3 Months Post Surgery

No news is always good news.  I haven't posted here, because my recovery has gone very well, and I am happy with the results of my surgery.  Goes to show that those most motivated to write about their stories online are those who have not had good results.

By 2 months post surgery, I was walking long distances.  Barely any pain and swelling in my 1st MTP joints.  Now at 3 months, I hardly think about my feet anymore.  I am happy that I moved forward with my surgery.

In the larger studies I have read, most patients who are good candidates for a cheilectomy have positive results.  Good candidate = still have a decent amount of cartilage in the joint.  This is a well studied surgical procedure with a proven track record.  If you are a good candidate for the procedure and suffering from a fair amount of pain, I think that this surgery is a no-brainer.  Just make sure to vet and chose and a good surgeon.

On the question of doing a bilateral surgery:  I am also happy that I did both feet and got it all over with at once.  My doc said that he would make a rare exception for me, since my case was very clear-cut and I was obviously a good candidate for the procedure.  If there are any doubts about whether or not this is a good procedure for you, probably best to do one foot first and let several months pass before you decide to move forward with the other.

Conclusion:  Cheilectomy of MTP joints worked great for me.

My final words are very specific to my case and thus probably not relevant to most who would come across this blog.  I had debridement done on the IP (interphalangeal) joints of my big toes as well (where I actually had the greatest amount of pain).  According to my surgeon, this is much rarer, and I could not find any academic research on this procedure.  Often when this joint presents problems, the bones are simply fused.  These joints have been more problematic and slower to recover, quicker to swell up post surgery.  They also lost quite a bit of mobility post surgery.  Still, the pain and swelling in these joints is slowly disappearing, and I hope that in a few more months, I will no longer notice them, as I no longer notice the MTP joints where I had the cheilectomy.

Good luck to all those with upcoming surgeries!  Michael

Days 11-13: Dwindling Patience with Pain

I've concluded that I practically have had a unilateral cheilectomy.  So few problems in my R foot, but my L foot, which received greater surgical intervention, is the source of a lot of pain.

Once the bandages are removed (in my case, at 10 days), it allows your feet much great flexibility and range of motion, and thus more potential for moving the joints in ways that cause pain.  At day 10, my doc sent me home with wrapped in only Ace bandages, and said that it was OK to not wear them around the house; not wearing the Ace bandage would encourage the joints to start moving again.  Still have to keep the feet dry until stitches are removed at 3 weeks.

Bathing without bandages:  I have figured out a way to clean my feet and other toes (I seriously cannot go 3 weeks without washing my feet!) without getting water on the wound.  While sitting in a dry tub, I carefully wash with soap and rinse using a cup, without the soap or water getting into the wounds.

Days 11-12:  I started to get bold, trying to live more normally.  Running around car shopping, going to picnics, walking a fair distance, standing in the garden for an hour watering plants.  Still putting a lot of weight on my heels and the outside of my L foot to avoid putting pressure on the big toe joints, which makes the entire foot hurt.  By the end of day 12, my L foot was in serious pain, the wounds so swollen that little drops of fluid were escaping through the stitches.  I had to take another painkiller to get to sleep and my left foot still hurt in the morning.  Today, Day 13, I stayed in all day and gave the foot some rest. Pretty discouraged that I'm still somewhat housebound, but I also know that I have to be patient and give it some time.

Day10: Pics & Doc Visit

Doctor visit today. Stitches won't come out till 3 weeks after surgery, so I have a while to go till I'm out of the "cast covers" for bathing.

Driving again:  Drove for the first time today. No problem at all to drive an automatic since my right foot is in much better shape.

Exercises:  Doc said to start exercises today; simply bending joints up and and down with a finger (pulling toe toward me and away from me). Five minutes every hour. Is there a degree I should aim to achieve?  "As far as possible."

Pain:  Left foot in considerable pain if I try to move joints. This will not be an issue for most people reading this (who most likely are just getting the standard cheilectomy of MPT joint), but what is especially painful for me is the interphalangeal (IP) joint of left foot (which also underwent debridement in my case). I'm generally optimistic, but a little worried about this joint since I have read that it is more difficult to fix with surgery than the MPT joint.

In the pic below, you see two different surgical wounds on each foot.  The lower incisions are for the "cheilectomy" on the MTP joints.  The upper incisions are for arthritis in the interphalangeal (IP) joint (which is probably irrelevant to most readers here).

One Week Post Cheilectomy Surgery

"Daddy, you're walking a little faster every day," my 5-year-old observed this morning.

Exactly seven days ago, I was under the scalpel.  The gradual improvements are noticeable.  The same day of the surgery, I was scooting around the floor on my butt.  By the next day, I could take tiny paces on my heels.  Now, I'm no longer just walking on my heels, but putting a little weight on the metatarsal heads.  The change is pretty unconscious; I just walk as my feet allow me to without feeling pain.

