1 Month Post Op - Hammertoe Pin Removal

I'm going to tell you, the steristrips they put over the incisions when they remove the sutures? They get ICKY!! Their purpose is to help hold the skin closed, so the incision heals well, and we always tell our patients to leave them on until they start to peel off independently, but I couldn't wait. The juices that ooze out of a healing incision just mess them up. After a week, I peeled them off, and stuck some dressings of my own over them, until the weeping stopped. (even after bleeding stops and in the absence of infection, which would result in a greenish, icky discharge and smell, incisions can ooze a yellowish liquid for weeks...especially when the foot is swollen, which it will likely continue to get when I am up and about, until walking around like normal)

By 4 weeks, the weeping has pretty much stopped, and the scabs are about all gone, as is the bruising, but the peeling continues. See the wrinkly skin?? That's all going to peel off eventually: 

No-one tells you ahead of time that the swelling will cause the skin on your foot to start to flake and peel....I have been putting a coconut oil scrub on the parts between the incisions but until I can massage the entire foot, the dermabond around the incisions and the skin won't all peel off completely....so I delicately do what I can. Coconut oil is wonderful for moisturizing....I used it on my knee, which developed a sort of callus from the knee scooter the first week...now it's no longer sore and flaking, and the coconut oil keeps it moist. Sort of like elbow skin, if not moistened, it gets dry and Elephant-skin looking. 

And the swelling is dependent now....just when my foot is down. Like in the shower. I take a shower, then sit back down with my foot up to allow it to dry and the fluid drain back, before putting my boot on each day. 

Of course, sticking this foot into a pedicure tub and having a pedicurist scrub away at it is out of the question until it heals up a bit more (2 weeks after the pin is removed I should be able to get one....I'm counting the days!!), so I do what I can at home.

By now, I've been doing some weight bearing on my heel per MD orders for a week or so, and after a busy Memorial Day weekend which involved visiting family and a lot more moving around, up and down stairs, using crutches more. It took a day or so to recover from that!! I actually took a percocet each night on top of my Motrin, to be comfortable enough to sleep; mostly Motrin has been enough.

Yesterday, Dr. Ritchey removed the pin in my hammertoe.  A hammertoe is when a toe gets bent over years time into an unnatural position, usually because of the shoes worn (too small, etc, which has been my problem with size 11 feet since my teen years, and 20 years ago, there wasn't the internet to buy bigger shoes; I had to make do with what we could find in town. And our town had a lot of ladies with larger feet. O-kay, so many of them were related to me, but still....)

This particular hammer toe had become so warped that when I walked, it slid up under the toe next to it, and become very painful. (it's the fourth one, beside the pinky).

To straighten it, he had to break it and pin it in it's new position to allow it to heal back more straight. (the dark dot is the scab over the top of the pin on the end of my toe: that's where he'll have to cut to get to it. )

Now as this was the part of the foot that still gave me some pain from time to time since surgery, especially after the busy Memorial Day weekend. I knew, in part, this was because of the foreign body in it (the pin, holding the broken bone straight so it will set right), so I was glad to be getting rid of it, even as I dreaded the process.

Other than a couple of times at the end of the day that busy Memorial Day weekend, I hadn't been taking anything stronger than Motrin, but for this, in anticipation of the discomfort to come, I took 2 Percocet before going in for my appointment, knowing that this was going to be uncomfortable. I had Jeff drive me....I had already driven a bit, taking my boot off and strapping a sandal on over an ace bandage, so I COULD have driven myself, but as loopy as Percocet makes me, I wasn't taking that chance.

After x-rays verified that everything was healing nicely, the process began. Now a pin looks very much like a finishing nail without a head, very smooth, with a point, so that when the doctor places it in surgery, he could push it into the toe, stabilizing it in it's new position....It actually surprised me how thick it was. No WONDER that toe was so sore!!

Of course, as the pin had shifted a bit, or rather, in his words, the end 2 segments of the toe had slid on the pin, so it was good it was being removed, before it slid down any further. But this meant that he was going to have to use a scalpel to cut in a bit to grab hold of the pin.

He used a numbing spray on the surface, but that couldn't numb deep down where he was injecting the lidocaine to numb the toe, and that was excruciating for about 30 seconds. I'm a nurse, I know that when you inject something, even if you numb the surface, the medication being injected under than numb skin hurts. It just does. Doesn't mean I was going to like it. I gritted my teeth, squeezed the heck out of the armrests of the table, then it was done.

