New Foot Problems

So now I have a very painful ingrown toenail in the big toe. Yup, the same toe that I had the surgery on.

It is making it extremely difficult to walk normally. Heck, it's almost impossible to walk at all!

I can't put on a shoe without the nail digging into my flesh. I was considering buying new shoes a size or two larger to give me more room in the toe box, but wore Mike's very wide work shoes yesterday for a bit and was no more comfortable than in my own shoes.

I haven't done anything different to that toe than I did before the surgery. All I did was shorten the nail since it had grown out while in the cast. And I did that three or four weeks ago. And it's not too short or anything.

I do have a bit of nail fungus in that nail and it has changed the shape of the nail some. I think that, the realignment of the toe, and the extreme swelling that is still in the foot is what is causing the ingrown nail.

So Monday I will call the doctor to schedule an appointment. I had hoped Epsom salt soaks and the larger shoe would solve this but it hasn't so the doctor will have to take a look. Right now, it is less painful and easier to walk on if I'm out of my shoe so that is what I am doing this weekend.

Geesh.

Small Improvements

I saw the doctor yesterday as a follow-up to the strapping she did two weeks ago, which was to see if an orthotic in my shoe would help the pain I've been having in the ball of the big toe joint.

The answer is yes.

So I was 'casted' for orthotics and they should be in within three weeks, which is when my next appointment is scheduled.

We also discussed the pretty painful heel I get when driving. I cannot rest my foot on my heel while the foot is on the gas pedal. I look forward to places I can use cruise-control so that I can move my weight off my heel. She ordered a silicone heel cup which hopefully will ease some of that sensitivity.

I am still compensating when I walk or stand. She had to keep reminding me to put weight equally on both feet while we stood and talked. It's partially habit but mostly triggered by the discomfort/pain I am still experiencing in the foot.

I am able to to do weight-bearing heel raises but will never have the range of lift of the other foot, even when back to full strength. I still have to think about my mechanics when walking so that I don't automatically roll off the the outside of my foot (which puts pressure and torque on the tendon). I am a work in progress on coming down stairs - still a lot of pain in the tendon and toe areas, but again those supposedly will work themselves out over time with use.

I have two weeks of PT left scheduled and the doctor said not to schedule any more, as I should be able to be discharged as of our next appointment on the 12th. She also said that that appointment would mark the end of the treatment protocol for the surgery.

Hm-m-m. I'm still unable to walk without pain, the foot and ankle are still swollen and balloon up whenever I'm on my feet for more than an hour, and the fused joint and toe bones are still very painful. This is the end of treatment? I'm supposed to be able to go on and function normally in my life like this? Hm-m-m.

Hopefully, the orthotic devices that go in my shoes will help with a lot of this. Hopefully.

I'm not happy with the severe swelling and random pain that I still have in the heel area that occurs with any usage. We just started ultrasound therapy on that to see if we can work that out. Luckily, I'll be able to get all six treatments in before I run out of PT appointments.

I'm pretty happy with where the tendon is. As far as recovery, it's pretty much on track and seems to be improving. Some backsliding occurs but the fact that I was able to go to a dog show this past weekend and compete and not have any major repercussions is good (altho I didn't walk 'properly' when in the ring since I wanted not to have to think about that while handling my dog).

Even better is that I was on it all day Tuesday when my friend came out to work ducks and it got tired but never sore. It didn't even flare up or stiffen up that evening after I sat down for the day. So that is a huge sign of improvement.

But then on Wednesday it was more swollen than it had ever been (and still is pretty puffy even now). And this morning it is kinda ouchy and stiff. Not like it has been but I sure can't do my PT exercises right now.

I guess I'm hesitant to say that I feel I'm ready to be discharged. I just kinda feel like I'm being tossed out to sea with a very small life preserver and will have to sink or swim on my own.

I will continue with my exercises here at home and finish up my scheduled PT. Hopefully the orthotics and time will fix my other issues. And keep an open mind until I see the doctor in two and a half weeks. A lot can change in that time. I'm hoping so anyway.

Roller Coaster Emotions

Okay, so I know my foot is making progress.

But I am still having problems that prevent me from moving forward at the speed I think I should be. I know that I need to adjust my mental expectations and when I do, it lasts for a day or two, or until my foot/toe hurts so much that I can't do my exercises.

And then I get depressed again.

Really. This is driving me crazy.

I'm sitting here crying while typing this.

The strapping that the doctor put on my foot last Thursday helped with the pain. But it came off on Monday. So the physical therapist taped it for me but it just didn't work like the doctor's taping. I wasn't experiencing the pain in the ball of the toe but it was cutting into the foot at two places which made it uncomfortable/painful. The toe also hurt a lot. So I took it off last night, taking some skin along with it. That's some strong tape! My toe is hurting again -- still. It was hurting even when it was taped yesterday. Sigh.

I can logically see that the foot is making progress even if it's not at the rate I want. I can deal with that. Yes, I get impatient when I take two steps forward and then the foot rebels and slides back a step or more. But I need to focus on what I CAN do now that I couldn't do a month ago.

I can get my foot in a shoe. I can walk without crutches. Some days I can walk without a hobble to my step (other days not so much). I have complete range of flexibility equal to my other foot, non-weight-bearing. I can curl my toes and pick up a towel with them. I can do modified heel raises, squats, and stand on one foot -- all weight-bearing! I can kinda run (which is all I need for the dog trials I'm going to be competing in this weekend).

But there is a lot that I can't do yet.

I won't list them as I don't want to dwell on them, but walking without pain is #1 on that list.

I know that it's going to take time and perseverance.

I have to stay focused on the prize, even if it's not easily attainable.

