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Old 03-17-2012, 10:43 AM   #1
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Screw removal, bone shaving, etc.

Had my surgery last night to remove screws from the calcaneal osteotomy, shave the bone on the lateral side where he did the original cut in the bone, and also cleaned out bone spurs etc at lateral Achilles attachment. Below is a recap so far.

Got my screws out today. It was a long day. My surgery was scheduled for 4:30 pm so I had to be at the hospital at 2:30. I couldn't eat all day. Miserable. I got to the hospital on time and the lady registering me was having problems with her computer. Ended up taking about 20 minutes but I was finally led into my own room for pre-op at about 3. The hospital did a major addition about a year ago and they ended up converting the old ICU to outpatient care and the old burn unit to pre-op. So, all the rooms are pretty huge and only one patient per room. Kind of nice. Anyway, the nurse came in right away and ran through all the usual questions. She made me change into this new kind of gown that seems to be made of paper. Then she connected a tube to it that blew air right into it for temperature control. Very fancy. Think I prefer the old way though. Right before she left, she mentioned that my doctor was running about 2 hours late. Sweet. I was sooo hungry at this point. The anesthesiologist came in at about 4:30 to start my IV and said my surgery was probably going to be at 6:30. He also reviewed the nerve block procedure. Since he was going to be in a different surgery at 5:30, he wanted to do the nerve block a bit early rather than risk there being a delay. He came back in at 5, gave me some valium (Versed) and did the nerve block. Very simple and painless. What was different this time is that he block a second nerve as well. The first was behind my leg, just above my knee. The second was in the front, just above and to the right of the knee. The block slowly settled in and my foot kept getting more heavy. At 5:30, my doc came in to review everything and make sure I was comfortable. He then left to perform a different surgery. At about 6:15, the operative nurse and another anesthesiologist came in to take me to surgery. The operating room was pretty cool, it's only a year old and had some very fancy equipment. Anesthesiologist gave me some more versed and had me start breathing through a mask. About a minute later, I was out. I woke up at 8 pm in recovery and was very groggy. Was there for about an hour and then was wheeled up to my room. Unfortunately, I never found out what my doc did to my foot. He called my house to inform my mother and she didn't ask many questions. It took about 2 hours for me to become less groggy and started feeling better around 10:30. One thing that is really strange is that I began to develop a burning pain in my shin (maybe a 2 out of 10). There is no way the nerve block should be wearing off so fast! The pain was getting worse (4/10) so the nurse gave me a couple of oxy at 10:30. Didn't do anything for the pain. At 11:30, the top right part of my calf is no longer numb and the pain in my shin continues to escalate (5/10). The nurse called Ortho and they said to give me dilauded and valium. I held off until 12:30 am and had to take it. Pain was about 6/10. It has helped a little but not much. Kind of concerning. So, now it's 1:30 am and my shin still hurts. I can't move my toes yet and the left side of my calf is still numb. Really hope this is a temporary pain. If the dialuded isn't helping for this, I'm really nervous when my heel fires up.


So, long rant. As mentioned, I'm on the dilauded so excuse typos or if this doesn't make sense at all. Will update again tomorrow.


Oh, I did get my screws. They're probably a good 2" - 2.5". Crazy.
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Calcaneal Osteotomy, Modified Brostrom Repair, Gastroc Recession, Screw Removal, Achilles Debridement, Haglunds Deformity, PIP Arthrodesis, FTL Tendon Transfer, MTP Capsulotomy, K-Wire Fixation

 
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Old 03-17-2012, 11:10 AM   #2
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Re: Screw removal, bone shaving, etc.

Pain in my shin was a bit up and down but seemed to be escalating overall. I was wide awake all night and didn't fall asleep until about 7:45 this morning. The nurses came through for rounds at 8:30 and asked how my shin was. I told her it was about a 2 or 3. However, 4 minutes later, the pain was a 7 creeping on an 8. Couldn't believe it. It was a horrible burning pain that seemed to be moving down towards my ankle. The nurse shot me up with some dilauded and gave me more oxy. It wasn't helping too much. Eventually, one of the docs stopped in and took off the cam walker and said that he thinks the ace wrap may be causing the pain. He unwrapped the ace and started tearing the gauze. My shin was really bruised and red. He accidentally put pressure on it when tearing the gauze and it was excruciating. He didn't really give a reason for the pain but said the tight ace wrap was aggravating it. He reapplied everything very loosely and I haven't really had any pain since. Very happy about that. I crashed for about 3 hours and feel a million times better.

