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Old 11-08-2010, 08:16 AM   #1
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Why is my recovery period expected to be so short?

Apologies in advance: I think this is my third new post in like 3 days. Swear I will stop after this!

I had a calcaneal osteotomy, removal of navicular bone, and something done to my tendon (embarrassed that I don't know) done on Nov 2. Talked to doc assistant today, and she expects to put me in a boot next Monday (Nov 15), and said I should be partial weight bearing by the end of Nov. She also said total recovery time should be about 2.5 months.

Why does this seem so much shorter than everyone else's recovery time, when the procedure seems similar? Any thoughts? On a perhaps related note, did you all have stem cells taken from your hip through a centrifuge? I did...I think the purpose is to spur bone regeneration. I can't imagine it would improve recovery time that much, but still, I'm curious if that procedure is typical for these surgeries. BTW, I guess we're not supposed to name names, but I had the doc in Baltimore. (msg me if you want info.)

Thanks for the help thus far!

 
Old 11-08-2010, 03:17 PM   #2
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Re: Why is my recovery period expected to be so short?

My doctor also took stem cells from my hip during my surgery. I was nwb 8 weeks. At the 8 week check up, I had a ct scan which showed that while my calcaneal osteotomy was healing nicely, it was not completely healed. I was PWB for three weeks, gradually transitioning to fwb in a boot. I am almost 15 weeks post op and hopefully at my next doctor visit in 10 days, I will be able to transition to a shoe. I know that my doctor is doing clinical trials about the difference between the longer recovery and early mobilization. If you are uncomfortable with your doctors protocol, you can always ask him about it. Good luck

 
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Old 11-09-2010, 09:00 AM   #3
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Re: Why is my recovery period expected to be so short?

I had an osteotomy earlier this year. I was out of my post-op bandages in 7 days, off crutches in 2 weeks, and out of CAM boot less than 4 weeks after surgery. I was pain free at about 6 weeks post op. So it's not unheard of.

 
Old 11-15-2010, 01:47 PM   #4
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Re: Why is my recovery period expected to be so short?

Hi JessStar and everyone else, I thought I would simply note what happened to me, trying not to give any opinions-I learned a lot from this site before my surgery, maybe this will help someone else know what to expect.
I am an active runner and ran Boston this year. I chose a surgeon who is a triathlete, someone who "gets it" that I want to be active after this. I had PTTD on right foot-medial pain went away but lateral ankle pain was worse after runs of 20 miles or more. Short, fast races no problem but I definitely felt lack of explosive pushoff power in right foot.
On Oct 11, I had a medializing sliding calcaneal osteotomy (saw heel bone base off and slide to medial side 7-8mm then screw together with 2 screws), an Evans osteotomy (designed to lengthen lateral foot by inserting bone from hip in lateral side of foot, one more screw) and FDL transfer (tie off dysfunctional tibialis posterior tendon to healthy flexor digitorum longus tendon). My surgeon has done several hundred of these (Manoli and Pomeroy "All American") procedures. No mention of stem cells.
Even considering that I won a race 2 days before the surgery and ran Boston 6 months earlier, I was told to expect a year to 18 months for full recovery (i.e., back to running again). No weight bearing or driving for 2 months. No swimming or PT either.
At 48 hours post op, nerve block wore off and pain was indescribable. Even with Percocet and total bedrest, did not sleep more than 90 minutes for first 6 days. Pain log says 8-9 on a scale of 10. Switched to Lortab 7.5 500mg acetaminophen, worked part time first week back because the swelling really causes most of the pain, gotta elevate the foot.

