Recovery: First Few Days After Surgery

https://www.shutterstock.com/video/clip-4544480-stock-footage-waking-up-from-surgery.html

Before I was released from the hospital, I was shortly kept for observation to make sure I came out of anesthesia okay and didn't have any other complications. Dr. Shah had wrapped my foot in Ace bandages told me to wear my walking boot until I got home. As I was getting dressed and ready to leave, I didn't feel any pain at all, hardly. In fact, I was able to put pressure on my foot right away, getting in and out of the car and into my apartment.

I was more tired than anything when I returned home, having been awake since 6 AM that morning, and went right to bed to nap. Per Dr. Shah's instructions, I kept my foot elevated with pillows and blankets. I was given Oxycodone for pain, of which I was to take 1 to 2 tablets every 4 to 6 hours as needed. I only needed the painkillers the first 3-4 days or so. They worked (wonderfully) at eliminating the pain those first couple days, but were not without side effects. I became very bloated and constipated, even after drinking plenty of water and Metamucil and eating fibrous foods. They also made me drowsy and a little dizzy (I am prone to vertigo, so that wasn't unexpected.) I was not able to take ibuprofen (such as Advil) or Naproxen (like Aleve, which Dr. Shah had prescribed me for PF pain.) When I stopped taking Oxycodone, I was able to take acetaminophen (Tylenol) for pain. Once I tapered off the Oxycodone, the side effects I'd had subsided.

The hardest part of my recovery was walking. Every recovery is different, but for me, walking or putting even the slightest amount of pressure on my foot was incredibly painful. My doctors insisted that it was okay for me to walk, and even encouraged me to do so, but it was, at times, nearly impossible. The first few days, I hobbled to and from the bathroom with intense pain, holding onto doors and furniture (and my boyfriend) to maintain my balance. Finally, I'd had enough and decided to get crutches, which were a lifesaver. If your pain is as intense as mine was after surgery, I highly recommend getting them. It's important to the healing process to put a little pressure on your foot, but if you're struggling just to walk to the bathroom and fridge, don't suffer. Get crutches.

https://www.amazon.com/DMI-Crutches-Adjustable-Handgrips-Accessories/dp/B000CSQJBY?th=1

The other part of recovery that was particularly hard was showering. I was told not to get my foot wet. As you can imagine, it was nearly impossible to stand on my good foot in the shower without losing my balance and soaking my bandages, so a shower stool was a must for me. I sat on the stool with my wrapped foot sticking out of the shower. I've heard of some people wrapping their feet with plastic bags or garbage bags to ensure that no water gets under the bandage, but I didn't find this necessary. Here is a link to a shower stool like the one I used: https://www.amazon.com/Tool-Free-Assembly-Adjustable-Anti-Slip-Stability/dp/B06ZYW53V5/ref=sr_1_1_sspa?ie=UTF8&qid=1526314164&sr=8-1-spons&keywords=shower+stool&psc=1
If you get surgery for your PF pain, you won't be able to drive for a while. I wasn't able to drive for at least two weeks, because it was my right foot that was operated on. Be ready to spend a lot of time in bed or on the couch with your foot elevated. There's not much to do, so I recommend using the down time to read a book (or a couple, if you're an avid reader like myself), get into a new Netflix show or documentary, or do Sudoku and word searches like I did. I wasn't as ready for all the free time as I thought, and went stir crazy pretty quickly! The first time I went out was to a store (with my crutches and walking boot, driven by a friend) toward the end of the second week. It was probably the most exciting shopping trip I'd had in a long time, after being cooped up for so long!

https://collegecandy.com/2015/02/23/going-out-in-winter-pros-and-cons/

Looking back on those first few days after surgery, I can say the recovery wasn't as bad as I'd expected. Having help and support from family and friends is very important, as well as listening to your body. No one knows your body better than you do; if you feel something isn't right, or you feel like you're in too much pain, talk to your doctor. Keep them updated on how you're doing. If you're struggling to walk, ask your doctor about using crutches until you can move comfortably on your own. Do whatever you need to get better.
In my next post, I will discuss the weeks and months following surgery, including follow-up appointments with my doctor, and how I am doing now, 6 months later. As always, I can be reached on my Facebook page, https://www.facebook.com/plantarwhat/ or via email (wsmalls12194@gmail.com) to answer any questions.

Thanks for reading,
Becky

Preparation for Surgery

https://www.spectator.co.uk/2018/01/patients-like-being-told-they-need-an-operation-it-doesnt-mean-they-do/

After no pain relief from 9 sessions of physical therapy (and many other non-surgical forms of treatment, including cortisone shots, custom orthotic inserts, night splints, and a walking boot to name just a few), my podiatrist, Dr. Shah, dropped the "S" word - surgery.

