cheilectomy-diary

 Six months is the point at which, according to the literature: you may reasonably expect to be back to 'normal' any swelling will likely have subsided you can wear 'normal' footwear  you can resume 'normal' level of activity and sports such as running. The literature also states: you may still experience limitations - especially where an osteotomy was part of the procedure swelling can continue for up to 12 months you may never be able to wear the same shoes you did before you may never be as active as you were before In my case, I know that I can't expect to resume all the 'normal' activity I enjoyed before the procedure because before the procedure was the injury and the time during which the cartilage in the joint was diminished.  Based on my particular set of circumstances, I can report my progress. First, a reminder of MY circumstances: Age 53 at time of surgery (now 54) Trauma injury which flattened the 1st MTP joint 3 years prior to surgery D...

 As each month milestone approaches, it feels like the toe is worst than the month before, but when I read back, I can see that's a fallacy. I guess, as it gets better, I just measure its progress day by day, so some days it feels worse and some days it feels better. And that's kinda the lesson learned in this post.  For example, the last couple of weeks we've had a cold snap in the UK (temperatures down to -2 in the daytime), so I've had to swap the trainers to more suitable walking boots (something I couldn't wear last month). I've been in the walking boots every day now for a couple of weeks. It feels roomier than when I tried the boots last month, so that indicates the swelling (from Covid probably) has gone down. It's more comfortable to wear the boots now, so clearly that's progress. I've been doing around five miles in them, but do find that it's a matter of one day on, one day off. So if I do a five mile walk one day, I'm not up for a...

 Gosh, four month mark already. Well, here's the update: the toe seems worse than it was at 3 months. Though in a way I think it's hard to tell whether it's just worse, or just different. The obvious clanger has been Covid-19 which I caught at the start of November and which had me off my feet (and pretty much in bed) for the best part of a week. After that it was a further week or so before I started to feel fit enough to resume the daily walks. Right away the toe was niggly. In fact, during the peak infection time with Covid and while I was laid up, I had stabbing pains in the toe joint where I had surgery. I also had similar in odd joints around the body - left shoulder, right knee, left wrist - which cleared up after a few days once I started to recover. I've read that this can be a symptom of the Omicron variant of the disease, so I'm guessing Covid is the chief suspect in all of this. Maybe also, being suddenly laid up and off my feet for almost two weeks at a...

It's been 3 months since I had the surgery. Whilst it felt like I took a bit of a nose-dive around 10 week mark, I've had my final review appointment with my surgeon, and I'm doing fine.  The wound is all healed up and isn't really that visible. I don't have much sensation on the skin around it, and that might come back eventually. There's minimal swelling and the range of movement is within 'normal' parameters for this type of intervention. It's not the same as the left side, and probably around the same as before the procedure, but I can walk pretty well.  I was concerned around the 10 week mark that I'd done something bad to the toe. But the surgeon gave it a thorough exam and suggested I might be over-doing things, suggesting I pull back from my 5-miles a day (which he described as 'excellent' at this point) and go easier on the tip-toe exercises. There may be a natural limitation as to how far the joint will move or allow me to walk ...

As I go into week 8 from the date of the cheilectomy and osteotomy to treat hallux rigidus stage 2, I'm mindful that this is supposed to be a big turning point. In my notes that I was discharged with it states,     "You should return to your normal daily activities (and stop the PT exercises) after 8 weeks, although exercising the joint from time to time may still help." Now I'm a bit literal, so I'm tempted to follow the guidance to the letter. But I actually think my PT has really only just begun. Maybe that's because I had the osteotomy, maybe the guidance is pretty good for cheilectomies on their own. And as for getting back to 'normal' activity, well, given that normal activity was much reduced due to the condition of hallux rigidus in the first place, this could be a little difficult to measure (and since I'm not a runner, and I'm in my mid fifties, it puts me a little at odds with the experiences of many in blog posts and discussions I...

