#14 ~ 6 Month Update

August 2017

It has been a bit over 6 months since I had bunion surgery, and I am sharing a quick update about my progress, and my decision to have my other foot done.

Current [6-month post-op] condition

My foot and toe have healed for the most part, although there are a few lingering things that have not totally healed yet.  

Ankle still a bit swollen 6 months post-op

Swelling and pain

The top of my foot and my ankle are still a bit swollen. I can tell this is the case every time I remove a shoe that has covered the top of my foot, and my ankle gets quite sore when I walk. I have been doing a lot of walking, hiking, bicycling, and yoga, so I have resumed all my usual activities. I tried to get a photo with both my ankles together so you could see the size difference; however, those pictures did not turn out well. From the research I did online, it does not sound like my experience is unusual. 

Shoes that give me toe pain

I am not able to wear shoes with much of a heel for very long. I have a pair of soft Skecher sandals with a 2" heel (or less), which I have been wearing around the house and yard for short periods to try and get my toe used to flexing in different directions. I frequently feel pain in my big toe when I step down in these shoes. It is tolerable pain, although it does make me gasp sometimes. This also happens with flat shoes occasionally. It seems like I have needed to wear excellent support shoes since having the surgery. I have one pair of flat sandals that I can no longer wear because my toe hurts when I walk in them. I guess they have low quality support. And, they are kind of old, as well.

#13 ~ 14 to 16 weeks (3½ to 4 Months) Post-Op

Before I had this surgery, I had planned to have both my feet done. Now, I am starting to have second thoughts because my foot does not seem quite right. This could just be because I have had time to scrutinize my feet and progress, or because I have not had very good communication from my doctor. Whatever the reason, I have decided I am not pursuing my second foot until I am sure my current foot is back to normal.

Pain and swelling

My ankle and foot are both still swollen, although the swelling around my foot has gone down a little bit. I still wear my tennis shoes most of the time, and I have worn a few pair of sandals and slip-on shoes for short periods. I wore a pair of sandals that covered the top of my foot one time, and I felt like I had to peal the sandal off a few hours later. It was not difficult getting that sandal on, nor was it painful walking in it; just difficult removing it. I measured my feet and ankles a few weeks ago, and when I measured them again this week, my foot was about ¼" smaller than it had been then.

The pain I was experiencing at 14 weeks was minimal, and I think a lot of it was caused by the swelling. Sometimes when I walked, I had ankle pain and pain in the arch of my foot. The pain was not severe; however, it was painful enough that I often felt like I was tensed up and not relaxed as I walked. This was worse at the end of the day. My toe is usually only painful when I am exercising it (or, driving my husband's 6-speed stick shift truck!).

At 16 weeks, my foot and ankle are still mildly swollen. I am not experiencing any pain, although my big toe does not touch the ground like it should, and I can still feel discomfort in my toe, and arch of my foot.

Photo taken at 13 weeks; click on it to enlarge

Scarring

I have two unsightly scars (I have four total) that I am not happy with. One is the spot at the end of the top incision that had not been healed when the cast was removed, and the second is the long scar extending up from my toe, which had rubbed against the cast when I exercised. I think both of these scars would be less, if my doctor had cared for them differently. For example, when I look at the photo I took for post #8, I can clearly see that both of these areas were thicker red with blood than the long scar on the top of my foot, which is only minimally visible. Again, I wondered why no one ever washed and changed the dressing when they checked my foot. This does not seem normal to me, and I would love to know what other patients have to say about their experience. Seems like if the blood had been cleaned out and new strips placed on the incisions, then these unsightly scars would look like the one on the top of my foot. It also seems like the toe exercises I did while wearing the cast aggravated the scars. Again, I wondered why my doctor had put a cast on my foot when I read about other patients who did not wear a cast. I thought I did a lot of research before this surgery, and now I have even more questions before I consider my other foot.

Range of motion

The range of motion on the surgical side of my body is not what it used to be. I have included a few photos that show the difference between my two sides. I have been doing my own therapy and exercises because my doctor did not provide any specific exercises or instructions. Details of the exercises I have been doing can be found under that heading.

