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    Old 06-18-2004, 02:36 AM   #1
    cmptrwun
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    Question Lots of Bunion Surgery Questions- Long Post

    I'm two weeks, two days post-op for bunion surgery on my left foot, and I have lots of questions that I'm hoping somebody can answer.
    First, to describe my foot and the surgery- I have very high arches, which I understand is unusual in people with bunions. I have also *rarely* worn shoes that would exacerbate bunions, primarily because as the bunions have gotten worse over the years, my feet have gotten so wide that I can't even find shoes to fit, and by the time in my life when I would have been wearing heels and such, my feet were already horrible. I wear a size 6.5 double- or triple-wide shoe! I've had to order shoes to fit my feet, and it's very hard to find any shoes in that size, let alone fashionable shoes, so I've worn boring flat clodhoppers most of my life. I'm 35, and my feet have always been disastrously ugly. The toe on the foot that I've not yet had fixed is more than thirty degrees off-kilter, as was the left toe before surgery. Also, I have a genetic deformity in the big toes that causes them to bend significantly towards the other toes at the first knuckle, not just at the base of the toe.
    In any case, my podiatrist performed osteotomies on both the toe joint and the metatarsal. I don't know which specific procedure he did (I have my two-week follow-up on Monday as he is on vacation this week and I will be asking him then), but I know that he removed pie-shaped wedges of bone from both places. I have two permanent titanium screws.
    So, on to my questions...
    First, how many here have high arches and bunions? It sounds like it's fairly rare to have this combination, and my doctor told me that arches like mine are the kind they hate to see in the operating room because they make the surgery more difficult. Before the surgery, he told me that clinically, my foot looked much worse than it did in the x-rays and that he hoped that he'd be able to do the cut in the metatarsal close to the joint rather than higher up. As it turns out, he was able to do it relatively close to the joint, which is good.
    Next, I have been in a soft cast and on crutches since surgery. I'm not allowed to put *any* weight on the foot as of yet, and I'm not even allowed to take the cast off for sleeping.
    Is the cast required to keep the foot and ankle immobile, or is it to protect the foot from bumping against things?
    Is it "bad" to move the foot at the ankle while recovering? My doctor has encouraged me to "wiggle" my toe a lot, and even told me to manually "wiggle" it with my hands in addition to wiggling it under its own steam, so to speak. So, I wiggle it like crazy. I've actually been wiggling the whole foot in the cast as it is driving me nuts not to, and I've been stretching it around in there because it feels good to do so. Am I going to shift anything out of place by doing this? I would hate to find out that I've yanked something out of alignment with all the wiggling, although I did call my doctor and ask him if it was okay to be a wiggling fiend and he said, "don't worry, the toe is not going to fall off. Wiggle it."
    Is it common to not be allowed to put any weight at all on the foot for two weeks? I see lots of things on the 'net saying that people are able to go home in a surgical shoe and start walking on it right away, although from reading these boards, I'm finding that there do seem to be lots of people who aren't allowed to do so, so I'm a little less worried about that. I also saw a post here saying that the length of time before one is allowed to put weight on the foot depends on how conservative the surgeon is, how high the cut is made in the bone and something else that now slips my mind. My impression of my doctor is that he is, indeed, conservative in his treatment, and I suspect that my high arches contribute to my not being allowed to put weight on the foot as I think the cut in the bone may be higher up or less stable than it would be if I had flat feet or normal arches. Does this sound right?
    The cast was supposed to come off at two weeks, but because of my doctor being out of town, my second follow-up (I had one two days post-op) isn't until Monday, as I mentioned. However, even though I know I'm not supposed to do so, I took my cast off. The weather is just too hot and I didn't think to put my air conditioners in before surgery, so the cast was driving me nuts. I have Ace bandages on the foot and I wear a surgical shoe when I'm up and about (I still use the crutches and haven't even touched the foot to the floor), and I put the cast back on after a few hours of having it off. I figure that since it would have come off on Wednesday anyway, that I should be okay with this. I know, bad me for not leaving it on, but it was seriously driving me nuts, and my leg is atrophying already! I live in New York, where walking is an inherent part of life, and the last thing I need is to have a wobbly little stick leg when this is all said and done. Basically, I think I'm looking for somebody to tell me I'm not a terrible patient for taking the cast off.
    (When I tried to post this, I got a message that it is too long, so I'm going to have to cut this into two parts, sorry!)
    More to follow...

     
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    Old 06-18-2004, 02:37 AM   #2
    cmptrwun
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    Question Lots of Bunion Surgery Questions- Long Post, part two