The main nerve block in the back of my leg is still active. Can't feel anything or move toes. The nurse wants to keep me on oxi until it wears off just in case it's painful. She will keep the dialuded on hand in case we need break through medication.

I did get some clarity from my mother regarding her conversation with my surgeon last night. Turns out that he did tell her that everything went as planned and I should have relief from pain.

Will update when block wears off.

Update: foot started tingling around 8 pm and I could start to move my toes at 10 (just barely). Nurse gave me dilauded so we can start out ahead of the pain. It's 11:50 now and I'm starting to get pain the achilles. Can have dilaudid again 12:15, valium at 12:30, and oxi at 1 am. A bit nervous now as the block is wearing off more and the pain is building. Will post an update in the morning.
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Calcaneal Osteotomy, Modified Brostrom Repair, Gastroc Recession, Screw Removal, Achilles Debridement, Haglunds Deformity, PIP Arthrodesis, FTL Tendon Transfer, MTP Capsulotomy, K-Wire Fixation

Last edited by Lurchy24; 03-21-2012 at 06:41 AM. Reason: Update

 
Old 03-21-2012, 08:51 AM   #3
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Re: Screw removal, bone shaving, etc.

Not sure if anyone is going through anything similar so I will hold off on posting updates unless someone asks specific questions. Good luck to everyone out there!
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Calcaneal Osteotomy, Modified Brostrom Repair, Gastroc Recession, Screw Removal, Achilles Debridement, Haglunds Deformity, PIP Arthrodesis, FTL Tendon Transfer, MTP Capsulotomy, K-Wire Fixation

 
Old 03-23-2012, 10:58 AM   #4
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Re: Screw removal, bone shaving, etc.

Sounds like you are slowly feeling better after this procedure. I had a calcaneal osteotomy in Nov 2011 and am getting anxious for screw removal also. I luckily have only one screw and my surgeon said it would be a brief outpatient surgical procedure and I can walk in my walking boot after the procedure.

What instructions has your surgeon provided you with return to walking and return to work, if it applies to you? I was told I can have the procedure on a Friday and return to work, likely with boot, by Monday. I would probably take the following Monday off work though.

 
Old 03-23-2012, 11:52 AM   #5
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Re: Screw removal, bone shaving, etc.

It turns out that my simple screw removal procedure turned into a more complex operation. I wondered why the doc sent me home with 80 oxy, 40 norco, and 25 valium. I just got the surgical report and now I know why.

Here are excerpts from the report:

Preoperative Diagnosis:
1. Left insertional Achilles tendonitis
2. Painful retained hardware, left calcaneus
3. Haglund's deformity, left calcaneus
4. Painful prominent ridge, left lateral calcaneus status post lateral slide osteotomy

Postoperative Diagnosis:
Same

Procedures:
1. Debridement of Achilles tendon
2. Removal of hardware from left calcaneous
3. Excision of left retrocalcaneal bursa
4. Excision of Haglund's deformity, left calcaneus
5. Removal of prominent ridge left lateral calcaneal tuberosity through separate incision

Technique (highlights only)
1. Achilles was cut in half and debrided
2. Screws were removed
3. Inflamed bursa was visualized and removed
4. Haglund's deformity was resected and the __ most portion of the tuberosity was smoothed down to a good bleeding calcaneous bone
5. The ___ portion of the calcaneus was then smoothed out with a bur obtaining a smooth surface and removing Haglund's deformity completely.
6. Incision was made over lateral tuberosity of the calcaneus along previous incision and carried down to bone. An inch of bone at the level of the previous lateral collateral osteotomy was removed and smoothed.
7. The two halves of the Achilles were sewn back together.
8. Skin was closed

Postoperative plan
Partial weight bearing in CAM walker and crutches for two weeks. Sutures removed and then 6 weeks in CAM walker.
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Calcaneal Osteotomy, Modified Brostrom Repair, Gastroc Recession, Screw Removal, Achilles Debridement, Haglunds Deformity, PIP Arthrodesis, FTL Tendon Transfer, MTP Capsulotomy, K-Wire Fixation

 
Old 03-23-2012, 01:28 PM   #6
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Re: Screw removal, bone shaving, etc.

