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Old 11-19-2009, 04:44 AM   #1
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Cheilectomy - post operative

I'm 37. I had my 3rd cheilectomy (on both big toes) on 4/11/09. The previous 2 occasions it appears I did not start my mobilisation exercises quickly enough. Apparently the surgeon thinks that my body repairs itself very (very quickly) - which in a way is a good thing - hence the previous operations were not particulary successful (although my toe joint pain has reduced and I could wear sandals/ shoes after 2-3 weeks with virutally no pain). On the advice of my surgeon - I thought I'd give the procedure one last time. Oh dear. I was advised to start mobility exercises from day 3 to reduce likelihood of stiffness occuring and raise mobility. I did this.

My left big toe is painful(ish) but not too bad (don't need painkillers and not using anti-inflammatories), am full weight bearing and doing my exercises. Increased mobility has not happened. It's about half what it should be.

HOWEVER, my right foot is a whole different ball game. I have had an internal infection (after about 6th day), am on antibiotics, and I cannot fully weight bear. When I try there's like a crunching feeling over the right hand side (inner side) of my big toe joint that feels weird and slightly painful. I am now worrying myself stupid thinking it could be a bit of bone/ gristle/ whatever that's got stuck/lodged there - and was not noticed and removed by the sutgeon. Is this a likelihood? Am I being over cautious/worried? Anyone with any suggestions on what I can do/ should do to help. It'll be 2 weeks tomorrow since the op, and I'm getting seriously worried (and climbing the walls with cabin fever). HELP!!! PLEASE!!

 
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Old 11-19-2009, 07:48 AM   #2
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Re: Cheilectomy - post operative

Wish I could offer you some advice but I was not aware that they would do this procedure more than once on a given joint. And I've not run into anyone who had the infection you mention either. Hope someone can give you some ideas. Good luck!

 
Old 11-20-2009, 02:24 AM   #3
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Re: Cheilectomy - post operative

Thanks for your response Titchou. I guess I'll have to ride out the infection on the antibiotics - and see what happens then. There only one thing that I am 100% sure of - and that is that I'm definately NOT going to have a 4th cheilectomy!

I just hope all will be good in the run up to Christmas....

 
Old 11-22-2009, 08:23 AM   #4
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Re: Cheilectomy - post operative

Garlaj, I'm on day 4. We're you started on antibiotics immediately after this latest surgery or did you start them after you were told you had the infection? ... and how did you know it was infected?

 
Old 11-22-2009, 03:56 PM   #5
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Re: Cheilectomy - post operative

Hi PaoloV,

Welcome to "Cheilectomy World"! On the 6th day after surgery - I had my bandages removed by a nurse. The healed wound from my last op was red and swollen and there was a streak of red running from just above my big toe joint down to between my big toe and the next one (referred to as 'tracking'). Last day of 12 days of antibiotics today. It has affected my mobility exercises and now my big toe on the previously infected foot is a lot stiffer and less movement. Have you signs of redness and swelling? Does the area itch/irritate? Is there a line of redness showing at all? If so - I'd get it checked. If it's swollen and hurts a little - I'd pretty much say that's within the realms of normality. Lemme know how you get on.

Cheers

JG

Garlaj, I'm on day 4. We're you started on antibiotics immediately after this latest surgery or did you start them after you were told you had the infection? ... and how did you know it was infected?

 
Old 11-23-2009, 11:16 AM   #6
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Re: Cheilectomy - post operative

JG,

I'm a bit taken back by the things I wasn't told ... and the quick answer is "No. No signs of infection".

I had my post-surgical office visit this morning (this is day 5). The nurse said the foot looks great. Minimal bruising. Very little (a tiny dot) bleeding from the incision. However, I'm battling some dizziness. When I told the nurse she said that was not uncommon ... almost expected. THAT would have been nice to know. Discussed it with the doctor. He said it might be normal post-op, might be the anithesia, might be the pain meds, might be the antibiotics. (Well, that narrows it!).

