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Old 04-12-2012, 04:44 PM   #1
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1 week PTTD post-op Calcaneal Osteotomy, Evan's Procedure, & PT tendon reconstruction

Hello Everyone,

First I wish to thank all of the courageous people who have posted and replied to topics concerning posterior tibial tendon dysfunction over the last couple of years. Almost 2 years ago (and 38 years of having flat feet) I was diagnosed with PTTD in both feet (Stage 2 A) and I have since read many posts to this topic on Health Boards.

I'm a 38 year old man in good health, neither over or under weight and lead a fairly healthy lifestyle (with the exception of getting exercise on my feet, of course : ) ) On April 5th, I underwent surgery on my right foot having a medial calcaneal displacement osteotomy (6mm medial slide with one titanium screw), lateral column lengthening - Evan's Procedure (using a cadaver bone graft, and a mid foot plate with four screws), along with a posterior tibial tendon reconstruction involving debridement of the PT tendon and a complete tendon transfer of the FDL tendon into the navicular bone (thus giving me two tendons to utilize for arch stabilization). After much consideration, the spring and deltoid ligaments were left intact because they appeared to be in very good condition. My Doctor is a well known foot and ankle orthopedic surgeon and researcher at a prestigious university and I very much trust her expertise. She is a personal hero of mine. She will likely operate on my left foot in one year if everything works out with the right foot.

I've done a lot of research on this procedure but less so on the recovery stage. After four painful days in the hospital, I went to recoup at my parents home (who live 10 minutes from the hospital). Since then I have been trying to reduce the pain medication, although somewhat unsuccessfully. Right now I'm on 20 mg of Oxycontin twice a day, 300 mg of Neurontin (Gabapentin) 3 times a day, 1000mg Tylenol 4 times a day and 5mg-20mg of Oxycodone every 4 hours as needed for pain. I've had a hard time reducing the Oxycodone less than 15 tabs (75mg. total) per 24 hour period. The break away pain is a daily issue and it appears that I sometimes need a lot of medication to control the pounding pressure in my foot. I tend to keep my foot elevated above my heart about 85-95% of the day (only when using the bathroom or moving to a different room is my foot below my heart for a few minutes at a time).

The two questions I had for old timers or really anyone more advanced in the recovery process, was how long did it take people until they could more or less keep their foot down for 50%-75% of the day (When I say down, I mean non-weight bearing but with your foot significantly below your heart). I'm looking for different scenarios that people have experienced in terms of the reduction of painful foot pressure that has come about through patiently enduring time. Also, is it likely that I can be off of these pain medications or at least severely reduce them by the three week mark?

I know that answers to these questions will vary from person to person and each of us will have a different experience based on our differing bodies, but I am interested in other peoples' stories.

Thank you for reading, any input would be very helpful.

-Posttibtend

 
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Old 04-12-2012, 10:38 PM   #2
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Re: 1 week PTTD post-op Calcaneal Osteotomy, Evan's Procedure, & PT tendon reconstruc

Posttib- I too had PTT repair, FDL tendon transfer and a calcanal osteotomy secured with two screws, and I am 5 weeks post op now. I tore my ptt when i fell 10 feet out of the back of an airline catering truck. I had my surgery at an outpatient facility and had to go to a nursing facility for ten days after because I am single and had no one to care for me. The worst pain was the incisions in the heel, it felt like i stepped on glass but 10 times worse. I could also feel the pain in my heel bone from those screws. Those first few days are the hardest, but I noticed that the pain got a little better after the 6th day. I was on 7.5 mg of Percocet every 4 hours, but the pain was so intense that I had to have it increased to two 7.5 mg pills every 4 hours. If I missed a dose or the nursing staff was busy, I would be in intense pain. After the 6th day I was able to go longer periods of time between pills. When I got home I was only taking the pain meds twice a day, mostly at night. Now that I am at the 5 week mark I think I am able to go off the meds, and i only take a pill if I over do it. Everyone responds to pain different, but hang in there you will probably be able to cut down soon. Listen to your body, and you will know when you are ready. Most people say they cut back after two weeks.
As for propping your foot (toes above nose), my OS told me to be on bed rest for 2 weeks. After that I was told that I could sit up, but I still have to keep my leg level. I prop it up on my knee scooter while I am on the couch. They say that I can let it hang down but only for 5 to 10 minutes. If I do too much and my foot swells I prop my foot up above my heart to get the swelling down. I was also adventurous and made it to the car for short trips (my surgery was on left foot) after the 2 1/2 week mark. I was having allot of pain and swelling and my OS told me that I was doing too much. I still get tired really easy if I do too much and I was told that it is normal. My body is still recovering from the surgery, and I have to be patient.
I hope this helps you out. Be patient and hang in there, you should be feeling better soon! Do you have a knee scooter? I found it to be a lifesaver, and I can't imagine going 7 plus weeks on crutches. Although I do use my crutches to get up and down my back stairs and to go to my car.
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Surgery March 6, 2012: Calcanal Osteotomy, PTT repair, FDL tendon transfer on left foot.