Progress, progress, progress! Vacation week and I loaded the bike on the car ready for a week of driving, cycling, camping, kayaking and hopefully, walking. Well, let's just say, I'm glad I packed the bike!  The good news is, I was pretty much able to enjoy my vacations (hols for the UK audience) without hinderance. The only bit I didn't manage was a walking trip. I can walk around all day pretty much without issue, but to actually go for a walk is - not ready for that yet.  It's been hot again, and I've been doing the exercises and icing a fair amount. I used the bike to do shops and get around. Kayaking was fine - before the op, I'd get burning pain from the spurs if I used my toes to anchor myself in the kayak, but there was also the pain of turning the toes downwards to accommodate the feet - remember, I have knee problems the same side as the foot, which prevents me being able to comfortably turn the leg outwards to allow the toes to sit sideways. But now w...

Have come away on holiday - a three hour drive in a manual car with plenty of motorway queuing, which went fine, though the under part of the MTP joint was a bit achy by the end. I'm hoping to be able to do a little walking next week, but for this week I'm happy pootling around on the bike.  At home I'm in a cheap pair of flip-flops. I couldn't bear flip-flops before the op - the bit between the toes drove me mad. But I reckon the numbness I've still got on that toe, or the op itself, is making it fine wearing them now. I actually think they provide some good PT as well, as the toe performs a little dorsal flexion - sort of gripping the sole - as I walk in them.  I was able to be pretty much back to normal at the weekend, with plenty of time on my feet, swimming and kayaking. I'm using the bike mainly rather than walking, which I would have done before the op. Otherwise, I did a lot with very little pain or discomfort. The beach here is very stony and there'...

I've started swimming again - yay! - and the salt water has helped move the incision wound into a better place. No scabs now, just a fresh pink line of new skin. Been walking more in a pair of new trainer/walking shoes a half size up from what I normally wear with a thick sole.  Walked to the park and around a small circle for the first time since the operation. Did the walk in 40 mins - usually takes me 20 - and I just concentrated on trying to make the gait as normal as possible. Hobbling around over the weekend took it out of the knee and made the foot pretty fatigued.  Getting around on the cycle now - shopping, visiting folk, getting to the beach.  The biggest thing at the moment is the sensation I get underneath the MTP joint. It feels like I'm stepping on a big wadge of something. I'm guessing this will be swelling. It probably takes around 6 weeks for bones to start to be healed. I had an osteotomy and a screw in there, so it's probably this not settled yet, and...

Today I got a letter from my consultant podiatric surgeon confirming my "uneventful recovery" from a right-sided 1st MTP joint cheilectomy with proximal phalangectomy, and conditionally discharging me. To celebrate, I've ordered a new pair of shoes. I've been going through my shoe wardrobe and reluctantly realising that my days in my lovely leather soled Loakes, Brogues and Chelsea boots are probably long-gone. In reality I haven't been able to wear any of them since I had the accident on my foot three years ago (bar the recent funeral of a dear friend - and then I had to send the mourners on while I hobbled my way from the church to the wake in my brogues).  Maybe one day, I'll be able to wear them for special occasions. Meanwhile, a different approach is needed. A sturdy sole, supportive and cushioned - and some modifications to the flat leather soles I've been used to. I've decided (rather reluctantly) to invest in a pair of rocker-soled sports shoe...

It's the 3 week mark and it's been a busy weekend - well, it's all relative. I've been able to get on a bike - lowering the saddle so I can easily put my foot down. It's been more a case of rolling along at walking pace than actually 'cycling' - the foot feels too fragile to go straight off out of the traps onto the road in case of any sudden mishaps that could mean mucking up the osteotomy before it's healed.  On healing, the incision wound is finally sealing up and looking less angry. Still haven't gone swimming - still looks like it needs a little more time to scar properly before risking the water (submerging the skin, risk of tearing, and infection from sea water). Hope that changes this coming week. I can't feel the top of the toe near the incision at all - it's numb. Hoping that changes.  Doing the exercises as directed - push and pull until it's uncomfortable twice a day for 5 minutes. I was able to walk the dog to the park and ba...

