I am amazed at how fast I am recovering from this! T recap my story, posted some months ago: 51, former runner, started noticing stiffness and pain in right great toe about 2-1/2 yrs ago. Consulted a podiatrist in the States who diagnosed Hallux Limitus in both toe joints, more advanced in right. gave me orthotics (never helped a bit). I then moved to Austria and consulted a sports orthopaedist in Salzburg. X-rays showed a fairly narrow joint space in right toe and significant spurring. He recommended a resection arthroplasty a la Keller-Brandes. Read up on this and thought it a strange rec. for someone who is not *that* old and fairly active. Plus it looked like I still had some cartilage left. Consulted a new orthopaedist in Vienna who recommended a traditional cheilectomy. Decided to go with this least dramatic intervention.
I was given a local and twilight intravenous sedation. I have no memory of the surgery. The foot remained totally numb for about 9 hours after surgery. I received Lornoxicam (a NSAID) and Xantac by mouth and a drip pain killer for the first night. It was not too bad and I was able to sleep. The next day I had to ask for another drip in the evening but the pain was still quite bearable. This doctor swears by a cool "boot" that is continuously filled with chilled water and wraps around the foot. I liked it and think it helped but my own homemade ice packs work at least as well. I did not receive any antibiotics, which the doctor thinks is over-prescribed for such surgeries in the U.S.
My doctor told me that there was no cartilage left on the top of the joint but still a decent amount on the lower part. He removed the dorsal bunion and bone spurs, cleaned up the joint and trimmed a bit on the sides of the joint. He says the joint looked inflamed from the constant jamming.
So far so good with so signs of infection or inflammation. Swelling is basically non-existent but I have been keeping the foot up and iced regularly.
I am to start rotation of the joint 4-5 days after surgery (tomorrow) and physical therapy when the stitches come (two weeks after surgery).
I may eventually need a fusion but hopefully this will buy me some time.
Day 6 and there has been constant improvement. My gait is almost normal in my ortho sandal. Last night I began ROM exercises and find that dorsally there is almost no pain, even pushing the toe up pretty far. Bending it down, though, is another story. I can't even imagine trying to pick up a pencil! The toe is generally stiff but I feel like I want to move it, at least a little.
Maybe when the stitches come out it will be easier. I am off pain meds except one Advil morning and evening. I am icing just before bed and once in the a.m. and that seems enough. By the end of the day, with a fair amount of walking, I feel the burning sensation in the toe, which means it is time to put back on the ice pack for a while.
Not sure how often to do the ROM exercises at this stage. I do them whenever I think about it (today perhaps 3-4 times) but maybe I should do more? I am trying to ease into this since I don't want to overdo but also want to preserve as much degree of movement dorsally as possible.
Tomorrow noon will be one week. I can't believe I am doing as much as I am!
Sounds like you are doing normal for this procedure. I was walking from Day 1 in the surgical shoe. No pain meds after about day 4 and none if I was driving...which I did on day 3.
(got to have that manicure!) I wasn't allowed to do any exercises till the stitches were out at 2 weeks so I can't address that issue. But at that point, I was told to do them as often as I could throughout the day. One thing that will help at that point is that you will be able to get it wet. Then you can soak it in very warm water to sort of warm the muscles up so they move better. That's what I did and it really made it much easier. I still don't, after years, have as much plantar movement as in the other big toe but heck - how often do you need it to bend that way anyway? When you walk or jog, it doesn't bend down, just up. But I can pick up a pencil or wash cloth with it so I guess that's enough!
Day 11 and I have noticed a big set-back. I stopped taking any NSAIDs on Thursday night to see how I would fare without. I also started some mild rane of motion exercises and found I could move the toe up a little bit but hardly at all down without pain. It, the whole joint and the stiched area, feels tight, stiff and burney-achey. I want to have the foot up all the time and icing still helps, even though I only do it at night and in the morning for a while. I can walk almost normally (if slowly) for some distance but find I still want to walk on the outside of the foot. My whole front foot area is black and blue, maybe this bruising is part of the problem.
Today trying to do ROM I can barely get any movement in any direction without pain.
Am going to see my surgeon day after tomorrow to get the stitches out...which I am not looking forward to. Just the thought of anyone touching my foot sounds horrible!
I'd keep taking the NSAIDs...in fact, 6 years out I still take 2 Aleve every morning and 2 in the evening if I'm going dancing.
I'd take Vioxx if it was still on the market! It's not going to hurt you and once you get the stitches out you can be more agressive with the rehab and that is going to hurt - no way out of that! Sounds like you are doing fine though.