Big difference between my two feet.  My left foot was more adversely affected by the arthritis and bone spurring than my right, and required more surgical intervention (removing loose bone fragments, drilling into the bone).  Now when I walk, I can already slightly bend the MTP joint on my right foot without pain.  On the left foot, by contrast, I'm still mostly avoiding placing pressure on the metatarsal heads (balls of the foot), walking more on the outside of the foot.

The difference between my two feet tells me this:  Every case is different.  If somebody else's anecdotal story boasts of an easy surgery and quick recovery, her case was not as severe as yours.

The good thing about my right foot being in better shape is that I feel that I COULD NOW DRIVE if I had to!  Still haven't tried, but I think it would be no problem.  This is a good feeling, because for me, mobility = liberation.  Although, once I'm driving, it also means the end of my reading "vacation."

Days 5 & 6: Out of Bed

A little better each day.  Now sitting at a desk for most of the day; don't feel the need to have my feet perpetually elevated.  Still slow shuffling around, but no longer feeling exhausted after minimal exertion.  Will visit the orthopedic surgeon on Day 10; I'm guessing/hoping that is when the stitches come out and I can start driving again.

Day 4: Bilateral vs. Unilateral Cheilectomy?

Little change since yesterday.  Still mostly in bed.  When I do get up, still shuffling around on heels, which is slow and tiresome.  After about 15-20 minutes of feet not being elevated, the pain and swelling increases.

Went out to dinner with family to get out of the house.  Exhausted by the time we returned.  My body is telling me that it needs rest, and for the most part I'm listening.

Beginning to see the advantages of operating on one foot at a time (I opted for bilateral surgery).  If I had done only one foot, it would be much easier to get around, making the non-surgery foot bear the weight and do the work.  I imagine that I would be driving already.  Having done both feet, the recovery is going to be much slower.  Maybe in a year, when I hope that this is all behind me, I will be glad that I did it all at once and don't have to go through it again.  Right now, I wish I had at least one good foot.

Preparing for your cheilectomy surgery

If you don't want to send your loved ones on multiple trips to the pharmacy post surgery, here is a list of things to have ready pre-surgery:

• Pillows or devices to prop legs (practice in advance).
• "Cast covers" that envelop and seal your foot/feet for bathing.**
• Shower chair for bathing (optional; I just took baths).
• Crutches or walker (optional; will help in first week).
• Ice packs that wrap around with velcro.
• Aspirin (take daily post surgery to avoid blood clots).
• Stool softeners and/or laxatives (painkillers cause constipation).
• Laptop and e-reader/books (you'll spend a lot of time in bed).

**  The "adult" cast covers come up over the knee and the rubber only seals at your thigh (they will not seal around calfs, which are too narrow).  I would check out "child" covers; I guess that they would fit better for just covering the feet.

Also, check out this great list of ways to prepare psychologically and emotionally for the surgery.

Have I forgot anything?  Please add to the comments.

Day 3: Stopped Painkillers & Doc Visit

Last night, the second night post-surgery, I slept through the night, awaking briefly with an alarm at 1AM to take a Percoset.  When I awoke in the morning, I was a few hours past the scheduled painkiller, but I didn't feel much pain.  Decided it was time to stop the painkillers.  In all, I only used the Percoset for about 40 hours post surgery.

Able to hobble around the house today walking on my heels.  Also made it into the doc's office with short steps so as not to put weight on the toes. Used a walker in the doc's office to get down the hall; much easier to walk when you can lean your weight on the walker.  Spouse teased me that I look like a 70 year-old using a walker ("all you need are tennis balls on the back legs"). Pain is gone except if I put pressure on or try to move my big toes.

Took a much-needed bath, using waterproof covers that wrap around your legs to keep the water out of the wound.

Doc removed my bandages and put on fresh ones; swelling not nearly as bad as I had imagined (see pic of incisions and stitches below).  He advised that I rest and not try to do much for the first two weeks; most people who have problems are trying to do too much too early.  He also said that I'll have to be patient with recovery; it took another patient who had a similar degree of arthritis a full year before he felt no pain and completely recovered.

Pic: Incisions two days after surgery

Incisions and stitches:  Two days after surgery. Bottom line of stitches is for MTP joint (standard cheilectomy), while top line of stitches was for debridement of interphalangeal joint (unique to my case).

