There is an incision about 6 centimetres long along the toe. All looking very clean. Just slight swelling. The only bruising is a small patch just below the toenail, separate from the incision, where some blood has migrated.

The stitches were removed - uncomfortable but not painful. Some plaster was placed over the wound.

Then the surgeon (Paul Rice) saw me. He was pleased with progress. Large chunks of bone had been removed from both sides of the joint to improve movement.

My instructions are to walk 20-30 minutes a day to start to start working the joint, plus puttering around the apartment. Gradually increasing the time and distance. Cycling is fine, as is swimming.  
I was able to wear my outdoor shoes out of the hospital. Hooray!

We then went shopping. I was tentative on the foot, but the only pain I felt, after about 10 minutes, was in my calf. The muscle must have atrophied a little from all the sitting and laying around. 

The crutches are now in the car boot and will be put out for the hard rubbish cleanup in our street next week. And good riddance to them.

Note: I mentioned the sensation I have been experiencing along a nerve on the right hand side of the foot to the surgeon. He said it is not unusual and will fade.

 

Day 16

Day 16. Tuesday. 7 March 2017

Tomorrow the bandage comes off. Hooray.

Here is an extract from Day 16 of the blog I referred to earlier, written in 2012 by a person called Parsifel:

'I did go to the gym today. I managed to put on my squash shoes. and I was perfectly OK. Obviously no running, but I spent 30 mins on the training bike (no problems whatsoever), stretched, and did weights. In the afternoon I went with my daughter to the beach and had a nice swim in the waves'

Hah! I, on the other hand, spent day 16 stuck in my apartment, obeying the surgeon's instructions to keep my leg elevated as much as possible, with my foot encased in bandages. As for going to the gym - well, I did lay on my back and run through my stretching regime (which has been helping with the sore back I was experiencing). Any other exercise I got consisted of hobbling around on my heel.

When I was considering a cheilectomy I had found Parsifel's blog and thought to myself 'this doesn't look too bad'. I suggest that if you read that same blog, you take it with a grain of salt. I expect it is more likely for patients to be up on blocks on day 16 - not peddling a training bike and going for a swim. 

Day 14

Day 14. Sunday. 5 March 2017

Another day not doing much.

What I did focus in on today was sensitivity on the top right side of the foot. My affected foot is the left one, so this across from the surgery and not, therefore, likely to be a direct result of the surgical incision.

Going back a step, I had noticed a row of 4 small bruises or blood blisters around the upper part of my ankle, about 2 centimetres above the top of the bandage, some time ago. They are spaced about 2 centimetres apart. I have assumed they were something to do with the anesthetic and didn't take much more notice of them until yesterday, when I had a closer look out of curiosity.

In addition, I had also noticed that if I stretched my foot, there was a slight pain, as if there was a small plaster on my foot that was being tugged, along the left hand side (under the bandage). I assumed this was something to do with the bandage and would go way when it is removed on Wednesday.

Now I'm wondering.

During the course yesterday's inspection of the tiny bruises, I gave the one on the furthest left (near the ankle bump - furthest from the incision) a little rub and it sent a bolt of nerve pain shooting along my foot. Along the same route as the slight pain I mentioned previously. Not a dissimilar feeling to having one's funny bone tapped. Just the slightest bump and -zowy- there's a pulse of nerve pain.

Naturally I am concerned about this. My first thought is that I have suffered nerve damage from the administration of the anesthetic.

I will discuss with the surgeon on Wednesday afternoon. 

Day 13

Day 13. Saturday. 4 March 2017.

We live on the boundary of two Melbourne suburbs: Toorak and South Yarra. They are quite different. Toorak is one of the most affluent suburbs in Australia. The many cafes of Toorak village are frequented by well-heeled older folk. South Yarra, on the other hand, with its trendy Chapel Street, is one of the most vibrant and fashionable suburbs in Melbourne. Most of its residents seem to be under 30.

I can walk to cafes in either direction in about 10 minutes. Normally. Today Wendy drove me to sedate Toorak for coffee. We then had a picnic lunch in the landscaped gardens of historic Como House. I can normally walk there in 3 minutes, but had to be driven.

The point being that I am getting thoroughly cranked off at my immobility. I usually walk everywhere - the car hardly comes out. But now I am being driven to a place 3 minutes walk away.

Patience. On Wednesday the bandage comes off and then I should be able to start moving around without a hobble and a crutch.

Apart from my frustration things seem to be progressing well, though I actually have no idea what things are like under the bandage.

Day 12

Day 12. Friday. 3 March 2017

Wendy took today off work to help relieve the boredom. She drove me out to Olinda, in the Dandenongs, where we sat in a cafe for a while. Then to a nearby picnic ground for lunch. After being cooped up in a sunless apartment for 4 days, it was pleasant to just lay in the sun for a while soaking up some rays and getting some vitamin D.

While I no longer use both crutches, as I quickly develop pain in my hands if I shift all my weight on to them, while out I did use one crutch as a prop to help take some of the weight off the left foot.