Today was Day 13 post-OP and I was feeling better than I had so far. The dip I experienced from Day 5-12 seemed to finally be lifting. But then came the bad news: I got the stitches out.
It was SO PAINFUL! He had stitched the incision especially tight with a big ridge of skin in the middle to achieve a minimal scar....but after 13 days the stitches were so deep and the whole thing so tight and sore (even though I had practically zero swelling) that I guess I was anticipating some pain. But this was MUCH WORE than my appendectomy or cesarean stitches that I recall only tickling a bit. He had barely touched the first stitch and I was howling. The whole waiting room apparently heard, and the nurses were worried I might upset the other patients! (When I went out later, on seeing their concerned/frightened faces, I sad :"Oh, it wasn't so bad....no, wait, it was REALLY bad!" A few weak smiles.)
I begged him to put something numbing on it, so he sprayed it with a benzocaine-type cold spray and only then was I able to bear the pain of the incisions coming out. Even then, it hurt like heck but I got through it, sweating like a pig (and I don't sweat). One of the worst things I have ever been through. If you are at all pain-sensitive (and frankly, after such a surgery, who isn't?) ask for the cold spray or a local first!
So I am sent home, told not to wear anything but normal shoes and go barefoot as much as possible, and to make sure the physical therapists "really work you over." We'll see how tomorrow is but so far I am back walking on the outside of the foot, barely able to move the toe, and feeling quite sore and beat up. The incision site hurts and I am miserable... but hopeful.
Thanks, Titchou, I tried the warm (hot) water and it did help.
Today (day 18 post-op) was my first day of physical therapy, and I was terrified. The last few days I was wondering if I would ever have any mobility in the joint again. Even though I did try to move the joint and walk normally on it, I felt like I was making no progress on my own. Still unable to get it into any of my shoes, not because it is so swollen but because the area is still so painful. I do feel as if the joint is finally recovering from the surgery, with less need for icing and elevating and less painful twinges. But the toe, even the distal joint not operated, is as stiff as a board.
So, with this mental burden I went to P/T, convinced it would be really painful. I was so worked up about it I felt almost sick to my stomach when I arrived.
The young therapist couldn't have been nicer. We talked about it at length and she began by just gently manipulating my whole forefoot to get mobility in it. She did this for a long time. Very gradually, she began to massage the joint and move it slowly up and down. She pushed me to just the point where it would begin to hurt but never more than I could take. She showed me how to do the exercises at home and tonight I did them myself. I can already feel a difference; the whole area feels more relaxed and I can tell the joint is more mobile. I am really glad I went and will see her again in two days. iMy doctor prescribed 10 sessions.
I am glad I got someone who was not the school of "no pain no gain," because that is not the way it will work with me. It will be interesting to see how long it takes to get more mobility as the joint heals from the operation.
Once you get into it, it really isn't a problem to work the joint. I wore the surgical shoe for about a week after suture removal and then wore a clog style shoe for several weeks until I could slowly get into other shoes. Just be sure to do those exercises every day!
Interested to read your story Titchou, I am an Aussie male 49 who is a keen runner. Just had bilateral cheilectomies done 7 days ago and am looking forward to some improvement. Dont know if I'm being over ambitious but am trying to hobble around the house as much as possible, but am finding the process very painful and feet swelling and burning. My main pain seems to be from the ball of my feet; suprising? Will get the bandages off and hopefully stitches out in 2 days. Hopefully this will be a turning point. Am interested to know if your Doctor prescribed any anti inflamatory meds. I used to use celebrex for my symptoms before the operation but have stopped and dont know if these will affect the healing process. One thing I am going to try after reading this thread is ice packs. These havent been mentioned to me as yet but this might be possibly due to the bandaging. Bring on friday
Gosh, I've been around here so long I assume everyone has read it. Had cheilectomy on left great toe in 2003. Walked out of the surgery center. Was never told to ice but just to elevate when I could. So I walked when I wanted to. Was just in bed the day of surgery. Up and about after that. Off work from Wed till Monday...was left foot so could drive with the surgical shoe. Yes, I took Vioxx this whole time and until they took it off the market. Have been on either Meloxicam (Mobic) or Aleve (naproxen sodium) ever since. Once per day.