At 2 weeks, my surgical bandages came off. Never was a cast. Boot goes on.
At 2 weeks, xrays taken again. At this stage, foot very swollen (e.g. I could not get a sock over it) and wearing no gauze or bandages.
On crutches for 60 days, wearing boot 24 hrs except to take a shower (if you ever bump your foot against anything without the boot on, you will know why).
I am about 35 days out. I take extra strength Tylenol at work, then Lortab at night. Weekends are best for keeping foot up. I will probably use pain meds for another week or so. Sutures look good, many have fallen out after this first month and foot looks much less swollen when elevated. BUT the minute you stand up, it will turn an alarming purple/red and start to hurt. At this stage, I can now see that I have ankle bones. Sometimes I have almost fallen, and put my foot down-it is very painful so I think it would be foolish for me to think about weight bearing yet-I still have a good three weeks to go before more Xrays. My right calf is already visibly atrophied.
I was not prepared for how long 60 days would feel, to be on crutches and not being able to drive. Like a marathon, it is mostly mental. The helplessness can lead to self pity, anger, frustration, irritability, loss of appetite and depression if you don't practice staying tough mentally. I wear a wristband to remind me to try to be pleasant and optimistic, and I have to look at it every few minutes. Sleeping in a 7 pound boot, risking your neck just to take a shower, deciding against a glass of milk because it is 15 feet away, HOPPING so much you now hate rabbits, and your crutches, one or both, propped up while you're hopping and then they slide and fall, slopping food and drink all over trying to carry things (by the way, get a backpack!) THESE are the adventures in frustration and madness that await you.
I am also using the EXOGEN device to promote bone formation-it cut my recovery time for a fibular stress fracture 3 years ago from 8 to 4 weeks.
I wish I could tell you my experience was like those folks who were done after a month, no pain after 6 weeks! Wow, that is a miracle. I don't think the difference between them and me is pain tolerance-I mean, I have suffered a lot in races, from blisters to puking and this type of pain, especially the first two weeks was nothing compared to a broken collarbone I once enjoyed. Some of it could be my age-I am 56-but I am still running times fast enough to get into Boston so fitness must counteract some of the age.
Who knows? But that is what happened to me. I keep a log and write in it every day, just like my running log. Screws come out at 6 months-back in boot for a short time. Then, walk,then run.
To those of you who had an All American and took a few Tylenol, and walked at four weeks, I stand (on one foot) in awe. To the rest of you mortals, get ready to do a fair amount of laughing and crying, and not be in charge of when or which.

 
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Old 11-15-2010, 03:14 PM   #5
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Re: Why is my recovery period expected to be so short?

Hi everyone. Nice to to talk to other runners. I am a big runner as well. All the runner names were taken, hence, now I am 12girlygirl.
I had a sliding calcaneal osteotomy with 1 screw, tendon transfer, and gast. lengthening on Sept 9, 2010. I am now 9 1/2 weeks post op.
I have to agree with you BostonRunner, my experience has felt like a marathon. I am pwb and have been for a week. I am wearing a boot and I actually tried a tennis shoe on today. Felt great, but don't want to use it until I get the go ahead from my doctor. I see my surgeon this Friday which will be my 10 week mark. I am using both crutches still. It hurts quite a bit under the arch of my foot when I put weight on it. i am going to ask my doctor on Friday if he can have my orthotic readjusted or if he can order me a new one.
I really hope to go back to running someday. Although at this point, walking without pain will be a welcoming gift.

 
Old 11-16-2010, 11:38 PM   #6
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Re: Why is my recovery period expected to be so short?

I had a very similar operation in March of this year and I am still recovering. 2.5 months is about enough time to get you at least walking with crutches. This surgery recovery is at least a year.

 
Old 11-17-2010, 05:21 AM   #7
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Re: Why is my recovery period expected to be so short?

I was given clearance to pwb in the boot at about 9 weeks and gradually transition to full weight bearing in the boot over a three week period. I found that I was not able to comfortably fwb in a boot until I was closer to 14 weeks post op

I am 16 weeks post op today. Yesterday, I went to the doctor and was given clearance to SLOWLY transition to a sneaker with a lace up ASO brace. The first week, I was told to use the brace and sneaker 50% of the time while in the house and wear the boot the rest of the time. Week two I could use the sneaker brace combo all the time in the house if tolerated and boot in public. Week three I can slowly move to using the sneaker and brace combination when out and about.

 
Old 11-17-2010, 06:02 AM   #8
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Re: Why is my recovery period expected to be so short?

Thanks for the info everyone. I went in on Monday and they fit me with a boot and estimated I'd be PWB in 2 weeks (which will be a total of 4 weeks post-op). For the time being they said that I can use a knee scooter and crutches to get around; I no longer have to worry about elevating it.

Not sure why there is such variance in people's expected recovery times, given that the procedures seem similar, but I guess there are a lot of different variables I may not be considering. For me this was also "voluntary", not the result of an injury, so that may be a factor.

Also, I guess it is very likely that I'll go in in 2 weeks and they'll assign me another 2 weeks before PWB!! Shouldn't count my chickens...

 
Old 11-17-2010, 09:08 AM   #9
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Re: Why is my recovery period expected to be so short?

ok now I'm scared..I have my bunionectomy Dec 1 and he says he has to shaved the bone and realign it with screws. I'm 40 yr ols and don't want to be put to sleep for this..lol

 
Old 11-17-2010, 09:24 AM   #10
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Re: Why is my recovery period expected to be so short?

Ask about a nerve block with IV sedation. I slept through my surgery and when I woke up I felt great.

 
Old 11-17-2010, 09:29 AM   #11
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Re: Why is my recovery period expected to be so short?

ok I'll ask thanks

 
Old 11-17-2010, 02:14 PM   #12
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Re: Why is my recovery period expected to be so short?