Milestones

This summary post will be ongoing and updated until my foot and toe are fully healed. Please let me know if you are interested in something specific that I have not listed here.

• Stopped taking Norco pain medication: less than 36 hours after I returned home after surgery.
• First checkup: 3 days after surgery (I had taken my last Norco pill overnight before this visit).
• Light housework: within the first week.
• Increased housework: week 3, and more during week 6. Pretty much all resumed during week 8.
• Sleeping usual amount: week 3 (I slept a lot the first week, and a bit more than usual the second week).
• Schooching up and down [carpeted] basement stairs: once within the first week when my husband was home with me, and again the second week. During week 3, I did this more frequently. During week 6, I did this as often as I wanted and when home alone (I just had to slide the crutches up and down with me).
• Made homemade bread: week 2.

#12 ~ Another Checkup, 10+ Weeks Post-Op

May 2017

Checkup and removal of surgical shoe

After my visit to the doctor a week ago, he said I could start wearing my shoes. My ankle and the top of my foot are both still swollen, so I have mostly been wearing tennis shoes with the laces loosened all of the way. I asked him if it mattered what type of shoes I wore, and whether I went barefoot, and he said no. He basically just told me to do whatever I could tolerate with the pain. I had planned to specifically ask him if he had information about specific exercises, and I forgot.

I was surprised to learn that both screws that are in my foot are in the same area where I have been experiencing the pain, redness, and swelling on the top of my foot. I had thought one of them was in my toe. Sometimes, the irritation on the top of my foot is so bothersome I need to gently massage the top and sides of my foot to make it feel better. The redness and swelling is not constant, and the area was not irritated at the time of my checkup. After learning that is where both screws are located, I realized I am probably having a mild reaction to the metal in my foot. I asked my doctor about removing the screws (remember, he had said this is not a big deal), and he told me this is not necessary. I have another appointment in a few weeks, so I am planning to get a couple of photos of my foot when this area is irritated, and talk with him more about having the screws removed during that visit. Photos in this blog can be enlarged by clicking on them.

Scars and swelling 11 weeks post-op;
mild irritation in circle where screws are located

Pain and swelling

Before I went in for my checkup, the pain and tingling in my foot and toes was gone for the most part. After exercise, I sometimes felt tingling along the top of my foot from my toes to my ankle; however, I no longer experienced this from temperature changes. Sometimes my muscles felt like I had a charley horse (muscle spasm). I felt pain in my toes after a lot of bending, and the incisions were still tender.

#11 ~ After Two Weeks with Walking Shoe / Eight+ Weeks After Surgery

April 2017

Yay! My pain and condition has improved considerably two weeks after walking with the surgical shoe. I still have a long ways to go; however, the healing process feels like it is improving tremendously. I was even able to grasp my foot this week to trim my toenails and scruff off some of the dead skin. I had used a dry brush to get rid of the skin on the outside edges of my foot after the cast was removed; however, I had not used a dry brush or exfoliator near the inside edge of my foot until this week. You can see in the photo below that my foot still needs some TLC. Since touching my foot is becoming less painful, I should be able to get it back into shape before summer sandal weather! 😊

Pain and swelling

I am not feeling hardly any pain along the underside of my foot like I did when I first started walking. I still feel some pain; however, it is not excruciating, and I am no longer using the cane. Most of the pain happens when I first stand up, or if I put too much pressure on the bottom of my foot.

The incisions are still tender, and the top of my foot closest to the ankle is extremely sore and tender. I have begun to wonder where the second screw in my foot is located, and whether this area being so sore has anything to do with that. The sore spot is where I placed the circle in the photograph below. The top of my foot is swollen, although not as much as it had been a week ago. I am continuing to use Aquaphor on the incisions. There are four incisions on my foot: two straight line ones on top, one around the inside of my big toe, and a small curved one along the side next to where the bunion had been located. The incision that had not been closed all of the way when my cast was removed (top of my foot closest to the big toe) looks nasty and jagged rough compared to the scar farther up on top of my foot. This is the area that was aggravated by the cast when I exercised my toes, and I hope I did not damage the scar tissue so that it heals less smooth. My husband seems to think it looks worse because it is not as far along in the healing process as the other longer incision.

