I'm currently under orders to keep my feet up following surgery so extra time to revisit this blog. I had good intentions of describing the various long distance walks we have made since 2013 but my enthusiasm waned, obviously! I hope to make amends...
I have inherited my Mother and Grandmother's feet!! In January this year, I began to notice that my second toe, particularly on the right foot had begun to creep over the third to the point where I needed to not only wear injinji toe socks, but also gel toe sleeves to prevent pressure enabling me to walk without rubs and pressure areas. For the past three long distance walks I had taped and padded the bony prominences of both feet in order to avoid blisters and skin breakdown, but the creeping of the toes over one another had added an extra complication.
Taping feet for Camino
Pre-op Xray Feet
My podiatrist advised me to think seriously about surgery while I was still strong and active - we had pretty much exhausted conservative treatments for bunions including orthotics, night splints, hammer toe splinting, taping, postural strengthening exercises for glutei and legs muscles. (Intrinsic muscles of the feet were already very weak with abduction of the great toe being a flicker only). The progression of the hallux on both sides continued regardless (as it did for my late mother whose hallux valgus became so bad that at 80, the toe lay under the second and third toes, requiring her to have different sized shoes and preventing her from walking comfortably).
For a number of reasons, (and after careful research and consideration), I opted to consult a local Orthopaedic Surgeon who specialises in feet and ankles as opposed to a Podiatric Surgeon (who didn't operate in my city anyway). Prior to the consult I had Xrays which I hope to add to this post if I can get hold of them. I was pleasantly surprised with the Surgeon I had chosen - much better manner than any Orthopaedic Surgeon I had previously encountered in my work. Suffice it to say that the Xrays looked more alarming than I thought. Dr N measured the angles - bilateral severe hallux valgus, intermetatarsel angles in mod to severe range, complete uncovering of sesamoid both sides, clawed 2nd toes both sides. We discussed treatment options - joint preserving surgical procedures vs continue walking with pain relief, cortisone with potential of developing osteoarthritis requiring fusion at a later date (which would interfere with my ability to hike). I went away with this information, read up on the procedures, and given the rapid progression I was seeing of the hallux and toes, and also considering my Mother's experience with her feet, I opted for the joint preservation.
Long story short, I am now 10 days post op. keeping my feet elevated (as ordered) most of the day to counteract swelling. (Walking to bathroom only). Procedure was minimally invasive hallux valgus correction plus distal minimally invasive metatarsel osteotomies of toes 2-4 as well as PIP fusion on the second toes - both feet. I'm mobilising to bathroom using a frame as I discovered my balance is a bit 'off ' with the post op orthopaedic shoes that have to be worn. (These are designed to keep weight on heels and off the forefoot - only problem for me is that my balance is ordinary at the best of time, so I have to be careful). That said, I'm starting to practise walking with my sturdy trekker poles just down the hall and back with the shoes twice a day. Elevation of feet on pillows, above my heart, I've discovered, is really important - the swelling causes pins and needles which are very annoying. Pain relief - panadol only with ibuprofen (which I use sparingly as I have to take half an aspirin at night to prevent clots until I'm more mobile). I was give a stronger pain medication in case I needed it, but I've been reluctant to take it - paracetamol has been quite OK.
As this surgery only involved an overnight stay, the physiotherapist at the hospital barely had time to recommend a walking frame , check the orthopaedic sandals were on properly, and tell me to spend the next two weeks on the couch with feet elevated, befor I was discharged. Therefore, I've added a few non weight bearing exercises to this - straight leg raises (3 sets of 12); crunches (3x12); hip abduction exercises in side lying (3x12); VMO exercises (as my quads are terrible). modified bridging (very small range, as foot discomfort does not allow for a full bridge), ankle circles and up and down movement (if pain allows. My left foot complains over the 2nd toe with toe up movements, so I'm going carefully until the Dr gives me the 'go ahead' to do more).
Bandages and stitches removed next Wednesday. I will then have a better idea on how much I can mobilise and I'll be heading off to the physiotherapist to regain some strength.
I'll continue to update my progress here in case anyone should happen to have similar feet to mine with the accompanying family history, pain on walking, blisters and pressure on bony prominences. I'll add here, that comfortable shoes were becoming very difficult to find - I was heading into a men's size walking boot and as for finding "extra wide" joggers that did not have tapering toe boxes ... annoyingly frustrating!!
Photos: Xray taken during op. Chevron-Akin osteotomy, osteotomies metatarsals 2,3, 4. Fusion PIP 2nd toe
Xray in op theatre