 
Old 04-14-2012, 02:45 PM   #3
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Re: 1 week PTTD post-op Calcaneal Osteotomy, Evan's Procedure, & PT tendon reconstruc

Hello Planemark,

Thanks so much for your reply. I feel very lucky to be having a fairly good recovery so far. Sometimes I need lots of medication and other days not. Today is a good day so far. I look forward to thinking in terms of weeks rather than days. So far I'm just one and a half weeks out now and just watching time tick by. The rash i'm having from the Oxycodone is pretty itchy all the time but an itch is better than pain from the surgery site. I have hopes that I can get off of it soon as I feel so loopy after i take it. It gives me hope knowing that in another three or so weeks I might only need pain meds on a very minimal basis, so thank you for relating your story to me.

I did not anticipate that having my foot below my heart for more than one minute would cause a minor trauma to my foot for a half hour or longer, so I'm learning how to do my best with keeping it elevated ALL of the time. I will need to be patient with this element of the recovery as my occupation requires that I keep my feet below my heart for up to two hours at a time-I guess I'll have to find a way to adjust to this in a month or so.

In terms of your question about a knee walker, I have something very similar, a seated scooter. I have pain in my knees so a seated scooter is much better (imagine a knee scooter with a bicycle seat where you would normally put your knee). It is an invaluable tool.

So again, thank you very much your your reply and I wish you well in your recovery too.

 
Old 04-14-2012, 07:27 PM   #4
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Re: 1 week PTTD post-op Calcaneal Osteotomy, Evan's Procedure, & PT tendon reconstruc

Hi, I am 6 weeks post op for stage 4 PTTD. I have 2 screws in my heel, 2 more laterally, a mid foot plate with 4 screws and staple. I am currently off all pain meds except for Ibuprofen as needed for swelling. I am able to now sit normally at a table for a meal but must get elevated at least in a recliner right after.
One thing that helped me was ice and lots of it. Not the reusable gel packs you buy at the pharmacy but real ice cubes. Dr tells me I will have swelling issues for 6 to 9 months. Fortunately my job is computer based so being off my feet has not been a problem. Best advice I can give you is to follow your doc's instructions. Good luck to you !!

 
Old 04-15-2012, 02:38 PM   #5
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Re: 1 week PTTD post-op Calcaneal Osteotomy, Evan's Procedure, & PT tendon reconstruc

Thank you RollTide09,
It's great to hear from others further along on the path. Day by day I seem to be improving but there can be set backs for no apparent reason. I'm trying to gradually decrease my medication but every so often there is a huge surge of pain that lasts several hours and can only be controlled by serious pain meds. I see the Doc in 5 more days and may get my stitches out at that point. I look forward to being one month post-op and hopefully off of the medication and the "pressure pain" by then. I also hope that in two or three months I'll be able to keep my feet down below my waist for at least an hour
Thank you for writing and may you heal well.

Last edited by posttibtend; 04-15-2012 at 02:38 PM.

 
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Old 04-15-2012, 07:13 PM   #6
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Re: 1 week PTTD post-op Calcaneal Osteotomy, Evan's Procedure, & PT tendon reconstruc

I had a fall off of my knee scooter and my surgery foot landed hard on the ground a couple weeks ago. Wouldn't you know that i would find a way to injure the only thing stickin out of my cast, my big toe. I went to see my OS and thankfully no damage to my surgery, just a stubbed toe. When i was there the nurse told me that recovery after this surgery is a roller coaster ride. Truer words could never have been said! We all will have good days and bad days for the next 6 months to a year, but we are in this for the long haul and are on the road to recovery.
Postibtend, you will probably get your stitches out and a new cast that should last for the next month. I would recommend asking if they can put foam over your incisions on both sides of your foot in order to make it more comfortable when your foot swells. The cast tech at my Dr did that for me along with lambs wool between my toes, and it made my cast much more comfortable and has helped in my recovery I believe. My surgeon is picky about our casts and I am so grateful. Just a suggestion if they didn't do that for you the first time,it doesn't hurt to ask. You don't want a cast that is too tight after all because the swelling has nowhere to go but press against the cast.
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Surgery March 6, 2012: Calcanal Osteotomy, PTT repair, FDL tendon transfer on left foot.

 
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