8 weeks post-op

The swelling in my ankle has gone down in the last week, although you can tell by the photo that it is still swollen. I am continuing to elevate it, and I put ice on it several times a day. The ankle pain I am experiencing feels like the kind of pain one would have after twisting or spraining the ankle. I am no longer experiencing pain rising up my leg from my ankle.

#10 ~ First Week with Walking Boot

April 2017

I had heard that bunion surgery is painful, and before this week I felt like comments I had read were overstated. I had quit taking my meds within four days of surgery, and I did not experience a lot of pain immediately following surgery. Yes, I had swelling and discomfort; however, I did not have extreme pain. I did not realize the more intense pain would be during the recovery when I started walking again; not the surgery itself. 

Activity and exercise

My doctor had not given me very detailed instructions about what activities I should be resuming, and he had not really discussed any exercises to assist with the healing. He basically told me to wear the walking boot when I was putting weight on my foot, to walk/do what I could tolerate, and continue bending my toes. I mentioned in my last post how severe the pain was when I tried to stand up, and this did not lessen any in the first week.

Although walking was painful, it was easier to do things around the house. I went up and down the stairs (walking, rather than schooching), vacuumed, washed the floors, prepared meals, etc; pretty much all of the typical household chores. I did yoga, toe bends, and ankle stretches daily. I always felt better after gently stretching my body. 

#9 ~ Week Six Checkup and Walking Boot!

April 2017

Cast comfort

I am providing a brief recap of the cast comfort first, as I think some of the pain I experienced this week was a result of the way the cast fit. The cast was tight around my ankle and front of my leg (just like the first one had been), and around my entire foot just above the toes. By the time I returned for my checkup, I had cut off a couple of layers of cast wrapping, and I had made a couple of cuts in the material above my toes. The wrapping ended at the top, so removing a bit of material relieved that area; however, it did not do anything for the area above my toes where the wrapping started.

The shorter cast had a few good points: less weight, and because it ended just above my ankle, I did not need to worry about where it hit the pad on the walker. It hung off the end of the walker, whereas the taller cast had rested partially on the pad. If the cast had not been so tight, it probably would have been quite tolerable.

Pain, tingling, blue toes

The tingling in my first two toes started to decrease after five weeks post-op. I could gently squeeze, massage, and bend the ends of these toes with my fingers. Before this, I had not been able to even clasp my toes between my fingers because the tingling pain had been so severe. I had frequent tingling from my big toe and up the top of my foot that was quite bothersome. I think my cast being tight aggravated this, since my toe knuckle rubbed tightly against the cast when I bent my toes forward. I also experienced mild pressure on other areas of my foot from the cast when I exercised or moved. This felt similar to the way your body feels when it starts to "fall asleep" from pressure on a nerve. Areas that was especially bothersome were the ball of my foot below my big toe, and the top of my foot.

Six Weeks Post-Op: Recap of Things I have Learned [so far] and Suggestions for Next Time

April 2017

Before surgery

• I stocked the freezer with over 10 meals, and I wish I had prepared more.
• Remember to stock the pantry, too. I had our cupboards well-stocked; however, there were a few things I did not think about. We eat mostly fresh fruits and vegetables, and we do not consume many potatoes or convenience foods. Since my husband is not going to take the time to cook like I do after working all day, I should have picked up a few convenience-type pantry products that I do not always keep on hand: canned vegetables, instant whole-grain rice and quinoa sides, and more soups for his lunches.
• Spring clean, if you can! I cleaned the entire house beforehand, yet there were still a few things I did not think about since they are not daily or even weekly tasks. If you are particular about keeping a clean house, these little things will drive you nuts six weeks later, when you are not able to reach them.
• Exercise to strengthen your toes, ankles, legs, and balance. You will be surprised how much you will need to accomplish on one leg. You will need a good amount of strength and balance in your useable leg to perform even simple tasks, like getting up from the toilet. Most handicap restrooms in public places do not have a place to rest your knee while you get your clothing back in place after standing. So, you will either be doing this with one hand, or while balancing on your good leg.

Things to clarify with your doctor

About five weeks post-op, I had questions about things I had not thought of before surgery.