I have to work thru the down and painful times to get where I want to be on the other side of the pain.

But I'm TIRED of pain. It really wears on one, both physically and mentally.

PT Continues

So the doctor wasn't pleased that I was still unable to walk on the bones of the foot.

She was pleased with the incisions and the progress of the tendon. But then, I'm satisfied with the tendon's progress.

Yes, I tend to over-do it when doing my exercises. I had a good talk with Don at therapy on Wednesday while doing the assessment. It turns out that my understanding of what a 'stretch' on the tendon was actually an over-stretching of the tendon. In other words, I'm causing the tightening and the pain and swelling in the tendon by putting too much of a pull during my stretching exercises.

For me, stretch means that I should feel a pull in the tendon, kinda like when you do a good stretch after sitting too long -- a tingly, good feeling. But for rehab purposes I shouldn't be getting it to the tingly pull as that is, according to Don, actually minutely tearing the strands of the tendon. Normally that would be okay as a healthy tendon will repair those tears and become stronger. But at this point, any tearing or stressing the tendon to that point is detrimental. The tendon tries to protect itself from further injury (i.e. the surgery) by 'freezing up' and preventing movement.

And since I have such a high threshold for pain, I don't realize that I am putting that much stress on the tendon. I've been stretching until I feel 'a stretch'. Apparently that is more than the tendon can take even tho I'm not feeling PAIN.

Until later when it freezes up and I can't move.

So lesson learned. Hopefully, I'll make more progress on the ankle from here on out.

They also added some new exercises. So far the only weight-bearing exercises have been walking and the slant board stretching. All the other strengthening exercises have been non-weight-bearing flexibility and resistance exercises. So now I am doing squats, balancing on one foot, and heel raises while standing. Cool. The ankle will strengthen with those as long as I'm careful. I've been adding those randomly for the past week or so and so am not throwing something real hard into the mix all of a sudden.

But my exercise time has now doubled. It seems that all I do is work and do exercises and PT. Three times a day for about a half hour each time seems to take a lot out of your day.

But the toe joint and foot is still an issue. The doctor watched me walk, or at least attempt to, and decided that she needed to adjust the alignment of the toe and joint. Right now the fused joint is hitting before the toe and they should be hitting at the same time.

So she did a 'strapping' of the foot, which is just a tape job, and moved the toe down just a bit. Voilà! the foot feels much better. She said that we will try the strapping for a bit and see if it helps, and if it does then will get an orthotic to position the toe and joint.

The big toe is also rolling inward, kinda like it would if I had a bunion on the joint. But that's not the case, somehow the toe is shifting. I am using a toe-spacer right now but don't know if that is the long-term solution. The doctor made noises about going back in and doing some realigning. Gotta say this -- she is dreaming. I'm not doing another surgery on this foot, especially 'realigning', as that means bone work and crutches and Mike doing chores again. Ain't gonna happen.

I go back in two weeks to assess the strapping work and probably get fitted for an orthotic. I'm hoping that fixes the pain issue. I'm continuing PT for another four weeks. I'm hoping when I see her again on the 23rd that there is a lot of progress to report.

But at least I'm not sighing and sniffling today!

12 Weeks

So yesterday was 12-weeks post-op. This is when my surgeon said that she expected me to be back to normal.

Guess she expected wrong.

While the swelling is 96% gone (really only swells if I do too much) and the incisions are healed nicely, the foot itself is still painful to walk on and I am still not able to stride normally. The tendon is good some days and not so good other days, again depending on how much and what I do that day.

Flexibility comes and goes in the tendon. I have more range of motion if I'm easy on it and do gentle stretching exercises. But as soon as I go to full weight-bearing stretches, it gets tender, sore, stiff, and I am unable to do the stretches. Hm-m-m. Kinda like what happened with the previous (three) surgeries.

Time will get the tendon back to being pain-free but the physical therapists tend to be aggressive with their treatment protocol and the darn thing has to fall apart and get real inflamed before they back off and go a bit easier.

But the foot is what has me really depressed. Now I've never had broken bones so I thought that as soon as it was fully healed and the cast came off that I'd be painless. Wrong. Or maybe it's just me. But the the foot, which includes all the toe bones and the joint that was fused, are still extremely painful when I try to bear weight on them. And walking normally? OUCH! Again, not just the fused joint which is causing my big toe to have to learn to bend differently, but all the toe bones hurt.

I'm assuming it's because everything has been rearranged in there and has to learn to work in its new place, but pu-leeze, it should be done by now! I've been weight-bearing for 4 weeks now and there is little difference in the pain level over those 4 weeks.

And the level of pain in the fused toe joint is no different than before when it was frozen with arthritis and couldn't move. I feel like I'm no better off having the joint cleaned and fused than I was with the arthritis.

Other than being way poorer due to paying the surgery bills.

I am diligent about doing my exercises here at home, even to the point of crying after doing them because of the pain. I do stop when I experience pain as the therapists say that "pain is no gain". They don't want you injuring the injury, only stretching and strengthening it, so to do only what is painless. Problem is that doing the exercises generally doesn't cause pain, but as the leg rests afterwards, the pain starts and increases, then I can't do the second or third series of exercises that day. It's a vicious cycle.

I am not sure that the joint-fusing, foot rebuilding part of the surgery (which was done to prevent the tendon from re-rupturing again) was the right thing to do. I feel I'm no better off now than I was before the surgery.

I am be 'assessed' at PT today and have a doctor's appointment tomorrow. She was planning to discharge me from PT and from seeing her post-operatively, but not with the pain I'm still experiencing. We'll see what the doctor says tomorrow.

Sigh. Sniffle. Sigh.