Wow that was a lot of work, when you just thought you were having the screw out. Good luck and keep up with the pain meds.

 
Old 03-23-2012, 01:37 PM   #7
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Re: Screw removal, bone shaving, etc.

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Originally Posted by maggietaz View Post
Wow that was a lot of work, when you just thought you were having the screw out. Good luck and keep up with the pain meds.
Thanks. The doc had given me a best and worst case scenario and this pretty much fell right in the middle. Worst case would have been him having to completely detach the achilles to clean things out. Very happy that didn't happen.
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Old 03-24-2012, 01:58 AM   #8
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Re: Screw removal, bone shaving, etc.

Wowsers! That was a lot of work, but glad if wasn't the worst! No,wonder you went home on all the meds!! How are you doing??

 
Old 03-24-2012, 06:23 AM   #9
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Re: Screw removal, bone shaving, etc.

Quote:
Originally Posted by Hollywood48 View Post
Wowsers! That was a lot of work, but glad if wasn't the worst! No,wonder you went home on all the meds!! How are you doing??
Thanks. I'm doing pretty well considering the extent of the surgery. It's kind of funny how the procedures performed fell within the scope of what the doc told me could happen but I had no idea it would be anything but a minor procedure. I don't know if it's because they are so used to performing these operations that they downplay the complexity and trauma to your body or they keep it vague in order to avoid confusion. I spent last night researching the procedures performed and was pretty shocked. I am pleased that the methods applied appear to be the most modern and recommended. I never thought to ask the doc which technique he would use to resolve the achilles pain, haglunds deformity, and bursa. From what I was able to read, many docs still utilize a lateral approach which doesn't provide as good visibility and can result in nerve damage.

I have cut down on my pain medication considerably (by about 1/2). It has been a week since the procedure so it's time to get my act together. Last night was the first time the pain has gotten ahead of me and that was not fun. Was very happy that the doc prescribed strong meds so I could get it under control pretty quickly. I did sleep through the night without waking up once for the first time since surgery.

Going to see how long I can go today without taking anything. It's a tricky game.....
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Calcaneal Osteotomy, Modified Brostrom Repair, Gastroc Recession, Screw Removal, Achilles Debridement, Haglunds Deformity, PIP Arthrodesis, FTL Tendon Transfer, MTP Capsulotomy, K-Wire Fixation

 
Old 03-26-2012, 12:27 PM   #10
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Re: Screw removal, bone shaving, etc.

I got a call today from my doc's office following up regarding my call to them about the odor coming from my boot and whether it was an infection. Everything is fine but it was my first time to ask them some questions.

First off, the original plan was for me to transition from PWB with crutches and boot to a normal shoe after 2 weeks. Well, since he had to split the Achilles, I now have to wear the boot for an additional 6 weeks after I get the stitches out this Friday. What a major bummer. Very very disappointed to hear that. I have follow-up phone interviews this week and may be flying out for face-to-face interviews over the next few weeks. Having to gimp around in a boot is not going to look as good as without. Darn.

On a positive note, the nurse was very impressed with my pain management. She was shocked that I've been down to 1 to 2 doses of Oxy per day since Thursday. With all the cutting and bone shaving, they typically have to refill scripts the second week after surgery. Looks like I have finally found a benefit to having the miserably painful calcaneal osteotomy and brostrom repair last year. To quote a classic movie, "Pain don't hurt".....unless they cut your heel in half.

As far as the stinky Cam walker is concerned, I called my orthotics place and they are going to get me a replacement sleeve at their cost since I bought the boot from them a year ago. As horrible as it is now, I'm going to wait until I get the stitches out Friday so I can wash my leg and start with a fresh and clean everything. Considering it was 85 here in Michigan last week, I need to be prepared for a warm spring.
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Old 03-26-2012, 01:59 PM   #11
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Re: Screw removal, bone shaving, etc.