Q: What should I do, doc? A: Stop taking the pain meds.
I already have.
OK, stop taking the antibiotics.
What about the chance of infection?
You're fine. You've been on them for four days.
But, ....
Stop taking them if they have a side effect.
Ummmm, OK.

Earlier conversation with the nurse ... I let her know a few of my toes were numb. Q: Should I be concerned? A: Oh, no. The doctor put a block in.
A what?
A block. You're toes probably tingled for 2 -3 days.
That's right. (THAT would have been nice to know. I was thinking the worst).

Back to the conversation with the doctor ...
Doc: Have you started moving the toe back and forth?
What? No!
Oh, you have to. Keep moving it manually, like this ... You need to keep the joint moving (THAT would have been nice to know)

So, I've got a stiff "boot" so the joint doesn't move, but I should keep moving the joint. No contradiction there.

And now the bonus ... I either broke the second toe on my other foot, or damaged a tendon while hobbling around on the crutches. (Caught it on the carpet). Nicely, bruised it is. They splinted that one. How long? Oh, about six weeks. Un-F'n-believeable.

Anyway, I guess I'll go do an internet research on cheilectomy rehabbing now.

 
Old 11-23-2009, 03:32 PM   #7
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Re: Cheilectomy - post operative

Paolo,

No way! the doctor and nurses at your hospital....what are they like? Same boat as me it seems....they either tell you something semi-definitive...or not at all....unless you ask. I think they do it to cover their @***s. I wouldn't be surprised if part of me was now unknowingly cyborg now...they've just not told me.

Here's the deal from the hospital (surgeon/doctor/nurses/ physio) from over here. I was on pain meds for first 3 days. A drug called co-codomal (with codeine) and that just knocked me out to sleep or made me feel a bit strung out. After that I've not had to use them but have used a drug called diclofenac - an excellent anti-inflam that can be bad news for your stomach - but it really works for me. Never had any dizziness, I'd stop taking pain meds for 24hrs. And if there had been an infection - surely taking anti-b's is an insurance policy taking "prevention better than cure" way too seriously. I have to confess that general anaesthesia is well weird, different each time - and can leave you spun out for maybe 3-5 days.

Have you just had a cheilectomy procedure? Nothing else with it? Surgeon confirmed that's all he's done? If just a cheilectomy.....why've you got a boot? I'd ask physio if you can remove it...

The previous 2 cheilectomies I had were very similar to your experiences. No problems with infection, and not too much pain. However, the reason I'm on my 3rd (and final) Op is because I did not start mobilisation exercises soon enough. Someone on this forum expressed words of wisdom from a well known doctor discussing mobilisation exercises: "must do the exercises as soon as you are able. Remember it can hurt you, but you can't hurt it'. So I thought balls, I got to go full steam ahead and move those toes. Hhhm. Painful. And progress slow.

On numb toes - sometimes there's temp nerve damage (like having acute 'pins and needles') which can remain for sometime. It usually clears up

Second toe? broken or trendon damaged? No way! What a nightmare...I think I'd be spitting feathers at this point! Take it easy, see if you can get that boot removed and time passes quicker than you realise. tried on shoes yesterday. Tight and uncomfortable bu do-able.

Cheers

 
Old 11-24-2009, 08:30 AM   #8
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Re: Cheilectomy - post operative

JG from Brighton ... greetings from Cleveland.

My theory on the incomplete information is that the doctors/nurses have been through this so many times that they don't realize what is common knowledge for them is a foreign concept for us. There does seem to be a few people following our correspondence, so for them ... ASK your care-givers QUESTIONS.

JG, to answer some of your questions: a cheilectomy with holes drilled into the cartilage to promote scarring/growth of the cartilage. I asked him in the pre-op to do what he could for the cartilage.

The damaged non-surgical foot toe: it hurts more than the other foot. I'm ******, but no one to blame but myself. I guess it's not uncommon to hurt the compensating foot/leg/whatever.

Day 6: I've been completely off all meds for 24 hours now. What a difference. Tingling is 95% gone. Dizziness is gone. Appetite is back. And hoping we're all adults, I even woke up with some stiffness in my shorts this morning (another side-effect that wasn't mentioned).