(I had an "S" word of my own, containing 4 letters.)

The only surgery I'd had up until this point was a tonsillectomy and a wisdom tooth extraction (all 4 in one day, without anesthesia - a decision I now regret!) I was mixed with emotions at the idea of getting surgery for my PF. I'd heard of other people who'd had success with it, including my aunt, so I thought it could be the one thing that would finally work for me. That was exciting. But every operation, of course, comes with risks, which made me nervous. I was already in enough pain; the thing I feared most was an unsuccessful procedure that would leave me with new complications. Needless to say, I had a million questions.

Dr. Shah recommended the Tenex Health Procedure, which is, according to the company's website:

"[A] minimally invasive technology [which] eliminates chronic tendon pain by precisely targeting and removing damaged tissue...and helps stimulate a renewed healing response." - https://tenexhealth.com/product-overview/

https://www.massdevice.com/tenex-health-wins-510k-tx2-microtip/

Thanks to ultrasound imaging, which makes it easy for doctors to pinpoint damaged tissue, the procedure was very fast; Dr. Shah and her partner, Dr. Wendolowski, had me out of the OR in about an hour. I have read online that for some Tenex Health procedures, patients are sedated but kept awake. I, however, was given enough anesthesia to sleep the entire time. On Tenex Health's website it states that no stitches are required, but this was untrue in my case, as I needed one stitch in my foot that had to be removed a week or so after surgery. (This may depend upon the location and depth of damaged tissue in the body; I'm not sure.) Recovery from the Tenex Health procedure takes 4-6 weeks but will vary patient to patient; I was off crutches and able to walk and drive after two weeks. (I will discuss my recovery in more detail in a later post.)

Here's a video with more information on the Tenex Health procedure for PF:

https://www.youtube.com/watch?v=RIgAe9-YzaY

If you've ever had surgery, you know just how much PAPERWORK is involved. I felt like I was doing nothing but filling out forms in the weeks leading up to my surgery: temporary disability forms for my job, medical clearance forms from my general practitioner, forms for my health insurance company, etc. What's worse is that everything is on a deadline; I had to make sure MetLife received the paperwork from my doctor promptly two weeks before the date of surgery, and so on. If you ever have to get surgery - for anything, not just PF - I highly recommend keeping a folder to organize all your paperwork. I bought one of those cheap folders from Staples that is now just about filled to capacity.

https://betanews.com/2016/12/14/paperwork-wasted-time/

One of the first things I had to do before surgery was get "medically cleared" by my regular doctor. This is really silly, considering I'd just seen him for a yearly physical only three months or so before - and, not to mention, my podiatrist (a doctor!) said the condition she was treating me for required this procedure... Nonetheless, it was something I had to do and wasn't a big deal. My doctor gave me a quick physical exam and I was in and out of the office in 15 minutes with my signed form.

I also had to go for pre-op testing at the hospital. This included an EKG, a urine test, a blood test, and a chest X-ray. Like getting medical clearance from my doctor, this was not a problem, and all my tests came back just fine - but the cost of all these appointments started to add up quickly. If anyone has any tricks for getting around any of these steps, by the way, please share!

Fast forward to the night before the operation: like most other procedures, I couldn't eat or drink anything (or even chew a piece of gum) in the twelve hours prior to my appointment. I was told I couldn't have nail polish on my fingernails or toenails, and couldn't apply any hair products the morning of. (Side note: my hair needs some sort of product in it every day, so I went to the hospital early that morning looking like a mess!) Luckily, I did everything I was supposed to and went in to surgery on time.

Here are some tips if you are preparing for PF surgery:

1. Start preparing early. Surgery day comes super fast. Make sure your paperwork is filled out, handed in, etc., on time. Your doctor will likely give you a prescription for a painkiller and antibiotic some time before your procedure, so getting those filled quickly will save you time (and pain) after you leave the hospital. 
2. Do your research and ask lots of questions. Be sure you know what type of surgery you're getting. That might sound silly, but I'd never heard of the Tenex Health Procedure until Dr. Shah mentioned it to me. Your doctor should explain every step of the process with you, as well as provide paperwork to take home and look over. If there's something you're unsure about, ask questions. That's what your doctor is there for.
3. Carefully follow all pre-op instructions. If your doctor tells you to wear your walking boot in the weeks leading up to surgery, be sure to do that. I did. Also, your doctor may adjust any medications you take prior to your surgery, as they could affect your recovery and response to anesthesia. Be sure to tell your doctor about every medication you take. Some things your doctor may tell you not to do - such as having nail polish on your fingers or toes on the day or surgery - may sound frivolous, but there is a reason for these instructions. As long as they are followed, your surgery should go smoothly.