#8 ~ Week Five and Extra Checkup

March 2017

Recap of my injuries [from post #7] after surgery

The first time I fell was at home about 3½ weeks after surgery: my toes hit the floor with force. The second time I fell was on concrete porch steps a few days later: the bottom of my cast thudded down on the cement. I had become quite active on one leg before my falls: vacuuming, cleaning the floors with a Swiffer mop, going up and down the stairs, showering at least twice a week with a bag over my cast, yoga, and more. Both times that I fell were a result of being careless, rather than from doing too much. Neither fall happened when I was performing any type of feat; I was standing in the living room next to the knee walker the first time, and I was going up two porch steps the second time. I had done both of these things numerous times before.

Pain

The pain and tingling in my foot was much worse after my second fall. The fall itself did not hurt as much the second time; however, the pain got worse as time went on, rather than better. In fact, a few days after this, I took a couple of Norco pills I'd had leftover after surgery, since I had not taken them all then. My foot throbbed when I first got up in the morning, and it throbbed within five minutes anytime I got up to move around. I could no longer bend my big toe without using my fingers, and I had been able to do so before my falls. 

Initially, I thought the pain and tingling was just a setback in my recovery because of the trauma to my foot. After the third day, I thought the pain felt worse than it had after surgery. It was actually difficult to judge the pain for sure, since I had been taking Norco for three days following the surgery, which dulled the pain. I called the doctor's office five days after my second fall, and they scheduled an appointment for two days later.

#7 ~ Week Four, Injuries, Second X-ray (third checkup)

March 2017

Blue-gray toe color and exercises

My fourth week started out great. I had increased my toe exercises, and I was keeping the blue-gray color in my toes under control. My toes still got discolored after I had been on my feet for over 30 minutes, and the color returned to normal after I did the leg and toe exercises. After I whacked my toes (details under next heading), my toes turned purple within 5 minutes every time I got up. The color still returned to normal after the exercises. Before my [first] injury, I had started to wash my big toe area as best I could around the stitched area with a cotton ball, and I was applying petroleum jelly or aloe to the toe. This helped with the cracked skin feeling I had when I exercised that toe (part of the reason I was afraid of scarring). I also continued yoga daily, except for two days following my toe injuries. I was afraid to do much of anything after my falls.

Injuries ~ twice this week!

I felt like I was doing very well, and then I got overconfident and careless. One morning, I misjudged the location of the knee walker, and was not able to catch my balance in time. My toes hit the floor with tremendous pressure and all of my weight before the rest of me then hit the floor. Even though I was on carpet, I should have had the walker locked, and I should have been looking down at it before attempting to drop my knee onto it. The fall was painful, however, the pain was overshadowed by the extreme fear I had about whether I had done any damage inside my foot. I stayed on the floor about 20 or 30 minutes - gingerly checking my toes and foot as best I could, and praying. I was not uncomfortable on the living room carpet, and I was not unable to get up. I was just afraid to move. The most pain I felt when it happened was in the arch of my foot, except when I tried to move my toes. My big toe was very painful when I tried to move it back and forth. I also felt mild pain in the ball of my foot (more than just the discomfort I had been feeling), and in the knuckle of my big toe. This fall/toe stubbing happened only a couple of days after my last post, when I expressed how carefully I had been taking care of my foot! I guess it was a good thing I had a cast on after all. 😓

#6 ~ Week Three After Second Checkup and Cast On

March 2017

Pain, swelling, and comfort

The minimal pain I had been experiencing did not change much. Since I could now move my toes, and the doctor had told me I should, I started toe exercises. I must have overdone it the first day, because in the late afternoon I had a lot of pain and tingling along the top of all of my toes, which also extended up the top of my foot from my big toe. The pain lasted for about an hour. I had thought about putting ice on my toes, but then the pain subsided before I did. I had a similar feeling the next day or so, although not as severe, since I cut back on the exercises a bit. After this, the only pain I felt when exercising my toes, was with my big toe. The entire end/tip of my big toe hurt when I bent it, along with the area where my big toe connects to my foot. It looked like a cut had been made almost all the way around my big toe in this area. This is visible in the last photo in this post, and in previous pictures of my foot with the bandage removed.

