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...

Main things to report are continued exercise regime of walking and PT exercises (going up on the toe and 'bouncing' - this can be painful, but that's normal), scar care (I use Hustle Butter which is actually marketed for tattoo aftercare and contains shea, coconut, aloe, vitamin E and so on), and scar massaging using castor oil. The walking gives some pain - mainly in the bone around the MTP joint (and the osteotomy site on the proximal phalanges) and all the way up the metatarsal bone along the foot. I'm guessing this is normal and I just need to ease off if it gets too much. It's a bit off-putting though because it feels like a burning pain much like I had before the operation (caused by the bone spurs). I do have a fair amount of diminished space between the proximal phalanges and first metatarsal due to loss of cartilage, so this may also be a factor (I will have to have a fusion at some point when this becomes too diminished). Image source: https://en.wikipedia...

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...

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'...

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...

It's a week now since I had a cheilectomy and osteotomy to help restore some flex to my big toe. Which means today I get to take off the tubigrip and TED stocking. (TED stands for thrombo-embolud detergent.) Yay! This is important in two ways. Firstly it's SO nice to have my legs bare again - the UK is experiencing unusual temperatures of over 100 degrees F. But more importantly it feels like a milestone in the recovery period. One small step for the overall recovery times for Cheilectomy surgery, but one big step for little old me. The pain level is zero, but popped an ibuprofen this morning with breakfast just to keep on top of any swelling (though clearly the main route to avoiding the dreaded swelling I've read about is to keep the foot ELEVATED 23 hours a day). The area around the incision is beginning to wake up and I guess the dressing may be stuck to it, so it pulls a bit from time to time and is beginning to itch a little. I've been advised NOT to remove the dr...

Yesterday, after a day without anyone around, it was a relief when friends turned up with dinner to cook for me. I was pretty low from being on my own and not being able to walk, get out, go swimming, do anything that requires being on your feet.  So a nice evening with friends, a couple of beers and food. The foot did feel pretty  'tight' by the time I got into bed, probably the tightest it's felt yet. Goes to show that REST is your best friend in the first couple of week. Foot UP, ELEVATED. Give into it. A mate stayed over, so I had tea and breakfast brought me this morning and the dog was walked. So she's happy. Now I'm spending the rest of day with my foot up in the garden, doing some 'bed/chair' yoga and mainly adopting 'happy baby pose'. I'm still taking ibuprofen twice a day for anti-inflammatory purposes, and will probably start to reduce that over the next couple of days. 

This is the first day off the pain meds. I swapped over to one 200mg ibuprofen in the morning and the evening, supplemented with a 500mg paracetamol during the day. It was fine, but I really needed that ibuprofen when I went to bed tonight! This is probably due to increased activity - I was moving around a fair bit, and sat on the sofa watching a movie last night with the foot on a stool - and there was less time with the foot raised above heart level. I can move the toe a bit now, just gently downwards - haven't attempted trying to bend it upwards yet. I do gentle exercises - rotating the ankles on both legs, gently flexing the ankle back and forth, and using a stretchy band on the non-surgical foot to stretch the calf muscles, keeping both legs elevated up a wall and feeling the lovely flow of fresh blood as I lower them down to waist level again.  It helps to bring a bit of massage to the feet, the ankles, the toes and the calves all benefit from stimulating the blood flow. Ther...

Good night sleep, walked to the bathroom - yay! - rested for an hour to let the foot settle after the pressure of using it - it does feel pretty tight after use. The feeling is now all back in the foot (they did need to give me a lot of anesthetic on the day of surgery, so maybe it took a while to get rid of the numbness). There's more 'nerve' discomfort than there is pain, and the foot feels really restless coming up to taking the meds, so I supplement with one or two paracetamol during the day, which helps.  Peaked up the tubigrip and found some bruising on the toe next to the big one, and some on the heel (this will be where I involuntarily kicked out during the nerve test and this caused the anaesthetist to catch a vein, so this was to be expected. Change of scene! I made it downstairs and into the hammock - good cos it means your foot is raised above the heart. I even supervised the making of supper and had a beer! Last night of pain meds and off to bed.