Orthopod appointment lined up!

I was really surprised to get an email offering me an appointment in 11 days! Perfect! I work odd hours and six days on three days off so getting an appointment on a day off was almost a miracle!

I have been wondering whether a steroid injection would bring some relief? I have had one before in the same area. So painful compared to the ones just into tendon and muscle. It felt like someone was shoving a red hot screwdriver in between the bones. If it works then I can pull up my big girl pants and have one but I know it would only be temporary.

The surgeon is very forthright so I’m going to have to keep my head clear and not be bulldozed into doing something I don’t want. Hopefully I can take a support person with me.

I’ve made it 4 years, 7 months and 4 days.

I’ve made it over four and a half years post calcaneal osteotomy. Four years were pain free but the arthritis started to win the battle. I’ve tried to brave it out because I don’t want to give up my ability to run. I was told when I had it performed that eventually I would need an ankle fusion.

I’m at that point, in fact way past that point but I don’t want to go down that track. For me the pros are far out weighed by the cons.

Ankle fusion or arthrodesis involves cleaning up the ankle joint and fusing the bones together with screws, plates and bone grafts. Sounds easy enough?

New York Marathon 2018

• Well, it means limited range of movement - I have two flash hip joint prosthesises so I can run so they’d be wasted.
• It can change how you walk which can lead to, you guessed painful arthritis in other parts of your ankles, knees and feet! 
• Recovery can involve 10-12 weeks in a cast. Mines my right side and we drive on the left hand side of the road so my right foot is responsible for the foot controls. Therefore no driving. I work odd hours and can’t take public transport so no work or pay for 3 months.

This is the only likely option if I use our public health system, as I did with the original surgery.

My surgeon also works in private so that gives me more options. She does ankle replacements. 

• It has a shorter recovery period - 3-6 weeks in a cast.
• You regain a wider range of motion. Apparently most people return to active lifestyles but that would depend on your definition of active lifestyle.
• Return to impact sport is rarely possible.
• Need to have little or no ankle deformity - who knows if the CO has made it so!

So this is better than fusion but still unlikely to let me run unless the surgeon is brave. I’m waiting to get an appointment. If I went down this road I’d want a mobile bearing replacement rather than fixed. I don’t even know if that’s an option in New Zealand.

So what do I want? At the moment, a sharp knife and a ton of local anathestic! It is the most pain I have experienced in my life and I have experienced some high level pain. I also have a very high pain tolerance level. Right now nothing even reduces the pain to tolerable. I am taking Naproxen, paracetamol and lots of tramadol and it’s like I’m eating lollies. I can barely walk. The lowest levels of pain occur when I’m wearing the steel cap boots I have to wear to work because it’s really rigid support. Still painful but at least I can carry out my job.

It is actually something I am considering (not the DIY method!) but seeing where non-traumatic amputation for severe osteoporosis-arthritis falls on the scheme of things. I have friends who are amputees so I know all about stump issues and prosthesis fittings being hit and miss but the pain is really driving me mad and not being able to run after all I’ve been through to guarantee I can continue to run after two hip replacements is making me want to scream “Chop it off and just shove a blade on it!” Plus there’s the whole leg length issue. I was lopsided when I only had one hip replacement and that caused back and hip pain until I was straightened out with the second one. I don’t want to go down that path again.

So I wait to see when I get an appointment - how much longer I have to suffer in pain. Then I will ask for ALL the possible options and see where that leaves me.

Spoiler alert: I made it!

After the removal of my screws I had no more heal pain. Hallelujah! Recovery was nice and reasonably quick. I just had to wait for my MRI to determine what was causing my ankle to forget how to ankle. I had an appointment set up and was hoping I'd have the results before New York.

The MRI was a piece of cake since it was only my foot and I'm used to being put in head first. I had an appointment for my review with the surgeon and things were chugging along. Then the clinic nurse rang to tell me I was booked in on a day my surgeon was away - they would have to reschedule. "Fine." I said "But I'm away 29th of October until 13th of November." This was noted and I was assured I'd be seen before then.