Was dancing at I think 4 or 5 weeks. Had to wear my Merrell clogs and put duct tape on the soles so they would slide but didn't have any problems with that. Back in low heels maybe at 2 months....but always had my Merrell's in the car in case the toe got to hurting. Full recovery is about 12 months...seriously. Lots of people try to push that but it really isn't realistic. I think that's the point at which you start not thinking about it anymore. My recovery was pretty much textbook. No problems. Did what I felt comfortable doing and just assumed it would all be OK. Did my exercises religiously. I jog, wear heels - though nothing higher than 2" max and usually 1-1/2", dance, whatever. Walled all over Las Vegas one weekend. Went to a dance weekend where we danced morning, afternoon and night. No problems other than taking 2 additional Aleve in the evening. I'm about to switch back to Meloxicam because WalMart now has it for $4 a prescription so that's about as good as the Aleve. The other great toe will probably need it at some point and I'd have no qualms about doing it.
Neil, I found the ice packs worked well in the first two weeks to just plain ease the pain. I also had the aching-burning feeling, felt like the forefoot was very tight. The feeling was in the entire fore-foot, top and bottom. The foot often felt hot.
The small gel ice-packs dentists give you for toothache or tooth surgery are ideal but they lose their chill pretty fast. I liked to have it on for at least a half hour and not have to constantly get up to change it. So I took two quart (liter) sized zip lock bags and put ice and cold water in the inner one, pushed out the air and enclosed it in the outer one. This helps prevent the condensation from seeping into your bandage. You might even try three in one to be extra sure. I cut an extra layer of plastic wrap and put it directly on top of the incision site, then on top of this one end of a thin kitchen towel, then the ziplocks with ice, and covered it all over with the long end of the towel. Having layers helps you control how cold it is.
I wear these packs with my foot propped up on a foot stool when I am at the computer, and at night I have a firm pillow at the end of my bed so I can prop the operated foot on or against it.I usually had it cold enough where I could even fall asleep with it on. Usually, though, I slid my foot from underneath it just before sleeping, but the towel kept the bags cool enough that I could slide it back on during the night if I needed to without having to get out of bed again.
I found I did not need the ice packs anymore about four days after the stitches came out. If you read my story below, you will know that the stitches removal was a kind of set-back for me. But since then things are looking better and I am working hard on the foot. I now like soaking in the foot in warm-hot water before doing range of motion exercises, as Titchou recommended.
I admire your guts having both feet done at the same time! I hope and expect that you will start to feel better very soon, but it seems we do need a lot of patience!
Figured I would post an update since it has been a while. I am now 6 weeks post-op and while I have made some progress, I still have a long way to go. By the second week of P/T (a week after stitches removed) I was able to ditch the sandal and wear my Nike running shoes, with the foot bed liner removed and the laces opened as wide as possible. Getting into them was (and is) still the most painful part. But it was a relief to not have to hump around in a shoe & sandal of different heights.
My range of motion is terribly limited --much worse than before the surgery --and no doubt part of this is due to my not being as energetic about the exercises as I should have been. After so much pain it has been very tempting to sit and just let the foot rest. In fact, many mornings after energetic exercises the evening my toe joint felt worse than it did after lazy days. Still, I have tried to walk a lot and take stairs, etc. as normally as possible. Nowhere near a normal gait unless I take it very slowly. My left foot (with less advanced HR) has been complaining since it is taking the brunt. Basically all the issues I had prior to surgery are there, but worse.
If I take a false step and bend the joint more than usual in either direction, it is excruciating. I am far away from being able to pick up a towel with my toes.
My physical therapist seems good and is a proponent of spiral dynamics, a Swiss discipline that views the joints and muscles and bones of the body as interrelated spirals. She lately has spent a lot of time on the ball of my foot as she is convinced that I need to work on getting all the toes to grab the floor as I walk to compensate for the diminished dorsiflexion. I have high arches which contribute to the problem, and she says my whole forefront is very rigid. She is against me going back to MBTs because she thinks they do too much of the work for me and I need to move the joint and whole foot as much as possible. I have 5 more weeks of p/t left, unless I want to pay for it myself.
At least I am working out again (step machine, weights, etc.) and although I can't take a lot of walking. By the end of the day the whole toe joint area is quite warm and a bit swollen, but not much. I can't imagine getting into "normal" shoes and ski boots are probably months away.
My main concern is getting more motion into the joint. And when does this happen... is it a continuous thing for a few months and then you plateau? Or have I already reached the point of no return?
Last edited by moderator2; 11-07-2009 at 02:13 PM.
Reason: please do not post pictures - as per the posting policy
Good to hear an update, Kerlin. Seems like you are doing pretty well compared to how I did at this point. I wore a Merrell clog style shoe at this point - snug fitting so I didn't have to grip with my toes to keep it on and could just side my foot in and not bend the toe.
Two things to try: 1) warm your toe up by soaking it in very warm/hot water before doing your exercises - like do them in the shower or tub when bathing which is what I did and 2) try picking up a small towel or washcloth with your toes to help with that front of foot problem.