Been to the beach last night and this afternoon, aided by a short car ride (someone else driving) and a short walk along the boardwalk to the sea. Decided against swimming just yet as the incision wound still isn't quite fixed. It looks a bit red and nasty in places and is still oozing a little, so I don't want to risk infection or soaking it too long.  Talking of which, when I shower, afterwards the foot looks nasty. It gets red and purple and puffy. It does settle down quite quickly and I've read in other blogs that some people experience this. I'll reduce the time and temperature of showers as much as possible. And afterwards, I elevate the leg and ice. Still, gonna keep an eye on that.  I've also noticed the skin is pretty scaly on this foot - possibly due to wearing compression sock for a period of time during the hottest temperatures on record (28 degrees at night) and an old tan coming off, as well as not walking, bathing and moisterising in my normal way.  T...

Spending a LOT of time reading other people's blogs and alternately making myself a) optimistic that the pain, flexion and swelling is NORMAL, and b) getting completely freaked out that it's all going to pot! So probably best just to STOP reading other people's stuff for a while and concentrate on getting back to normal. But what does 'normal' look like? Well, for me, it would be walking 5-7 miles a day, being able to swim in the sea and ride a bike and get out and do stuff. None of that is possible right now, so it looks and feels like I'm a very long way from being 'normal' again. However, I am doing more than I was two weeks ago. I am able to shower, dress, get downstairs, make my own meals, hobble the dog down the street and back, do my gentle toe bending exercises, be pain free (apart from when I'm stretching and walking on the toe) and I was even able to go down to the corner shop and back yesterday. And I went for a little walk while a friend ...

Still resting and icing and elevating. And the area of the surgery is still stiff, swollen and sore. But that's to be expected. I've been reading lots of blogs and other literature on the recovery to see if I can track my recovery. There are variables obviously - age, fitness, healing propensity, type of surgery and so forth - but it's really helpful (and often reassuring) to track your recovery along side similar experiences of folk who have had the same procedures.  My go-to's are these: https://jemesouviens2004.com/2016/06/ https://cheilectomy-surgery-experience.northwoodswebdesigns.com/ https://cheilectomyexperience.blogspot.com/2013/07/table-of-contents-full-history.html?m=1 I've started doing my physio stretches as directed - 2 times a day for 5 minutes each session. There's really not much flex there at the moment (it IS quite swollen) and reading the other blogs, that seems to be fairly standard at this point, just over 2 weeks post-op. The dorsal flex (...

Had a walk-in shower today. Hoorah! Then did the first of the exercises - pushing the toe back and forth. Had to put a dressing on the wound because it's still weeping, and then got a lift out to sit on a bench and watch the view while a mate walked the dog.  I guess I had worked myself up to the milestone that was yesterday, without much thought as to what comes next. So in my mind I was going to be doing a 5K walk already and just getting back to normal. Boy, how wrong was I. Once I had got round the fact that it's going to be AT LEAST another 2-3 weeks before I can hope to even get to walking far, and that this is NORMAL, I reset my expectations and got over my disappointment.  Right now I feel more sore and more vulnerable when I'm walking than I have been the last few days scooting around in my surgical shoe. But that's NORMAL. The consultant encouraged me to start to walk around gently on the foot, that it will be sore at first, and I should be realistic in my exp...