Sounds like you got quite the surprise in your surgery. Despite them saying more can be done we always hope for the best. Glad you didn't have to get the worst case scenario. I am amazed that your doing so well managing your pain with the cut back. Bummer you have to stay in the boot longer, but at least your getting a new liner. We do seem to ge having an unseasonably warm March this year across the states. Enjoy it while it last, definitely better then tons of rain.
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Old 03-31-2012, 09:23 PM   #12
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Re: Screw removal, bone shaving, etc.

Haven't updated for a while so I thought I'd put something out there in case anyone is going through the same or pondering.

So far, this surgery has been a breeze compared to the osteotomy and brostrom repair. The one thing that is weird is that the pain has actually been worse the second week than the first. It's mostly in the evening and starts around 5 pm or so. I can usually get by with one or two doses of meds. I've been sleeping straight through at night and not having any significant pain until the next evening. The pain is all over the place but it seems to mostly be the worst in the front where the Brostrom was done. Strange considering nothing has been done there.

I did have my two week post-op yesterday. The MA used that wonderful magic spray to numb everything before taking out the stitches. Didn't feel a thing. She didn't have me stand or do anything. Just put me right back in my Cam boot. I had been told to take pain meds before my appointment so I took two Oxy at 920. My appointment was at 1030 and I was home shortly after. Didn't have any pain at all until about 1 pm and within 10 minutes I was in the most pain that I have been in since the surgery. Apparently, the Oxy was wearing off. It was crazy because we didn't do much with my leg and I didn't even stand on it. Spent the rest of the day yesterday on meds but today has been better. It really started hurting about 20 minutes ago (midnight) which is pretty normal.

I have one more week in the boot 24/7 and I am allowed to take it off to shower (no baths though). Then I can transition away from PWB to FB and start getting things back to normal. I'll be in the boot for a total of six weeks. I do have an interview in three weeks and the MA is going to check with the doc to see if I can go without the boot for that one day. That would really be incredible.

Hope everyone else is well. Good luck with your recoveries!
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Last edited by Lurchy24; 03-31-2012 at 09:26 PM. Reason: Error

 
Old 04-01-2012, 12:53 PM   #13
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Re: Screw removal, bone shaving, etc.

Hi Lurchy, thanks for updating. It's interesting to read about your progress! Glad that it has been a much less traumatic op than the original one. That must be a huge relief. I find that my foot gets more painful in the evenings too, especially at first. It seemed odd to me as I wasn't doing much during the day except lying on the couch!

 
Old 04-01-2012, 04:19 PM   #14
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Re: Screw removal, bone shaving, etc.

Quote:
Originally Posted by Amethy5t View Post
Hi Lurchy, thanks for updating. It's interesting to read about your progress! Glad that it has been a much less traumatic op than the original one. That must be a huge relief. I find that my foot gets more painful in the evenings too, especially at first. It seemed odd to me as I wasn't doing much during the day except lying on the couch!
Isn't that strange how the pain works? I did begin putting more weight on my foot today and tried to use the crutches a little less. Ouch. It started with a serious burning pain in my heel that lasted about 30 minutes. That went away and this afternoon the upper part of my achilles feels like it's torn. Horrible muscle type of ache. I'm going to take it a bit easier going forward.

On a positive note.....oh how nice a shower is after surgery! Bathing with a foot sticking out of the tub just doesn't cut it. I'm 6'5" and 235 lbs so I barely fit in a normal tub as it is. It really is wonderful to get a good thorough cleaning.
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Old 04-01-2012, 07:25 PM   #15
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Re: Screw removal, bone shaving, etc.

LURCHY--Yay for a shower! You aren't kidding! It is nice to be able to shower all of you and not part of you! I bet with your size that was difficult! I can get all the way in our stand up shower, but I have a cast cover on and I can't wait to be able to bathe that leg and foot tomorrow night after my cast comes off tomorrow (hopefully). Let's just say that that leg and foot aren't looking, ahem, feminine at the moment! Can't wait to bathe, exfoliate, shave, and lotion it up! LOL! It IS strange how the pain works. Mine is worse at night too even if I've only been on the couch all day! So strange! Hang in there!
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