The cast was initially uncomfortable around the ankle area, and on the second evening with the cast I noticed a new problem. I loved that my toes were exposed so I could move them; however, I had not thought about the comfort of where my cast ended until I experienced the discomfort 24-hours later. The cast ended at the start of the ball of my foot, when it seems like it would have been more natural to extend to where my toes connect to my foot. The purple in the photo below is the cast. A full cast photo is visible in previous post #5. The cast was made by the doctor hand-rolling the cast wrapping around my foot, so it seems like it could have been made to fit my foot. You would not think having something rest on the edge of the ball of your foot would be bothersome; however, after a length of time it is! In fact, I considered going back to the doctor a couple of days later, as I was not sure I would be able to stand it for two weeks. Even though I was not standing on my foot, this end of the cast pressed against my foot at all times, even when my leg was elevated.

Underside of my cast

My ankle no longer felt swollen at the end of the third week, and this area was not bothersome. The top of my foot was uncomfortable instead. Even though there was soft gauze around my foot under the cast, the top of my foot was sore. It felt raw, as though the tender stitched area was rubbing against the rough cast. The ball of my foot where the cast hit underneath was also sore, as if this area around my foot was now swollen instead of my ankle. I did not understand why my podiatrist had chosen to fully cast my foot when I saw many more comfortable looking foot wrappings online. If you do an online search for "foot cast after bunion surgery," you will see many options. I thought the type of covering in the photo below looked the most comfortable. This would not be as protective as the cast; however, I would have preferred it. I was extremely diligent about the care I gave my foot, and about not putting any weight on it. I had not thought to research foot coverings, and I had not specifically asked my doctor about what kind of foot cast I would have before I had the surgery.

Photo from Margaret River Correspondent blog

Exercise

I continued the same yoga and leg raise routines, along with the added toe bends. I did the leg raises more frequently, and I added a few more leg exercises after my toes turned blueish gray in color (more about this under the next heading). I did about 10 minutes of leg exercises every hour or so. After my toe pain the first day, I initially cut back on the toe exercises, and then I gradually increased the amount I did. I did not stretch my big toe as much as the others; not only because it was painful, but I also wondered if the activity might increase scarring from the cut around this toe.

#5 ~ Week Two, Second Checkup, Stitches Removed, New Cast

March 2017

Pain and swelling

My foot pain was minimal the second week. Sure, I could feel discomfort on the top of my foot where the stitches were, and I am sure it would be painful, if my foot got bumped; however, I did not experience continual or severe pain. It was mildly painful when I wiggled my toes, which I had a difficult time with. Just like the first week, most of my discomfort came from the wrapping around my leg and foot. It felt like my toes were all scrunched together, especially my pinky toe. This contributed to me being unable to wiggle them much. The gauze between my big toe and first toe was extremely uncomfortable, as was the wrapping over the top of my big toe around the knuckle area. It felt like my ankle was still swollen at times, causing discomfort in this area. I could not wait for my second checkup to have the wrapping removed! The firm backing/support behind my leg was too tall for me, and I planned to ask the doctor to cut this down, if my leg was going to be wrapped the same way. I continued using an ice pack under my knee for a few days, which felt like it helped the swelling initially. It did not feel like this was helping after a few days, so I did not continue to use it regularly. Instead, I raised my leg higher or did leg exercises to help reduce the swelling and discomfort.

Activity

I continued with yoga daily, and I did the leg exercises about 5 or 6 times a day. Since I was moving around more, I did not do the leg lifts and bends as frequently as I had the first week when I was more inactive than active. I thought (or, hoped!) maybe my belly would become rock hard from the leg lifts and bends everyday. I did them for 5+ minutes each time; about 50 leg lefts and bends on each leg each time, and I did not see any evidence of this yet. I did, however, feel as though my leg strength was increasing.

We went out to dinner the second week. I am sure my husband wanted a break from all the dinner prep and cleanup! 😉 I did not have too much difficulty getting around with my crutches, and sitting in the restaurant was comfortable enough. I thought one of the most difficult actions was going up and down steps - Not the carpeted stairs to our basement that I schooched up and down, but the two cement steps from the porch in front of our house, and the restaurant steps with no railings. I had to be strong enough and stable enough to hop up and down each step, and then move the crutches. The drive/ride was just over a half hour one-way.