Day 2

Spent the entire day in bed with feet elevated, taking my Oxycodone faithfully every 4 hours.  After 3 hours, I start to feel some pain and throbbing, and I fear that if I do not take another pill the pain will be unbearable.  I have not dared to remove the bandage to peak underneath, but it feels like I still have a lot of swelling.  It has been almost 36 hours since the surgery; I have been great at keeping the feet elevated, but I have not been good at icing.  I tried a little yesterday when I came home from surgery, but I felt like it was useless since I could not feel any cold through the bandages.

Having a bilateral surgery, I can definitely understand why different people report such disparate results.  On this wonderful blog, several people trace their progress in the "comments" section, and some of them speak as if the surgery was no big deal.  If I were writing only about my right foot, that might be the case for me.  But my left foot seems to be in greater pain.  If I try to move my right toe just a little, I feel stiffness; if I try to move my left toe, I feel burning pain in both the interphalangeal and metatarsophalangeal joints (see my first post for explanation of why doc worked on both joints).  I don't know if or when I should even be trying to move the toes.  All of the questions I forgot to ask.

Appointment with doc tomorrow.  I hope to get more answers about what exactly he saw and did in the joints, as well as what I am supposed to be doing now for recovery (moving the joints, PT?).

Pics of wrapped feet post surgery

24 Hours After Surgery

Taking painkillers faithfully:  They gave me Percocet (Oxycodone with Tylenol).  The hospital nurse recommended that I take them consistently every 4 hours, because once pain sets in, it is hard to shirk it.  Even my spouse, an anti-narcotics-unless-absolutely-necessary ER physician, agreed (a few days ago, he joked that he was cutting off my narcotics after 24 hours).  So I set my iPhone alarm to go off every four hours. 

Around 3 hours after taking the meds, I feel a little pain and I know that the time for another pill is approaching.  The first time I tried walking to the bathroom, I was almost due for another painkiller, and just lowering my legs off the bed was painful as the blood rushed down.  Remember that I had both feet done, so I had to scoot on my bum to the bathroom.  Now I'm timing my bathroom breaks for AFTER I take my meds, and I am able to walk on my heels.

Also taking a stool softener, since painkillers cause constipation (something nobody told me at the hospital), and aspirin on the advice of my doctor to avoid blood clotting from lying around all day.

"What have I done to myself?"  Lingering doubts as I lie in bed all day with my feet propped up.  I tell myself that fear and doubt are probably normal after any surgery.  I read online horror stories of people whose surgeries did not succeed (I know, I should be reading a good novel instead).  People with bad experiences are probably more motivated to write.  I add my anecdotal story to this mix, hopeful that it will ultimately counterbalance all of the bad stories.

Post-Surgery, the Surgeon Says

My surgeon told me that the arthritis in the left toe was considerable, which I inferred to mean that it was worse than he expected.  He also said that they found loose fragments of bone, and that I should anticipate swelling and discomfort for up to 9 months.  Although this recovery period confirms much of what I have read online, this alarms me since the surgeon originally portrayed my case as simple and straightforward.

The surgeon also said that he drilled holes in the bone, which I understand helps encourage the growth of cartilage.

Background on My Case

About my surgeon:  My surgery was performed by an orthopedic surgeon (M.D.) that specializes in foot and ankle surgery.  I also consulted a couple of podiatrists (DPMs), but I felt more comfortable going with the M.D.  The surgeon and one of the podiatrists recommended a cheilectomy on both big toes (the surgeon uses the term "debridement" instead of cheilectomy).  Both said I was good candidate for this procedure since my Xrays seemed to show a good deal of cartilage remaining in the joint.  Both doctors communicated optimism, saying that studies show very high success rates with this procedure.  They both had a very similar claim:  Once we perform this procedure, we don't see the patients again; they don't come back needing followup.  The surgeon said that the studies extend to 15 years post-operation, and that the vast majority of patients have no recurrence of bone spurring. 

Unique in my case:  My case is a little different than your standard cheilectomy, because I have bone spurring and joint deterioration not only in the common place--the first MTP joint--but also in the interphalangeal joint in the big toe itself.  The pain in this joint was often worse than the pain in the MTP joint.   Since bone spurring and pain are less common in the interphalangeal joints, all of the podiatrists I consulted seemed to ignore my symptoms there and focused on what they commonly see: problems with the MTP joints.  The orthopedic surgeon or M.D. that ultimately performed my surgery listened to this complaint, and noticed the phalangeal spurring on the Xrays.  Hence, the surgeon performed debridement in both joints on both sides.

Why bilateral?  My surgeon originally recommended doing one foot at a time, as is common practice.  I asked if doing both feet at once was possible, in order to not have to go through this ordeal twice.  He said that he would not do this for most patients, preferring that they have the full experience and recovery from the surgery on one foot before committing to both.  However, since I was a good candidate for this and my case was straightforward, he agreed to do both.