May 12, 2009
I promised to report in on the pre-op doctor report. I decided to do a journal on this and this will be my first entry. (this site will not get them all - I promise) I took a whole page of questions to the appointments. I just don’t do smoke and mirrors well and needed to know where I am headed so I can focus. Here is what I am having done, and my generic interpretation of what it is:
1. Triple Arthrodesis. This fused 3 joints in the hind foot to stabilize the foot. In the process the doctor will rebuild the arch, and move the heel pad back under the foot. There will be multiple screws and plates involved that they hope my body will be able to tolerate and keep forever. If not they will come out in around 9 months. Cadaver bone grafts will be used.
2. Gastroc Slide. This procedure involved stretching the heel cord. (Achillis tendon?) It will involve either 3 incisions above the back of the ankle or one higher on the side of the shin.
3. MPT Fusion. This will fuse the second big toe joint. No cartilage there, and he says I should be in pain, but I am not. I could actually hear the grinding/grating sound as he moved the toe. He said they usually only fuse the joint because of pain. I finally said, fuse it – I’m not coming back for this foot. Do it all now. They are.
4. Shortening of the 2nd and 3rd toes. They will shorten the bones in the forefoot, and pin the toes straight. These will have external pins that will be removed after 3-4 weeks.
Prognosis? Excellent after I get the next one done next year. Actually the biggest obstetrical as I see it is my other poor joints. I am having a walker issue. My left wrist will not support me for the non-walking time without further wrist joint deterioration. My left foot will not support me adequately to be able to crutch for the duration… I will have a “shelf” walker I am getting the day before surgery. My weight will be balanced on my forearms.
Timeline
• Right foot Surgery May 27. Out of the hospital May 28. I will go to Shirley’s home in cast #1 as being alone is just not a good choice for the initial weeks. No weight-bearing.
• June 8. Back to the doctor. Remove cast, and hopefully the stitches will be able to come out. Cast #2
• 3-4 weeks out. Pins pulled from toe shortening. New cast #3– toes get to be exposed.
• 6 weeks out. X-ray to determine healing. If healing well enough, no more cast. Move to surgical boot. If not cast #4 goes on, for another 4 weeks before the boot stage
• Boot stage. PT starts. No weight bearing prior to this. PT approximately 6-8 weeks.
• 10-14 weeks (when go to boot stage + 4 weeks pt) can return to the pool. Real downtime can end at this point and movement limited only by pain, swelling and my own determination.
• Total recovery 9-12 months
• Left foot surgery…Late May 2010…maybe
Other
• I will be having a spinal and a lower limb block for the surgery and initial pain.
• Pain pills and muscle relaxers will be prescribed to go home.
• Question: When can I drive? Answer: When you can walk normally. As I have never walked normally…. I figure we are back to the 10-14 week minimally. Depends on the mobility in the boot.
Thanks to this site I did have the questions I needed answered. And by getting answers, I am feeling more in control and will be able to know what to expect when.
Peg
You sound like you asked all the right questions. I am 8 weeks today from surgery and am in boot partial wb. I use crutches in the house and walker outside ( I'm not great on crutches) The only thing you might be a little premature on is timeline for driving. My Dr said that until I am back in a shoe no driving. It is my right foot too. I hope it will be at 12 weeks...we will see. Good luck with your surgery. Mar
It is amazing how different my triple is from what you described. different bones, no toe involvement and no external pins.
I am 17 weeks out, 5 weeks in the boot and ready to give the boot the boot (bought some big comfy sneakers) as soon as I can get in to see my surgeon and get a clearance. I am starting to stumble around without the walker every minute and think I could walk better without the awkward boot.
I recommend a knee walker if you do not have a major knee problem...I found it to be a lifesaver (roll-a-bout or any brand...google search to find them)
My surgery was the result of long time RA - so I had a lot of the same issues.
You'll like the shelf walker, plus you will get really buff arms. I used a walker with forearm rests. I second the vote for a knee walker -- it's better for making yourself food or rolling out of the shower. Add a pillow if you need to and off you go. My bad joints were also the reason for getting a "night potty". This way if your joints are hurting, you don't absolutely have to walk.
If your good foot is also bad (mine was too) you can actually do a lot of sliding rather than hopping on it. I kept a towel under my foot so I could slide along on the wood or tile floors with a gently bent knee...this made moving around as gentle as possible. Door thresholds were my nemesis -- I wish I'd have smoothed over them with homemade ramps.
Sorry so much detail. Getting everything prepared and under control soothed my nerves and it sounds like it helps you, too.
rochelle, a true triple arthrodesis is fusion of the calcaneus, talus, navicular, and cuboid bones. nothing else. some also include an achilles lengthening.
I asked about a knee walker, and they said there is a 50-50 chance I will have an incision on the side of my shin bone... Not sure why the indecision, but it is for the tendon lengthening part. Anyway, I get the shelf walker at least for now.
Peg
My triple was exactly as you described it. I have 5 screws no plates. I am 8 weeks out and saw Dr. yesterday. He said boot another 2 weeks then depending on xrays possibly into a shoe. I am still to be only partial weght on foot. I found the knee walker heavy and not so easy to maneuver around house especially on carpet. What worked great for me was a secretary chair on wheels. Take care Mar