Haven't seen a physical therapist yet. In fact, there's been no mention of seeing one. I'm guesing that won't be discussed until I have the sutures out in two weeks. My bad for NOT ASKING QUESTIONS.

So, on to my questions: regarding the mobilization exercises, as you called them ... how far (degrees) up and down should the joint be moved? In the office he just gave the joint a slight wiggle, maybe 5 - 10 degrees. Or put another way, how much should I make it hurt? Remember, I'm day 6. When I expressed ummm, concern, he said they had the joint 90 degrees up during the surgery. I ... wow.

Why did the lack of aggressive mobilization cause problems? Did the bones start to heal/fuse? Or was it the tendons shortening/tightening?

Take care, PV

 
Old 11-24-2009, 10:04 AM   #9
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Re: Cheilectomy - post operative

Hi PV,

Yeah...I think you're probably right about the reasons behind the doctors and nurses and incompleteness of their advice/ responses etc. I couldn't agree more on asking questions....be sure to write the buggers down though. Too many times I've gone to the doctor/surgeon and asked questions...then after I've left the appointment - I've remembered at least a dozen others I should've asked.

Hhmm. I never got holes drilled into the cartillage with my ops. It was a simple case of chip/scrape the bones spurs away and tidy up scar tissue. I maybe should've asked the surgeon to undertake the hole drilling procedure. I kind of assumed he'd have "done what's best"...as he's the bloody expert.

I guess your other foot will hurt due to compensation and nearly severing the little toe on the carpet. Ooh that's gotta hurt big time. Good news on the stopping the meds! Have you noticed any difference in pain at all? What kind of meds were you on? I never had any that caused tingling or lack of stiffness as it were! That's well strange. Ha ha! At least now you KNOW you're onthe road to recovery! If the "old chap's" doing OK in the morning - the future looks bright!

As to your questions - they are tricky to answer really. My surgeon also said he achieved 90 degree mobility straight after surgery, however my left toe goes about 30 - 45 degrees and my right even less (maybe 10-15 degrees). Wiggling is good - just to stop scar tissue from c0cking up the procedure completely...but I was told to do rigorous exercise (as much as I can) from day 3-4. My thoughts are that when you are unconscious in theatre, your tendons etc do not respond to conscious or subconscious stimuli. What I mean is - I think my toes and connecting tendons are "fixed" in position when I'm fully awake/cosncious (hope that kinda makes sense). I suppose this is the brain saying don't push your luck, we're gonna keep things rigid so you don't hurt too bad.

I think the mobilisation exercises help to prevent scarring and tissue retraction which is common after surgery (for example if you touch a hot surface - your hand retracts, cos it hurts..internally your body does the same sort of thing). I also think you're right on the tendons shortening/ retracting. If your foot's compensated for ages with a dodgy toe, then your tendons will probably adjust accordingly. Aggressive exercises though prolong the bruising and pain (as I'm now finding out). It'll be 3 weeks tomorrow, I can just get a pair of old shoes on now (which are a tad tight cos of swelling), and beginning to move around a little outside. THREE BLOODY WEEKS!! Last 2 ops I was out and about and driving by then. What with cabin fever and lack of exercise my patience wears thin at times.

Having said all of this about the exercises - my range of motion doesn't seem to be increasing. Don't think I'll achieve full range of motion (90 degrees) - my toes up to a certain point - will simply not flex anymore. I notice my connecting tendons are tight as feck underneath on the sole of my foot, but when I grab my toe, pull it out a little and then bend upwards ( I was recommended to do this by physio) - it just doesn't wanna move. It's totally solid. So I try (very hard) to push it further and absolutely jack all happens.

Think I will go for a long stroll this eve. I need the exercise. May hook up with a mate and have a quick pint. Not had a beer for 5 weeks.

Cheers

JG

 
Old 11-24-2009, 10:06 AM   #10
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Re: Cheilectomy - post operative

Good grief. Looks like I've written a thesis! Apols for that...