Quote:
Originally Posted by roxygirl1 View Post
I was given clearance to pwb in the boot at about 9 weeks and gradually transition to full weight bearing in the boot over a three week period. I found that I was not able to comfortably fwb in a boot until I was closer to 14 weeks post op

I am 16 weeks post op today. Yesterday, I went to the doctor and was given clearance to SLOWLY transition to a sneaker with a lace up ASO brace. The first week, I was told to use the brace and sneaker 50% of the time while in the house and wear the boot the rest of the time. Week two I could use the sneaker brace combo all the time in the house if tolerated and boot in public. Week three I can slowly move to using the sneaker and brace combination when out and about.
Thanks for the details Roxygirl1, it makes me feel better to know what your time frame has been. I am not anywhere near being able to fwb at 9.5 weeks. I feel like my progress has been about the same as yours.

 
Old 11-18-2010, 11:07 AM   #13
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Re: Why is my recovery period expected to be so short?

One thing I discovered is that there are so many types of osteotomies, with differing degrees of invasiveness and recovery times.
The Evans is a calcaneal (heelbone) osteotomy-but it is the cutting and insertion of bone into the lateral and forward part of your heelbone to lengthen the lateral (outside) of your foot. They can use donor bone or get a chip from your hip-they may or may not anchor the chip with a screw but the hoped-for effect is to twist your forefoot to the inside, restores your medial/longitudinal arch.
The "translational" or "sliding" calcaneal osteotomy is not merely a wedge or chip of bone insertion like the Evans. It involves the rear of the same bone-the calcaneus but they saw the bottom off and slide it to the medial or lateral side, rounding off the sharp sawed edge and screwing the 2 pieces of bone back together.
If you have both done, you have had a "double calcaneal osteotomy". That's what I did, along with tendon transfer (I already had a calf muscle lengthening procedure called a gastroc recession). In my case, the tendon transfer and hip incisions healed first and pain is gone at 5 weeks. The incision for the Evans is almost healed, but it hurts at worst maybe a 6 on a 10 scale. The last to approach heling is the most invasive, the sliding-the incision is healed maybe halfway, but the pain on this still can reach 8 when I go all day without elevating it and by "elevate" I mean lying down and propping your boot/cast above your head.
Even bunions can be treated with an osteotomy-compared to sliding calcaneal, minor league stuff in terms of invasiveness and recovery.
So, not only are people different, but osteotomies are different-and when you add 2 or three together, your recovery may take longer than someone who had a single comparatively minor procedure. For example, I saw a Patient Info Sheet on the Evans saying it cound be done under a local, as a single day surgery, but I have never seen that said for a sliding calcaneal osteotomy, let alone a double.
Listen to your body. Worry may not be good for healing.

 
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Old 11-18-2010, 09:31 PM   #14
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Re: Why is my recovery period expected to be so short?

Hi Bostonrunner (and other foot surgery victims)

I canít tell you enough how much I appreciated your posts. On October 19, I had a sliding calcaneal osteotomy with 1 screw, a FDL transfer (my dysfunctional tibialis posterior tendon was shredded and had to be totally removed so the surgeon used a screw to secure the flexor digitorum longus tendon). I also had a gastroc recession at the same time. No stems cells. My surgeon also has done hundreds of these over the last 10 years and averages about 3 a month with good success rate. However, I did do my own research as well as got a second and third opinion. Going into the procedures, I felt confident that this was something that I needed to do to relieve the pain I was experiencing from standing and walking.

Two years ago I had spent 2 days on a ladder washing windows while wearing shoes with poor support and partially tore my tibialis posterior tendon. Was in a Cam boot for 2 months for healing, nwb. Had pt for about two months, but still had pain while walking. Had custom orthotics made (took me 4 months to get used to) but still had pain after wearing for 8 months. My podiatrist said that I already had flat feet prior to the torn tendon, and the tendon was so weakened due to the injury that my arch was continuing to collapse so much that it was compromising the structure of my foot, thus causing pain. Although I am not a runner and not in the same category of athlete as Bostonrunner, I did lead an active life and walked 6 miles a day prior to the injury. I wanted to be able to return to that ability but could barely get through food shopping without pain. I am 50 years old.

This brings me to my current post op status of 31 days (Iím about a week behind Bostonrunner) My doctor had a different post operative treatment plan than what Bostonrunner had. I had same day surgery at 12:00 and was home by 6:00. He told me that I would be placed in a hard fiberglass cast directly off the operating table for 2 weeks. Then xrays, take out staples (which felt like sharkís teeth in a cast when the foot swelled - I wished he had used stitches) and in another hard fiberglass cast for 3 weeks. Xrays again, and in another hard fiberglass cast for 3 more weeks Ė a total of 8 weeks in a hard cast. Then in a Cam boot walker for pwb with 4 months of pt leading to fwb and with a transition to a shoe. Total recovery, I was told would be about six months.

