Tuesday, April 4, 2017

#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.

My toes still turned blue, and my foot throbbed tightly inside the cast by the end of the day. This went away when I exercised my leg, although sometimes it took over five minutes of exercise.

My skin continued to feel painful around my big toe at the incision, so I tried to keep this moisturized with aloe. The top of my foot was also sore. This pain felt like it was from the cast gauze rubbing against the incisions (just like with the first cast). I really felt like my foot needed to be out of the cast, so I could clean, moisturize, and care for it.

I experienced mild pain in my toes and the arch of my foot after I exercised my toes.

Exercise and activity

By the time I went in for my six-week checkup, I could bend all of my toes back and forth somewhat without using my fingers. I probably would have been able to bend them farther, if the cast had not been pressing against the base of my big toe where the bunion had been. The only area of my toes I could not bend was the tip of my big toe. I could not bend the tip at the first knuckle, like I could on my other foot, or my other toes, even when I used my fingers.

I frequently got dizzy when I did yoga this week. An online search indicated this can be caused from pressure against a nerve - another problem with the cast! I did not get dizzy when I did yoga the morning after having the cast removed, so I am certain the cast was the cause of the problem.

I continued with the leg exercises, although I was not as diligent about doing them by the end of this week; sometimes I only did them four or five times a day instead of every hour. I began some air bicycling along with the leg lifts, because I wanted to make sure I was strong enough to ride my bike as soon as I was able to get my feet on the pedals.

I did more work around the house, which took much longer than usual. Vacuuming on one leg is a trick! I hand washed the floors for the first time since surgery. Swiffer cleaning the floors was not cutting it after five weeks. Hand washing the floors took almost the entire week (one room a day), and this is something that normally would have taken me about an hour. I also went up and down the stairs several times on my own to do laundry and other things. My husband carried the laundry up when he got home, although I did the rest. We have a clothes chute, so getting the laundry into the laundry room was not a problem.

Visits to the grocery store became easier. I even stood on one leg from the store scooter to reach items on the shelves when I needed to. The week before, I had kept my leg elevated on the scooter basket the entire trip, because my foot was throbbing more that week.

Six-week checkup and walking boot

The dry skin and scaliness on my foot was much worse than it had been a week earlier when my cast was removed. I had brought an exfoliating brush and lotion with me to the doctor's office, so I took care of some of this around my ankle while I waited for the doctor to come in. When he came in, he removed the steri-strips from my incisions. One spot on the top of my foot where the bunion had been was not healed, so he put Neosporin and a bandaid on the spot. I am sure this was a result of it rubbing against the cast when I did toe exercises. I was surprised no one ever washed my incisions when my cast was off.

Walking boot

The doctor said my X-rays looked fine, and I could get a walking boot. He told me to wear the boot anytime I put weight on my foot. He said I would be gradually resuming activities, and that I could use my foot as much as I could tolerate. He left the room, and someone else brought my boot in.

Walking boot

Even though the doctor had mentioned that I could use my foot as much as I could tolerate, I was totally unprepared for the excruciating pain I felt when I stood up. Unfortunately for me, the person assisting me when I stood up was the rude, uncaring assistant I had met right after surgery (she even fastened the boot strap unevenly, which is visible in the photos). As I gingerly put weight on my foot (after feeling the pain when I had started to stand up as usual), I asked her if this was normal. Instead of giving me the facts, she merely shrugged and said everyone is different. When I pressed her for more information, she told me most people in my situation just walk right out. What - really?! I am by no means a wimp, so I found this difficult to believe. Rather than question her further, I researched recovery and pain expectations online when I got home. What the rude gal told me in the office was not correct. All of the medical information I found online, said something similar to: Expect some pain after a cast is removed. Your muscles often become smaller and weaker from lack of use, and can feel tight or sore. Joints can stiffen from inactivity and be painful to move. Skin often becomes dry and scaly, and may have patches of redness where it rubbed against the cast. Gradually increase activity to strengthen the limb to prevent overuse injuries, soreness and pain. Additionally, I read comments from people who were in so much pain trying to walk after the cast was removed, they were almost in tears, and did not want to do anything. My ankle was very painful, as was the entire bottom of my foot. I imagine the ankle soreness was from the cast, and I am not sure if the bottom of my foot was painful from the cast, the surgery, or both.

I am finishing up this post less than 24-hours after I received the walking boot. So far, I have been walking around carefully, using one of the crutches like a cane. I have been up and down the stairs a few times already, and I did yoga this morning. To say that doing yoga was painful would be putting it mildly. On the other hand, the yoga stretches also made my body feel good, and I plan to try more stretches this afternoon.

I now have an entire month before my next checkup, which will be 2½ months post-op. I will share my experiences after one week with the walking boot in my next post:

First week with walking boot

Let me know if you have any questions!