    Part two of my questions:
    Okay, so on to other stuff. When the doctor cut my cast and unwrapped my foot on the two-day post-op appointment, I couldn't *believe* how great my foot looked! I think I will actually be able to buy shoes in shoe stores after this! I've also "peeked" at it a couple of times and the incision looks amazing. No redness, it's not raised, it hasn't been bleeding, and it's just a tiny line on my foot (with a bunch of Frankenstein stitches around it).
    I had a Morton's neuroma removed from this same foot a few years ago when I lived in a different state and the scar from that is almost invisible (my doctor hadn't even noticed it until I pointed it out to him when he was going over possible complications from surgery and mentioned scarring and asked if I had a tendency to scar badly. He took one look at it and said, "okay, you don't scar." Granted, the neuroma scar is mostly between the toes, so it's not like he would notice it anyway, but the quarter-inch or so that shows is nearly invisible.
    I think that my doctor may have done some kind of plastic surgery stitching on the incision, because the black stitches that show do not seem to be what held the incision shut; I suspect that there were dissolvable stitches inside the incision and that the black stitches are just "reinforcing" stitches. Does this sound right?
    Also, there doesn't seem to be any swelling of the foot. As in, *none*. I expect that this is a Very Good Thing, but from what I've been reading, most people have lots of swelling afterwards; has anybody had virtually no swelling, and if so, why do you think that was the case?
    Now, on to the pain-related questions. On the day of the surgery (I had sedation and the ankle block thing, and I don't remember one whit of the surgery), after the ankle block wore off, I experienced some *excruciating* pain. I ended up doubling my Vicodin dose (with the doctor's okay) plus taking prescription Naprosyn, and it barely touched the pain. I have a very high pain threshold, for what it's worth, so that should indicate just how bad the pain was. I wouldn't say it was the worst pain I've ever felt in my life because I've had migraines during which I'd probably have consented to having my head cut off, but it was bad. Anyway, my mother, who stayed with me for a few days after the surgery, suggested that I lower my foot a little bit as the pain seemed to be worse the higher that I had the foot. I did, and the pain did diminish. Does anybody know if raising the foot too high normally exacerbates the pain? It seemed odd for it to do so, but I tested various heights at which my foot was elevated, and it was consistently less painful if I kept it lower (just above waist level, about even with or slightly higher than my heart).
    Since the first day, which was definitely the worst as far as pain (and the pain progression has been very consistent with what my doctor told me it would be- he said that the first two days would be the worst and that it would lessen very quickly after that), I still do have pain at times. It will ache after I've been wiggling it a lot, and sometimes I'll get shooting pains in the toe and at the metatarsal joint. Is this normal? (I am guessing that it is, but I'd like to find out if others have experienced it.)
    I also have a question regarding numbness. The outer edge of my toe is completely numb from about the tip of the toe to the first knuckle. I *think* that it is improving a bit, but I'm really not sure. I asked my doctor about it and he said that I need to keep in mind that there is a whole "net" of nerves in there and that they're probably healing, but is it normal for there to be no feeling in part of the toe after surgery? If so, does it go away? Are the shooting pains that I feel in that area indicative of the nerves "regenerating"?Am I going to always have no feeling on the side of the toe?
    When I had the Morton's neuroma removed, my orthopedist told me that I'd not have any feeling between the toes as the nerve would be removed, but that the surrounding nerves tend to "take over" after time and that some of the feeling might return. He was right, and I now have no "dead spots" between those two toes, so I'm hoping that eventually I'll get the feeling back in my big toe, too.
    Okay, I think I'm to my last set of questions with these next ones. Regarding range of motion- I can bend my toe down a little bit and up a little bit, but because of having had two different parts of it cut up, the range of motion is really limited. I expect that this is perfectly normal and that it will get better with time, but unlike most of what I've read here, I seem to have an easier time bending the toe down than up. I think that this may in part be due to the operation on the toe itself, and the doctor told me that I'd never be able to bend my toe upward at the first knuckle after the surgery. However, I couldn't do that, anyway, so that really didn't faze me. I've always had excellent range of motion at the joint near the metatarsal, however, and I definitely don't seem to have that anymore. Once I get into the surgical shoe and then into tennis shoes, can I expect that that will loosen up quite a bit? Also, in the long term, is it possible to recover *full* range of motion in the joint?
    Okay, this has gone on really, really long, but I just have not been able to find answers to these questions in all of my searching, so I figured I'd ask 'em all of people who've been through this.
    Oh, one last thing- at my two-day follow-up, my mother asked the doctor how quickly I could have my other foot done and he said "a couple of months". Given everything I've described so far, do y'all think that my left foot will have recovered enough by August or September for me to have surgery on my right foot? I'd really like to have it done as soon as possible, but it means that my left foot will have to support me while I'm on crutches for my right foot and I don't want to risk damaging the left foot at that time. I assume that the bone will be completely healed by then, correct?
    Thanks for taking the time to read this tome, and I appreciate any responses!

     
    Old 06-18-2004, 06:52 AM   #3
    piggy22
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    Re: Lots of Bunion Surgery Questions- Long Post

    wow long post! i don't know if i can remember all the questions...but i'll try to answer at least some of them... about the pain/numbness - i too had this numbness on my big toe during the first few weeks at least...it kind of scared me a bit too, but my doc said the same thing yours did and it eventually went away gradually as i started walking on it more...this was the case for the shooting pains as well. from what my doctor told me, the "healing" should be pretty complete by the 2nd-4th week (but i guess this would depend on what type of procedure you had done) so you can't really "hurt" it after that point by walking on it...it might still be painful, but the bone would have healed by then....so i think by aug/sept you'll be ready in that sense for the other foot, but your left foot might still be too painful/tender to support your right foot well....and people (including myself) have had both feet done pretty much at the same time, but your case might be different because of the high arch... and don't worry too much about your leg getting stick-like...once you start walking on it regularly, it goes back to normal in no time... oh and also with the swelling, for me, my feet didn't look too swollen either, but once you start walking, (and you have to wear normal shoes), you'll notice that they are/will swell more as you walk. although my feet didn't seem too swollen (even the doc agreed), i still can't fit into my own shoes yet - i have to wear a size or two bigger than usual (i'm at about 3 months post-op)

    you probably have lots of questions that'll come up throughout your recovery, but if i were to give you one piece of advice, just take it slow and be (VERRY) patient because some days you'll feel spectacular and some days you'l feel like you'll never get better...it's a long process and you've just got to be patient.

    oh and also, you mentioned you were in ny...i was just wondering, who your doctor is? i'm thinking of getting a second opinion for one of my hammertoes that i'm still having some pain with...

     
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