I had a cheillectomy and osteotomy 4 days ago and have a pin through the osteotomy. The whole thing is wrapped up like a burrito with the tips of my toes bare. I can wiggle the toes with the muscles but cannot isolate the MTJ to do any range of motion with my fingers. Has anyone done that? Doesn't hurt to wiggle and I think it is not swollen much because the foot is elevated up high. I get a bandage change in 3 days.
As far as I know, the most you should be doing at this point (unless otherwise advised by your doctor) is to just gently and slightly wiggle your toes...nothing agressive. I wasn't allowed to do any ROM exercises until the pins were removed and even then it was partial weight and SLOWLY start flex and bend...that was at 4 -5 weeks post.
Based on my own experience I strongly agree with the other responses.
I had two pins due to two osteotomies (bunions on either side of foot). I did too much following stitch removal and really irritated the incision and pin sites and had pain far worse than the initial pain after surgery. Wiggling the toes while the foot is elevated did help. I began to notice that I was gaining ROM every day. I'm 4 wks post-op and had the pins our Thursday. Big toe still a bit stiff, but greatly improved. I'm walking FWB in the "shoe" and wiggling my toes as I write.
Doc told me I could start ROM 2-3 days post surgery and could weight bear immediately after. I am at 6 days and have not been weight bearing just because in the first few days it seemed to stress the foot. But today I tried gently placing bandaged foot on floor, with no shoe. Then I support osteotomy with 2 hands around foot, extend toes out a bit and and gently lift heel. It works! I don't even have to support the osteotomy, but I think it is better to. I have considerably more ROM than pre-surgery and can lift my heel 3 inches. Now I remember doc said something about repeating about 30 times and doing so 3x per day. (Except he was demonstrating manual ROM.) Whoo! It also works to sit on a rolling chair and simulate walking across room with very light weight on foot. I can tell my foot remembers rolling to the outside so I have to train it to have a better gait. I am very surprised and very happy with outcome so far. PS I am off pain killers and these exercises do not hurt. I elevate afterwards, my MO these days
Last edited by dncergrl53; 06-08-2008 at 09:22 AM.
I have been reading this thread on ROM and read your other threads about your recent surgery. I had the identical surgery 11/29/07. I opted for a podiatrist, too, and have been very pleased with the results. I didn't start ROM exercises until I was 2 weeks post op and that was actually a week earlier than he starts most patients. I had gotten my bandage wet and went in for a change and he decided to leave it unbandaged. My exercise was to hold the osteotomy site and force the big toe upwards/backwards for a count of 10, three times in a row with more pressure the third time. I started walking in an athletic shoe at 4 weeks but built up by adding an hour each day. I was very careful to stay NWB except as allowed. You'll find that you will want to do some exercises to regain downward motion, too. The podiatrist said that isn't needed for normal gait, so those exercises aren't pushed, but I asked. If you want to point your toe, you'll need to. I practiced scrunching a towel with my foot.
For the first 2 weeks I could walk with my camwalker no more than 10-15 minutes each hour - and not all at one time. Like you, I have stretchy hamstrings and kept my foot over my head when sitting in a recliner and propped it on the kitchen counter when I wanted to do something in there. I also propped it on the bathroom counter when brushing my teeth. I really think the flexibility made the recovery easier.
I walk and hike a lot but didn't start walking for exercise until 9.5 weeks. I started back to pilates and yoga classes at 5 weeks, but wearing tennis shoes and doing only seated exercises. I didn't start my workout with weights until I got the orthotics my podiatrist recommended. He said any standing exercise, even if not walking, was weight bearing and said I should wait until I got the orthotics. His opinion is that the orthotics will help protect the repaired toe and limit destruction of the mtp joint on the other foot.
I was fully released at 14 weeks and resumed everything I was doing before, including extensive hiking.
Yogini, Thanks so much for your feedback. I was wondering when I could go back to Pilates. I love the reformer and think i could do upper body things with the foot elevated on the bar. Getting a ride there will be the most challenging. I am concerned with downward ROM, too, mostly for landing jumps, although a nicely pointed toe would be nice to have. It pulls a bit on the pin site when I try that, so I will hold off awhile until the skin is healed another week. I will have this pin in until 6 weeks post and don't want to disturb it. Last thing I need is to catch it in the reformer straps. Ouch! If I get back to doing a normal dance class with jumps and turns on that foot, that would be my dream come true. Have you tried that? Big jumps like grande jete? Or are you a yoga/pilates person? I have been pivoting on my heel for years to protect the toe joint. How much cartilage do you think you have in your toe? Could you balance better on the one foot when the big old MTJ was a more normal size? To me it has been like balancing on a golf ball and very annoying. I will need my old orthotics modified to fit my new foot. Nice to "meet" you. PS It is also good to hear success stories.
Last edited by dncergrl53; 06-08-2008 at 12:32 PM.
I have a permanent screw instead of a pin at the osteomoty site. I guess that's why I could wear a tennis shoe at 4 weeks - nothing to rub or catch. I only do mat pilates, so everything was seated or lying. As I said, I wore a shoe so as not to knock the foot, and some of the lifts with a shoe made the workout interesting!
I'm not a dancer but wish I was! I took ballet classes as an adult starting when I was 28 but stopped after 12 years because of bursitis. I tried pointe shoes only one time and felt like my toes were being slammed in a door!!
I do take an exercise/dance class now which you may have heard of - Zumba - and there are little jumps and lunges. But we all wear athletic shoes. Seem the health clubs are concerned about proper lateral foot support. Interesting when you consider that a ballet slipper provides no support.
I am an avid hiker and took a hiking trip in Utah at the end of April. That was 5 months post op. We were on some pretty rough terrain and some of the hikes required leaps and climbing with pushing off with the "new" foot. My toe doesn't hurt with normal activities; but when I stand on tip toe barefooted, the mtp joint aches. My main complaint before surgery was a sharp pain in the joint when I did that. Now the pain is a dull ache. I think with continuing the ROM exercises, I'll eventually get to where there is no pain.
I had 40% cartilage loss and he did the drilling to encourage new cartilage growth. I didn't notice any difference in balancing on one foot before or after surgery.
I wanted to share my success story, because I read several foot boards before and after my surgery and it can get really scary and depressing!
When I was doing my "reconnaisance" in deciding what to do, I talked to my foot physio who said that she doesn't see any people who had my procedure. We thought it was because people get good outcomes and don't even bother about PT.
I have a dull ache in my instep when light walking (with no shoe, so I can feel the floor) and my doc said it is the muscles moving in a different position from before, when I was compensating for my lack of ROM. He also said the muscle on the inside of the shin will have to adjust. So, it is slow but steady for me as I rebuild my lower leg. I suspect my long standing low grade back troubles may dissipate, too, as I get more even in my gait.
Yes, I trashed my MTJ with pointe shoes (and high heels) for 10 years. Ballet and modern dancers don't wear supportive shoes because the idea is to work the muscles and strengthen them. I notice even the better "So you think you can dance" dancers don't wear shoes. They must have major callouses to do those turns. When you think of it, some indigenous people in warm climates didn't wear shoes and did ok. Of course, their life span was 45. (I think the health clubs are also concerned about athlete's foot.)
BTW, when they drill, cartilage does not grow back. It can't re-grow. What happens is that fibrous tissue (scar tissue) grows there that acts like cartilage.