At home I hobble around on my heel. Mostly, though, I continue to sit on the lounge, lay on the bed or floor with my foot propped up. Prior to this surgery I would go to the gym most days and, living in the inner city, would walk everywhere rather than drive. So this inactivity is driving me up the wall.
The toe itself gives me no trouble.

I pulled the bandage back a little from my big toe nail, just a few millimetres, to peek at what might be going on in that direction. Beyond the toenail the toe looks pretty bruised and dark. It will be interesting to see the wound site when the bandage comes off next Wednesday. 

Day 11

Day 11. Thursday March 2. 2017.

I am not the first person to write a blog about their cheilectomy experience - copy and paste this address for an account by someone who had the surgery several years ago. There is a link opposite.

It is interesting reading that blog to find how far the writer had progressed this long after his procedure. He had his stitches out on day 10 and by day 11 was in shoes and walking around!

I, on the other hand, have my foot wrapped in a mummification of bandages and am under instruction to rest and keep the foot elevated as much as possible until my appointment with the orthopaedic surgeon next Wednesday. I'll do as I'm told, but it's quite frustrating.

Nothing to write about yesterday - kept a low profile at home. Ditto today.

I have dispensed with the crutches - the weight they transferred to my hands was making them quite painful. I watch movies, read, listen to music and keep myself amused until Wendy comes home in the evenings.

Day 9

Day 9. Tuesday. 28 February 2017

Half way to having the bandage removed. This has become an event I am keenly looking forward to - like Christmas when I was a child.

As usual, the foot itself gives me no trouble. No pain, no swelling.

However, this morning I found that my hands have developed significant pain, particularly around the thumb joints, when I put my body weight on them while using the crutches. Hands are not designed to carry 80 kilograms in this manner. So instead I have been either crawling or, occasionally, hobbling by putting the weight on the heel of my injured foot. My back also continues to give me trouble - probably due to being out of my usual exercise regime and not being able to walk normally. Not to mention going a bit bonkers from being unable to get out of the apartment.

Not enjoying this one bit.

Half way.

Day 8

Day 8. Monday 27 February 2107.

One week gone.

I was given the option of today for my surgery instead of last week. I'm glad I didn't take it - I'd rather be a week in to this today than just being prepped for surgery.

Wendy has returned to work and I am back to entertaining myself in the apartment. A bit easier knowing that I only have to get through this week now and then the following Wednesday the bandage comes off to reveal goodness knows what.

Still hobbling around on crutches avoiding putting weight on the foot.

Still no pain. Occasional itching which may indicate good things are happening with the healing under the bandage.

Day 7

Day 7. Sunday 26 February 2017

Similar to yesterday. Wendy took me for a drive to the coast, we found a pleasant place to sit on the grass and watched some guys fooling about in a small metal boat fitted with an oversize outboard motor. I obtained a Coxwain's Certificate many years ago and much time was spent during the course emphasizing safety around boats. These guys were clueless. No wonder so many people get into trouble on the water.

The foot has given me no trouble. It does not appear to be swollen, though it is hard to tell under the thickness of bandage. I continue to have no pain (other than my back being more sore than usual).

Showering has been no problem - primarily due to the design of our shower, which we had renovated 18 months ago. As well as a shower rose, we have a shower attachment on a flexible cable (European-style). There is also no door, instead a large sheet of glass enclosures one side and ends at a step. I can sit on the step with my injured foot hanging out of the shower and wash with the flexible shower head. We also took the precaution of installing a couple of grab rails. I didn't ever expect to use these, but life is full of unexpecteds.

The two days out have brightened my outlook - I was getting a bit sour from the inactivity and being cooped up. 

Day 6 - A day out.

Day 6 - Saturday 25 February 2017

Today my wife took me for a drive to the Dandenongs (a range of forested hills on the edge of Melbourne). We found a picnic tables for a couple of hours, had lunch and enjoyed the trees and breeze. After having spent the past 5 days stuck in the apartment I had been going quietly bonkers - it was good to get out.

Nothing to say about yesterday (other than it was my wife's birthday) - much the same as Day 4.

I notice elsewhere that people have been given a big boot for their foot. I asked about this at the time of surgery and was told no boot - I have to avoid putting weight on the foot and a boot might tempt me to do so - then I was handed crutches.

I hate the crutches. It is very difficult to carry anything while using them (I hook a bag over the hand grip) and I find there is considerable stress on my thumbs when the weight comes off my feet. Hence I have quite sore thumb joints at the moment.

The have also developed some lower back pain. My lower back has been troublesome since I took a nasty fall while running in wet weather, but I manage it with exercise and stretching. I don't usually run - I don't like it as a form of exercise and this just confirmed for me how hazardous it can be. Usually my back gives me no trouble other than the odd tweak. However, since the cheilectomy it has been quite painful at times. I have put it down to the twisting of my spine due to moving awkwardly while favouring the injured foot, together with unusual stresses involved in getting up and down. I am now making an effort to avoid twisting, which seems to be helping.