#4 ~ The First Week and First Checkup

February 2017

I had read about many different experiences that people had with this type of surgery, so I was not sure exactly what to expect. Some people said they had no pain, and others said they were practically bed-ridden in severe pain the first two weeks, or longer. Possibly, the different experiences may have to do with the doctors and procedure type, the severity of the person's situation, and/or the person's health. 

A brief reminder/summary of my situation: the bunion itself was not painful, although it caused other problems as my big toe pressed against my other toes; my surgery took less than 1½ hours, my bunion bone had been shaved/cut, and I had two screws in my foot; I am in my mid-50s, and I was healthy and active before surgery. Additionally, I had twisted my ankle falling on the ice a few weeks before surgery. My ankle had healed in terms of walking on it; however, it was still a bit swollen at times. My primary physician had told me this is normal, especially since I have a bit of arthritis in my joints.

Pain and swelling

The places where I felt pain from the surgery were the top of my foot closer to the ankle, and around my big toe. My greatest discomfort, however, was around my entire foot, just below the ankle and heel, where the foot connects to the leg. This area around my entire foot (not just the top part) became especially painful and throbbed when I exercised my leg. When I went for my first checkup, I found out this is because my ankle was so swollen. There is more about this under the checkup heading father down in this post.

#3 ~ The Day of Surgery

February 2017

At home in the morning

We needed to be at the surgery center at 6:30 a.m. My instructions said to wash the foot I would be having surgery on with anti-bacterial soap for 5 minutes. My body was also supposed to be free of all nail polish, jewelry, and any lotions or scents; including deodorant. I took a shower that morning, and then did not apply any lotions. I used my usual shampoo and conditioners on my hair, which did not cause any issues at the surgery center.

Since I would not be able to get jeans or similar pants over my leg after surgery, I opted to wear a calf-length sweater dress, which easily slipped over my head. And remember, I could not consume anything - not even water. I had been specifically told to spit out any toothpaste, and not to swallow any water, if I brushed my teeth. Which, of course, I did! Along with mouthwash, too...

Prep for surgery

At the surgical center, we went through the basic admitting process: insurance info, questions about my identity and what I was there for, confirmation of any allergies and medications, and so forth. I was in the operating room with my two physicians and assistants before 7:30 a.m. 

#2 ~ Preparing for Surgery

February 2017

Pre-op exams

I had an office visit with both my foot doctor and regular physician a few weeks before the scheduled surgery date to make sure I was healthy enough for surgery. I have always been a healthy person with nothing out of the ordinary, and the only experience that was new for me during my pre-op exams was that I had an EKG at my doctor's office.

My foot doctor gave me three prescriptions to fill: Norco (pain killer for after the surgery), crutches, and a knee roller. I asked him if there were any exercises I could do beforehand that would assist with the healing process, and he said no. He said that since I am quite active (yoga, walking/hiking, biking, etc.), I would already be ahead of many patients. Even so, my projected recovery time was 6 to 8 weeks non-weight bearing with 3 to 4 months total recovery time. Yikes! I guess there are two types of bunion surgery, and mine was the more severe kind, needing two physicians to perform the operation.

#1 ~ The Decision

Fall 2016

Is bunion surgery right for you? Why I decided to do it ~

My previous physician had always advised me not to have bunion surgery. She said that it is very painful, and that if I was not having problems, I should just live with it. I have always thought the bunions were unsightly, although my husband assured me they did not bother him any. So, I lived with them for several years.

A few years ago, my doctor transferred to a different area of medicine, and I had to find a new physician. The doctor I started seeing then had a different opinion. She said that if I was going to need surgery eventually, I would be better off to have it now, while I am healthy and active, because the healing process would be quicker than when I am older. I thought about this, as I discussed it with her a bit more, and then I asked her for a referral. 

My situation was that the bunions themselves were not painful; however, I did have other problems: difficulty finding shoes that fit over or around the bunions, and the bunion made my big toe crooked, pushing it into my other toes. This caused me to get blisters between and under my toes when I walked a lot.