However, things are not altogether going as planned. At 24hrs post opt, nerve block wore off and the pain was unbearable, even with Percocet. I have had ear surgery, major abdominal surgery (was hospitalized for 5 days) and bore 2 children (first one was 52 hours labor) and I have never experienced this kind of pain Ė a 10 on a scale of 10. Was on Percocet for 2 weeks but my doctor said that I should not be experiencing that much pain after 2 weeks, which made me paranoid that something was wrong. Swelling increased the pain as the staples dug into my skin and the cast felt like it was strangling my foot. At 2 weeks, the staples were removed, xrays showed good healing, and according to the doctor, the foot looked appropriate for this stage. I was relieved and got some pain relief with the staples out in the new cast. Went off the Perkoset and experienced awful withdrawal symptoms. However, the next 7 days in this new, tighter cast proved to be a torture chamber. Every night my foot and leg would swell to the point that my toes were engorged and bright red and the skin on my upper leg would bulge over the top of the cast (by the way, I have skinny legs with very little fat) It would take six hours of icing the cast to get the swelling down and I usually could finally get to sleep at about 3 or 4 in the morning. Every day I kept the foot elevated (nose above the toes except for when I went to the bathroom Ė I couldnít even shower) and I was on 3 Ibuprofin every 4 hours for pain and inflammation. I kept thinking each day that I would turn the corner and this would stop, but it didnít. On the 8th day I could not get the swelling down, called my doctor and he told me to go to the ER and get the cast taken off Ė he suspected a blood clot. When the ER Dr cut the cast, it sprung open and I got immediate relief. The foot and leg were bright red and there were bruises all down my shins from the cast pressure. The ER Dr thought that the cast was just too tight. He tested for a blood clot but it was negative.

I was sent home with instructions from my podiatrist (who was in communication with the ER Dr that night via phone) to use the Cam Boot, elevate, let the swelling go down and see him in 5 days. I noticed that my foot was numb on the top of the one side from the pinky toe down to the osteotomy incision. My heel also had several numb areas. Within a day I started to get pins and needles in my toes and heel, which escalated, into sharp, horrible, electric shock feeling pain. Called my Dr and he said I was experiencing transient compression neuropathy (due to the cast pressure from the swelling) and told me to take Perkoset for pain and the numbness and pain should dissipate in a couple of days. When I saw him on the 5th day, the pain had reduced to mostly a strong ache with occasional sharp electric pain periods. The numbness was the same. He said that would go away more when the swelling went down. (To date it is still numb) He wanted to put a new cast on but I just burst into tears. He kept saying that this was so unusual, but it was important to continue the course of treatment in a hard cast (foot needs certain position to heel properly) in order to get optimal results at the end of 8 weeks. After some discussion and some reluctance on his part, he agreed to let me use the CAM Boot walker for the next two weeks and then at the next appt he would xray and put a hard cast on again for another two weeks.

Needless to say, I am terrified at the idea of another hard cast. I have never had a hard cast before and didnít know what to expect. On the other hand, my journey with this experience has been so bumpy and I am so afraid of not following the optimal course of treatment for fear of making recovery more difficult when I start pwb and fwb. In addition, I am very concerned about the numbness on my foot and fear that it may get worse in a hard cast if it is compressed again.

What really struck me about Bostonrunnerís experience is that most of his procedures are similar to mine (did you have a gastroc recession prior to your current surgery or at the same time?) and he never even had a cast at all!!! Just bandages the first two weeks and then a boot for 60 days. Is this boot the same as the Cam Boot Walker that I am currently using? It would give me great peace of mind to know that continuing with it instead of a hard cast would also give good results. Is there some way that Bostonrunner could let me know who his doctor is so I could possibly have my Dr consult him? Also, what is an EXOGEN device?

Thank you all so much for taking the time to post Ė it has been a tremendous help to me!

 
Old 11-19-2010, 08:40 AM   #15
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Re: Why is my recovery period expected to be so short?

Thank you both for the interesting posts. A few questions/thoughts, if you have time to indulge me:

Bostonrunner: According to my papers, I had a medial calcaneal osteotomy, cuneiform osteotomy, and bone graft. Stem cells were taken from my hip but I don't think (?) bone chips were taken. Does this sound like the double osteotomy you referenced? Or is that not enough information to tell? I'm embarrassed I don't know this but its not for lack of asking. (For some reason both docs I always tried to use the most simplistic terms, which is only helpful to a point!).

Chocoholic: Sorry to hear that your experience has been so painful. I can't be of much use, but I am surprised that your doc allows Advil. I've been instructed not to take any NSAIDs as they impede bone formation. Also, like Bostonrunner, I too went directly from bandages (with a partial brace that only covered the sides, to allow for some swelling) to a hard boot or "aircast". I think you might be correct in trying to contact another doctor, if only to get another opinion on the healing process.

 
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