 
Old 11-24-2009, 04:42 PM   #11
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Re: Cheilectomy - post operative

JG,

Rigourous exercise from day 3-4 on? That's sounds a bit too aggressive. We've just been cut down to the bone. I'd be worried about opening that wound wide open.

Can anyone else pipe in on what post-op instructions they've been given for the first two weeks? Titchou?

I'd read about the cartilage drilling somewhere in the past few weeks. The theory is that you can't really regrow/regenerate cartilage, but you can force some scar tissue to form which increases the amount of ... substance between the bones. "They" are currently working on drugs and/or procedures to initiate cartilage regeneration.

The drugs were Toradol (for pain), Darvocet (for pain) and Keflex (antibiotic). I appreciate that I was loaded for bear, but this guy did such a nice job that I didn't need the pain meds after two days. Hell, maybe I didn't need them at all. I took them and never really hurt (although I did bump the top of my foot on the bottom of a chair on day 4 and WOW!).

I'll get a call into the doctor's tomorrow to see if I can get some info on the wiggling the joint.

For right now, that pint sounds pretty good.

More tomorrow,

PV

 
Old 11-24-2009, 05:10 PM   #12
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Re: Cheilectomy - post operative

I was not allowed to exercise it till the stitches were out at 2 weeks - though I did walk from Day 1. And yes, the drilling does promote scaring - supposedly - that will cushion the joint. After a year, I could really tell the difference. Only drug I had was Lortab - which I took the first 2 days...then maybe a couple of times after that and then no more. However, I did take Vioxx (would LOVE for it back!) continually - I have the same problem with the right toe joint but haven't had it corrected as it isn't as bad. Hope this helps!

 
Old 11-24-2009, 11:49 PM   #13
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Re: Cheilectomy - post operative

Titchou,

Vioxx sounds similar to the UK's Diclofenac (Kind of "same...but different"). I see Vioxx was taken off the market a few years back! Diclofenac is a really good NSAID..do you get that in the States? It's such an amazing drug that's able to pinpoint exactly where you're inflamed and need pain relief. Absolutely incredible...for me. The ONLY problem is is this stuff is incredibly tough on the stomach....I'm talking really hard on the stomach lining etc. So I use them sparingly and always take with or just after food.

Paolo,

That pint down the pub was good. In fact the walk in the fresh air (even though it was pouring with rain and blowing a hooley...it is England after all) did me more good than the Guiness. Feel the sense of freedom creeping back in. 3-weeks post op...and the shoes are on...and the walking doth commenceth. Woo-Hoo!

Good luck with the doctor. Get him to explain about consequential scarring and it's impacts and what it means for your toe.

Cheers

JG

 
Old 11-25-2009, 04:44 AM   #14
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Re: Cheilectomy - post operative

I think it's more like Aleve (Naproxen Sodium) and Voltaren here. There were 3 drugs here - Vioxx, Bextra and Celebrex - in one class and the the other NSAIDs (advil, aleve, etc). Bextra and Vioxx both are off the market. I'm allergic to sulfa drugs so can't take celebrex. I take either Aleve or meloxicam now. Meloxicam seems to work a tad bit better - and only 1 pill per day as opposed to 2 or more for the Aleve.

Hope all works out for you.

 
Old 11-25-2009, 09:21 AM   #15
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Re: Cheilectomy - post operative

I walked and did what I could after a couple days and opened up the wound wide, though stitches didnt rip. They told me no bearing weight on it til stitches out the next week. I didnt listen, because im too active. I would do things differently if i get another operation. What I would do is get in the pool rite away when wound closes to start walking using the toe. 2. I would do what I do now, only way sooner- I cut a bike intertube so that I had two open ends. Then made a cut lengthwise in each end so I can sandwich the ends around my toe, then take a hose clamp and clamp the tube around your toe- underneat the middle knuckle so it wont slip off when doing the following: then take the tube and hang it from back of chair or something else, so that your heel cannot reach the ground. Let your leg dangle, this helps stretch the tendons and muscles so they dont contract too much and cause the bones to start fusing. Dont screw the clamp too tight to cut off circulation, just enough to keep it on when letting leg hang.

 
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