But I didn't watch. If it were anyone else, as a nurse, I'd be watching the procedure, but I can't even watch when I get my own blood drawn (something I've done to other people many times), there was no way I was going to be able to watch him slice into my toe and grab hold of a pin and pull it out....so I closed my eyes while he sliced and gripped, and VOILA!! Dr. Ritchey handed me a hemostat with the finishing-nail looking pin on it. Weird!!


Of course, I've been taking Motrin for weeks, which can thin the blood, so I bled like a stuck pig...after holding pressure on it for a few minutes, he slapped some bandaids on it as a make-shift pressure dressing.  (12 hours later I took them off, and guess what....more bleeding!! If anyone ever needs my DNA, there's blood on my carpet....more bandaids. By the next day it had stopped, though)

He then told me to park the scooter and start walking with the boot on. Hallelujah!!! Freedom!!!

I pushed the scooter out to the waiting room, walking on my boot, and Jeff was like "Uh oh, she's free!!"....of course, with the Percocet in my system, it felt pretty good, so I happily walked to the car.

I went home and slept off the Percocet.

Later that night, after waking up from my Percocet-induced nap, I cleaned bathrooms, but with the lidocaine worn off and the Percocet effects done, I discovered, no surprise, it was going to be a bit more uncomfortable than it was at first....but dangit, my bathrooms hadn't been cleaned properly since right before my surgery, if I had to do it in stages, I was going to clean them!! (and for those who say "Why can't your honey clean the bathrooms?", I point out the obvious....bachelor cleaning and MY cleaning are 2 different things!! :) )

Aside from the soreness, and needing frequent breaks, not having to use crutches or a scooter for the first time in a month felt amazing. And getting rid of that pin did decrease the discomfort I had been having at the base of that toe, discomfort probably related to the foreign body in my foot. Why you ask? Well, have you ever had a sliver? If you have, then you know that if you don't get it out pretty quickly, it starts to get red and inflamed; the effects of your body attacking the foreign body in it, trying to get rid of it.

But the boot takes some getting used to walking in. Hit an uneven spot wrong, your knee tries to go backwards. And I'm walking on a lightly padded hard boot...these first few days I need frequent breaks to rest the foot, decrease the pain. By the end of the day, I'm watching TV with the boot off, my foot up, as I have since surgery.

There are numb spots in my foot still...near the incisions, as nerves that were cut or abused during the surgery take time to heal;  the inside of the hammer toe that has the incision on it, the inside of the toe next to it....some of this is just because of surgery, some is because he rooted around inside my foot, trying to find that danged neuroma that was thought to be the cause of all the pain in the ball of my foot, and sorting out the tangle of nerves that were in there...some nerve damage was to be expected. And some of it will heal, as the body finds other ways to get nerve signals to those areas; but I might still have some numb spots permanently. But thanks to the fact that there WASN'T a neuroma in there that he had to remove, I've got a whole lot less numbness than I could have had.

Addendum: a week after I was told to start walking in the boot more, I added an insole. I'm sorry, I guess my tender tootsie status is going to continue...yeah, it might get better once everything is healed up...but my heel is killing me in that boot!! I happened to have a bunch of insoles I had tried over the years, so I stuck one in there...we'll see if it helps. Well, off to clean the house!! 

Two weeks post-op: Suture removal

Unlike many other surgeries, where doctors have moved to staples or glue to close the incisions they create during surgery, Podiatrists usually use sutures to close the skin; the logic is that the bony structures are so close under the surface, they require the extra support of sutures, rather than glue, and staples...well, metal and bone, ugh!! Kinda seems not really flexible enough. 

Anyway, as a nurse of a certain era, I've done my fair share of suture removals over the years, so I gave a fleeting thought to taking them out myself, but one look at the S-shaped incision from my 4th toe to the top of my foot, and the scabbing and all that...well, let's just say, the thought of doing it myself was rapidly filed away for "I'll let the pro do it!"...the pro being Dr. Ritchey's nurse in the office.

Again relying on friends, since driving is still not an option, I toyed with taking a Percocet before going, but I know the small pain from the tugging on sutures compared to the in general much harsher pain I had already gone through, for such a short period of time, really didn't warrant the itching that results. 