Day 4

Day 4. Thursday. February 23 2017.

Much like yesterday. I alternate between laying on the floor, sitting in a lounge chair, sometimes on the bed, all the time trying to keep my foot elevated as much as possible. Occasional hobbles to the toilet or the kitchen with the aid of crutches.

Still no pain, for which I am grateful. I have taken almost no painkillers the past three days.

One part of me that does ache is my back from so much laying around.

Here are the photos of my foot.

If I had to summarize my experience so far: inconvenient and boring.

Day 3

Day 3 - Wednesday 22 February 2017

I expect the days following until this thick layer of bandages is removed on 8 March will be quite similar. So if I leave gaps, it's because there is nothing to say.

Sleeping is awkward, due to the need to keep the foot elevated. I can sort of manage to sleep on my back, and also roll over on to my right side, as I can still keep the foot raised on that side. I wake up several times during the night. Generally I have been sleeping tolerably well.

Still no pain, for which I am very grateful, though I do have a vague, slightly burning sensation where the wound is sometimes.

My wife went to work today and has left me to my own devices. She left breakfast out for me and I managed to put together a few sandwiches for lunch. I am glad she is here to cook in the evenings, otherwise my diet would become very poor over the coming 2 weeks. I would not like to be attempting this without someone's support - it would be a difficult business on my own.

I spend a fair bit of time laying on the floor on my back with my feet up on a foot rest. Sometimes I sit in a lounge with my feet propped up. I don't spent much time in bed during the day - I just find that too demoralizing.

Overall, I am finding the actual surgery ok (ie there has been no pain) but the post-operative inconvenience has been greater than I had expected.

Day 2

Day 2 - 21 February 2017

My foot is encased in a huge layer of bandages the size of a cast, within which is a supporting layer of fibreglass. Effectively a cast without the plaster. I'll attach a photo some time soon.

I had been told to expect pain when the anesthetic wore off. My foot was still numb until about midnight last night, so whatever they used lasted over 12 hours. Fortunately I have been experiencing no foot pain whatsoever.

However, as for the rest of me, this is not particularly enjoyable. My next appointment with the orthopaedic surgeon is on 8 March. Meanwhile I have been told to keep my foot elevated about 95% of the time. For 17 days! That's a pretty difficult thing to do. I have a pair of crutches for getting about on when I need to.

My wife took today off work to look after me and has been having to do everything around the apartment. I am pretty much useless until this bandage comes off.

Day 1. The operation

Day 1 - February 20 2107.

The operation.

At 63 years of age, my big toes have experienced quite a bit of wear and tear. I have done a great deal of hiking, both in my home country (Australia) and overseas, often carrying a weighty backpack.

However, this doesn't explain why I have developed arthritis in my left big toe but not my right, which is in good shape. Most likely it was due to dropping the corner of a heavy bookcase on the toe in 2002, an event I can still recall clearly. In my journal I wrote: '...it has gone black. Extremely swollen and excruciatingly painful...' If I could go back I would advise myself against moving furniture in bare feet. But I already knew how stupid that was, and did it anyway. Knowing there could be unpleasant consequences has never stopped some people from doing dumb things.


Since then I have experienced minor discomfort in the joint when walking long distances with a pack, but I put it down to just being tired on the day. Then last year I began to experience increasing pain whenever I walked, not severe (maybe 2 on a scale of 1 to 10), but as I like to walk, it had become a significant annoyance and a cause for concern. My doctor sent me for an xray last August which showed osteoarthritis. The radiologist's report stated it was moderate to severe.

This was followed by an appointment with an osteopaedic surgeon, who said I still had movement in the joint and it was not quite as bad as the radiologist had stated, but that cleaning the joint out (a cheilectomy) should get rid of the pain.

I ummed and arred about the surgery for several months. But every time I walked, and I do a lot of walking, I was going 'ouch, ouch, ouch' every step I took. Not big painful ouches, but annoying. I have also been getting a bit pf pain in my hip, which I suspect may be related to adjusting my gait to minimise the ouch.

My wife has also secured a three year posting to Shanghai commencing early next year (I have a blog about my previous posting experiences in Moscow - see opposite) and I wanted this sorted before we went.

So I have taken the plunge.

Yesterday was the surgery.

I arrived at the hospital at 6.30am, went through the formalities, had my toe shaved, donned the funny green gown and was under general anesthetic by 9am. An hour later I woke in the day ward with my foot heavy bandaged and totally numb from the ankle down. I was fed a couple of sandwiches (I hadn't been permitted to eat or drink since midnight). A lesson on the use of crutches and then my wife arrived at 11am to take me home.

My instructions are to spent the next fortnight with my foot elevated for 95% of the time.

Yesterday afternoon I spent on the bed with my foot propped up, a little dopey from the anesthetic, but able to read and listen to music.

I have been given some pretty heavy duty pain killers, and I took one last night before lights out. By late evening the foot was still quite numb. I can sort of sleep on my back, but prefer my side, but it wasn't great laying there with my foot on a pile of pillows. Still I slept through pretty well.