In my next post, I will discuss the first few days of my recovery after surgery. As always, I can be reached on my Facebook page, https://www.facebook.com/plantarwhat/ or via email (wsmalls12194@gmail.com) to answer any questions.

Thanks for reading,
Becky

Walking Boot

My "Franken-boot"

By late September of 2017, my podiatrist, Dr. Shah, decided the next thing for me to try before surgery would be a walking boot. Over the past year or so, I'd tried the following with no success: cortisone shots, custom orthotic inserts, physical therapy, and night splints. PF can be extremely painful, as you know, so to have gone this long without any relief was really starting to wear me down not only physically but mentally. A big part of the reason that I'd left my job as an activities assistant at a nursing home was that it was worsening my PF pain; I was on my feet almost 8 hours a day, walking around and pushing residents in wheelchairs. I was now almost 6 months into a sit-down office job that put no stress on my feet and was still having pain, so Dr. Shah was almost certain surgery would be next if I didn't have success with the walking boot.

Getting a walking boot was far easier than getting custom orthotic inserts. Your doctor will give you the size you need depending on your shoe size (I believe walking boot sizes run S, M, L, and XL), and will make sure everything fits properly and comfortably before you leave the office. The boot I have has two pieces of fabric that go across the top part of my foot, just below my toes, secured by Velcro. There are another two pieces of fabric that secure (again, with Velcro) at the bottom of my leg, just above my ankle.

Bottom Velcro strap

Top Velcro strap 

The next piece that goes on is a detachable plastic shell which looks like this:

Top part of the shell

Bottom part of the shell

Once that is in place, two straps secure the shell to the boot, like this:

Lower strap

Upper strap

There are these little "airbag" things (using my own terminology here) on the inside of the boot, just above the ankle. These can be inflated or deflated via a little pump if the boot fits too loosely. They maintain air well; I'm pretty sure I've only had to inflate them once or twice in the past 6 months.

Air pump

Originally, Dr. Shah wanted me to wear the walking boot for only a few weeks to see if it would lessen my PF pain. It helped a little bit, but I was still at a level of pain that she decided I would need surgery. (I will discuss the type of procedure I had and what was involved in a future post.) After my surgery on November 15, 2017, I wore the boot through my recovery and was told I would no longer need it after November 29. I would still need to wear sneakers with good support (my doctor recommended New Balance) and custom orthotic inserts, but that was fine by me. As you can imagine - or already know, if you've worn it - I was more than ready to get rid of my walking boot, which I call "the Franken-boot."

One good thing about the boot is that I could wear it on my left or right foot, depending on which one was hurting me more. As you know by now, my right foot has always had a significantly higher level of pain then my left, so I never had a reason to wear the boot on my left foot. (I'm not sure if this is possible for all walking boots, so this would be something to discuss with your doctor if you're looking to buy just one.) My doctor told me not to drive with the boot, since it was my driving foot, but I did anyway. It's probably not the best idea, I know, but it never caused me any problems. It just felt like driving with a big snow boot on, once I got used to it. I'm not saying that driving with a walking boot is okay or even safe to do, so please follow whatever your doctor tells you! 

I did not wear my custom orthotic insert in my walking boot. (I still wore it inside my New Balance sneaker on my left foot, as I normally would.) However, the podiatrist I saw after Dr. Shah, which would be my fourth, recommended wearing a cork heel lift inside my boot. (I will discuss cork heel lifts and how they help PF pain in a future post.) 

As I mentioned earlier, wearing a walking boot feels a little like wearing a big snow boot. It's not uncomfortable or painful, just a bit awkward. You might limp a bit in the beginning, having this clunky thing on your foot; but like anything else, you get used to it with time. I hardly notice a difference from my left or right foot when I wear it anymore.

Unfortunately, my surgery was not as successful as I had hoped, so my doctor recently recommended that I start wearing it again, this time with the cork heel lift. I don't wear it daily, and haven't the past two days because it was rainy outside. One downside to the boot, at least the kind that I have, is that it's easy for water to get in. You definitely don't want to wear it in the snow, and if you are able to go without it, you might want to forego wearing the boot when it rains - or at least tie a plastic bag over it when you're walking outside. It looks ridiculous but will keep your foot dry.

Overall, the walking boot has been helpful to me. I still feel pain in my heel with almost every step, but it's much less noticeable with it on. When you have severe PF, wearing a walking boot can be a big help. You might notice a difference in pain as I did, so it's worth discussing with your doctor. 

In my next few posts, I will discuss my surgery - the procedure itself, the recovery process, and my results. 

As always, I can be reached on my Facebook page, https://www.facebook.com/plantarwhat/ or via email (wsmalls12194@gmail.com) to answer any questions.

Thanks for reading,

Becky