And I was right. Mere minutes it took her to remove the suture, even the wonky incision on my fourth toe. There were a few cringes, but ultimately she had them out and steristrips over the incisions lickety-split. 

The end result: not bad. The toes are still bruised, as is around the heel and the arch, where all of the blood pooled from the surgery...but it's looking much better. And Motrin is all that's really needed, when they get sore.

One thing that continues to be uncomfortable is if I let the foot dangle, don't keep it elevated continuously, it swells. It just takes time....and I knew about the discoloration that can happen when the foot is dependent, not elevated, for example, when you are walking around on crutches or a knee scooter. Even forewarned, though, it's disconcerting to look down and see a purple, swollen foot....but elevate it for a while and it goes back down. Best thing to do is to wear your boot as much as possible when you are up and around, the compression can help decrease the swelling.

Comparing feet when foot is elevated...both the same color, not much swelling:



And when I've been around the house a bit, on my knee scooter, without putting my boot on tightly; that discoloration. It's quite common in limbs that have been operated on for a few weeks afterwards, but still not pretty.

All in all, healing well. First trip out of town this weekend, and because I tend towards motion sickness in the back seat of a car, I'll probably just sit up front...and my almost 6 foot tall frame means no foot up on the dash for me. We'll see how that goes.

Post-Op Day 11

Mom and a family friend, Annice, have been here for a few days, so we've been getting out of the house...Wednesday was dressing removal and boot receipt day, so after the reveal of Frankenfoot (see that day's post) we drove around Knoxville a bit....We had iced tea on Calhoun's patio, where I camped out while Mom and Annice took a walk down the waterfront...I tell you, the knee scooter makes things MUCH easier, but still is hard to get around, and after shopping a bit the day before, Wednesday I was a bit worn out....thank you the the lovely waitress on Calhoun's patio who didn't charge us for our iced tea, what a lovely girl.  (my view from the most easily accessed part of Calhoun's on the River's deck...yes, the river IS out there somewhere!!)

Mom, Annice and I did Dollywood yesterday, and although it was fun as always (the train was not running, though. :( ) it WORE ME OUT...talk about a new perspective, being stuck in a wheelchair/scooter all day, having to THINK if able to go to certain places, or find a bathroom...I was exhausted by day's end. I am every SO thankful that for me, this is a temporary thing. This experience is really opening up my eyes.



BTW, if they read this by some weird coincidence, Dollywood REALLY needs some automatic doors on their family/handicapped bathroom doors, I tell you...I didn't have my crutches with me, so had to drive the scooter right into the bathroom, and getting in and out of manual doors in one of those scooters is almost impossible without help. 

Today we opted to skip the Biscuit Boulevard downtown Knoxville...Missing it again this year, but I just wasn't up to the logistics of getting around downtown on my knee scooter or crutches, and in those crowds, nonetheless...and did the simple, tasty breakfast at Horn of Plenty...then we braved the rain showers to Crab Orchard so, on their last day here, Mom and Annice could see Ozone falls, one of our favorite sights to show people who visit....I had my books, and camped out in the back seat with my foot up while they hiked a bit.....finally finished a book I started several months ago!!

Even after an afternoon riding around I'm the car, foot down, in my boot--well, we DID stop at Riverside Grill in Oak Ridge, TN, enjoy some of the rowing from their patio with a cold beverage:
 

a couple of hours elevated and a bit of ice, and I have to admit, it's looking better. 



That long, bruised, second toe sticks out furthest in my boot, and when it gets shiny and swollen, I know it's time to get my foot elevated a bit!! Looking good now.

Pain-wise, Motrin is enough. Oh, it throbs a bit when I put it down, but really I don't need anything else. 

Will post a pic without dressings tomorrow. Dr. Ritchie just put gauze over the stitches with an ace bandage loose over it, saying he knows anything tight can be uncomfortable, but I've found that, even loosely wrapped just to hold Gauze on over the stitches, it feels like the ace bandage makes my foot joints lightly but constantly grind together. So I dug into my first aid kit, and this is what I've come up with. Still did the ace bandage loosely inside the boot today, but taking it off to relax and sleep.

I can still see the faint outline of Dr. Ritchey's Happy face foot. :)

Post Op Day #8 - It's free!! Frankenfoot, it's free!!!