Finally, it's the day of the post-op hospital visit. Because of the Covid-19 pandemic (and other stuff), all these types of procedures are being done in a suite at a small private hospital near the airport, so it's a 70 mile round trip from where I live (even though usually I'd go a few minutes down the road to the County hospital in my town). So needed have someone drive me. Meanwhile I tested out what shoes I'd take to replace the surgical shoe. Once at the hospital I had a couple of x-rays (which required me to weightbear on the foot). The screw I had inserted is clearly visible on the pics, still not quite sure what its purpose is! The one above shows the diminished space between the MTP joint where the cartilage is missing. All looks good according to my podiatry surgeon (Dr James Alvey). The incision wound is still a bit weepy - it's been in the compression bandage a couple of very hot weeks - so it really needs exposure to air now to finish off healing. So no...

 Lots of mobility now - whizzing around doing everything for myself, except shopping and walking the dog. Can walk ok in the surgical shoe and do stuff like preparing meals and washing up, getting up and down stairs, walking to the car. Still icing the foot just to ward off any swelling, wiggling the toe and stretching it. Sometimes, without warning it has a sudden ache - similar but not as intense to the pain I'd experience often before surgery.  Went out to the local tea rooms for a couple of hours with the Sunday papers, so feeling a little more normal.  Looking forward to tomorrow when I have my post-op appointment back at the hospital, and to losing the surgical shoe and the bulky bandages. 

Managed to hobble to the park for a bit using a mate's crutches. Surprised I didn't get issued crutches when I was discharged. They would have come in handy. Maybe they don't issue them because they'd encourage being on the feet too much when you should be resting. No pain, and no swelling after my park jaunt - though I did ice it just to be sure.  Worse problem now seems to be getting cramp in the middle of the night. And the toe is still pretty active when I'm sleeping - doing lots of involuntary stretches!

I went out last night! Whoa! OK so it was just a 2 minute drive to the local park to sit on a bench while a friend walked the dog, but it was amazing to be out. Made it feel like a bit of a milestone. Last night was the most restless the foot as been. I kept being woken up with the toe going through full stretching. It felt pretty tired and achy this morning, but more mobile than it has been. Icing it this morning and taking a paracetamol for any swelling.  The area around the incision is lively in the evening now, and I can feel it more. Not pain, just healing I guess. Can't wait to get the bandage off. I've seen some posts where folk have had the dressing removed/replaced a few days after surgery, but my discharge notes clearly state NOT to disturb the dressing or bandage until the follow-up appointment 10-14 days after surgery (14 days for me). In fact, I watched a good video on how to do the type of bandage I have (linked to here Meyerson's Wrap  technique), and it does...

Foot continues to improve. Icing a couple of times today continues to improve overall sense of 'tightness' in the foot. Have discontinued the ibuprofen now, see how that goes. I'm pretty much fending for myself now - though I did need to employ help to take out the rubbish/garbage, and did have my meal prepared for me last night.  This lunchtime I really fancied eggs, so I made myself an omelette. Strange how little moments of returned independence really boost the serotonin levels (or maybe that was just the food..!) My work is normally mostly a desk job but I don't have any work at the moment, which is a kind of relief, because although I'd welcome the distraction (not to mention the money - luckily the NHS paid for my procedure), I think being able to keep the foot elevated these last few days has been really beneficial. Working on the laptop in a lying down position is fine for the purposes of writing this blog, but I wouldn't be able to do it for 8 hours a ...

Returned to the icing and cold packs today. Completely forgot yesterday.  Previously, I had been placing the cold press behind the knee as directed by the patient guide I'd received on discharge. But today, I've placed in on the back of the heel, and oh boy, the difference! I could immediately feel the cool blood pouring into the foot. What relief! I'm fine while the foot is elevated, but as soon as I put it down, the blood rushes there and it throbs. It gets better after a while, and now when I'm up and about on it - I cooked dinner last night - it does still take a while for it to settle when I rest up. But that is getting better all the time - the recovery time is less and less. I'm beginning to wonder if I could do with unwrapping the bandage - it's feeling tight. Perhaps due to the weather - unseasonably high temperatures continue. Meanwhile, I keep it iced, elevated and make sure I hydrate more. Doing some gentle wiggling of the toe now and it feels much b...