I have never been so afraid and so glad to get dressings off at the same time. Try living and sleeping with a boot on your foot, never taking it off, for days on end. Extremely uncomfortable, even as it protected my foot. 

Actually the whole process, getting the dressings off and viewing the stitches, the bruising, and the happy foot that Dr. Ritchey had drawn on my foot to mark it as the one they were doing surgery on that morning,  the straightness, was so liberating, yet at the same time I was afraid. Without the splint and any dressings, my foot felt so..delicate. I immediately nicknamed it Frankenfoot...for obvious reasons:

BEFORE:

AFTER DRESSINGS OFF:

Dr. Ritchey's nurse had me scoot into the other room for x-rays (putting my foot down flat on ground, although not bearing any weight on it, since the surgery...weird) to make sure everything was healing well.

The whole process took 30 minutes, and he wrapped me up in my splint with just an ace bandage and just gauze over my dressings...after brunch at Crackerbarrel, Mom, Annice and I made a trip to Hanger's, the place that distributes boots for those of us with Humana insurance. Anther $120 (danged deductibles) out of my pocket. For the next few months my foot will spend much of my awake time in a boot, one of those big, black boots that braces a broken or otherwise operated on foot...eventually it is what I will bear weight on my foot in for the first time, but for now it protects my foot and allows me to use my heel to move around...up and down stairs, I can bear weight on my heel.

And I can wash it!! Not the boot, my foot!!!  Oh, I'll still be sitting in the shower, and I won't be submerging it in water (no swimming for me the next month or 2), but I can lather up and wash between my toes...and remove that Happy face foot Dr. Ritchie drew on it. Hallelujah!

My second day straight of running around outside on my knee scooter (went shopping the day before) had my leg muscles and knee protesting, so we drove down to Calhoun's on the river and had cold tea there...I relaxed on the part of the deck it was easy for me to access,

while Mom and Annice took a walk down the river...Annice has never been to Knoxville before, so it was nice for her, but I was tired. Yes, the Tennessee River is out there. Somewhere. But the chair was comfortable and the iced tea was cold!

Pain-wise, I took a Percocet before my doctor's appointment, just in case, but really Motrin is enough. Ice, elevation....the bunions themselves hurt the least...the most painful is at the base of the incision on the top of my foot, extending from the hammer toe he broke, straightened and pinned, that was for exploration and possible removal of the tentatively diagnosed Morton's Neuroma in my foot (diagnosed based on symptoms, only way to confirm the diagnosis: surgery), and I think maybe that it is just bruised...

But about the neuroma, I almost forgot the GREAT news Dr. Ritchie gave me today: he got in there and found NO NEUROMA!! This is good news...he said the nerves to the toes feeling so much pain were smooshed and tangled and basically all wrapped up amongst the tendons and structures of my mal-formed feet...he just lysed a bunch of adhesions, tried to free everything up, basically unstuck everything, and stitched me back up. What does this mean?? The numbness I might have had in those toes, and the possibility of different pain in the ball/arch of my foot related the nerve stump he left after the neuroma (nerve tumor) was removed, the risk of those are gone. And hopefully, with fixing the main problems in my feet, the pain will resolve. I'm so relieved at THAT little turn of events. 

Tomorrow, we'll do Dollywood, and I will pay the $40 to rent an electric scooter....I want to do Dollywood, but my leg will fall off at the knee if I have to roll around there on my knee scooter, and crutches...fuggedabout it!!

Post Op day 7 - Surprising pain

Well, I'm pretty much down to one Percocet in the morning and one in the evening, just Motrin through the day. However, despite the horror stories about how painful bunion surgery is, it's not my bunions that are hurting so much as the incision from my hammer toe to the top of my foot, where he removed the Neuroma. I don't know if the dressings are just rubbing wrong on that, or what, but I'll be ever so glad to get rid of the dressings tomorrow morning, see if that helps the pain.

The knee scooter ended up being the best investment....I use that daily, and the crutches rarely....but my knee, where I bear the brunt of my weight, has become inflamed and almost abraded. I have ordered a knee pad to see if that will help protect that knee. Thanks to Amazon, it should be in tomorrow, so I can try it out around town tomorrow.  Thursday we'll do Dollywood, and the hardest part of that will be not having my foot elevated on the scooter I plan to rent for the day.