I kept on running and training for New York and waiting for my appointment letter. It arrived in mid-October and was set for ......November 3! I had to ring up and explain again that I was away then and I'd need rescheduling. An appointment would be sent out to me.

Finally October 29th arrived but no appointment. We flew out of New Zealand on a 19 hour flight to LA and then flew 6 hours to New York. We arrived very tired but managed to get out and check out Times Square.

The next few days were filled with preparations. We fought the crowds at the Expo and looked around New York in a relatively sedate manner.

Finally November 1st came around. We were on the buses to the start at 5:30am. Disabled athletes get checked by security before boarding the buses and then get driven right into the village - a very relaxing way to start. We had a tent to wait in and bagels to chomp on. The time to start came around surprisingly fast.

We started behind the elite women but in a different wave. Our little pack ran off filled with joy and a little trepidation (a lot on my part.). The course is relatively flat apart from the five bridges and a nasty hill up Fifth Avenue to Central Park and continuing up to the finish line. The number of people lining the streets was amazing. There was not one spot not filled. I had taken a tramadol when I woke
up because all the walking around had twinged my left hip and my ankle was twinging as well. This kept me going until halfway through when I had to take another one. My ankle seemed to have decided to ankle and we kept to my plan of running four minutes, walking one and always walking up hills and running down them.

And we finished! It was incredible. The best marathon ever.


We then had a great time visiting New York, San Francisco and Las Vegas, where I shopped up a storm at the outlet malls.

When we arrived back there was a letter with an appointment in two weeks time. I was hoping it was good news.

The MRI revealed possible osteoarthritis where the bones had rubbed. I was prescribed a steroid injection to determine if that was the case. If it worked we would know we had the right place and cause. I also got custom made orthotics made. They are really great - I don't even notice them which is a huge improvement on the previous ones which were off-the-shelf with bits of foam glued on.

The steroid injection was not fun. I had a registrar do it and he had two supervisors so must have been pretty new. It took a long time but he got the needle in perfectly. It's now been three weeks and I'm still pain free so that is fantastic. Previous experience with steroid injections have been very disappointing.

Something's missing

I've been following my post op instructions to the letter. I rested with my foot up for three days. I took off the crepe and cotton wool dressing after three days. Then I hit a problem. I was to leave the clear dressing on until day 10 but someone forgot to put the clear dressing on. I had ooze all over the crepe and cotton wool but fortunately it didn't stick. Then I had a healing but not yet close wound open to the air. I had to put on a temporary dressing until I could get a better one.

The heel is very hard to put a clear dressing on! I had to sort of wrap the op site round and it has wrinkles and crinkles at change of direction points. Still it's on and covering the wound and stopping any ooze getting out and hopefully any germs getting in.

The wound looks quite nicely done. There's a couple of whacking great black sutures sticking out but it's not much longer than the original. I'm at day 7 and can quite happily walk short distances on it. I'm not sure how long distances would go but we'll see. I have a bucket load of Tramadol left. I'm sure they gave me more with this little op than they gave me for the original. 

It was very handy getting the screws out because the following day I got an appointment for a head MRI. No need to enter big discussions about my foot metalware.

One year on

Everything had been going peachy keen for ages until about 6 weeks ago. Then the screws started to make themselves more apparent. Then the ankle suddenly went unstable and started clicking. 

I went to my GP and got a referral back to the orthopedic department. It was about six weeks wait including a cancellation of one appointment and then getting a new one.

I had X-rays and they felt that the screws were still stable so unlikely to damage any tissue. However the orthopedic surgeon agreed that they are palpable. She also examined my foot and decided the best thing to do was get the screws out and then do an MRI to see what else was happening. 

I went in on Tuesday and on Wednesday got a call to see if I could show up for surgery on the coming Monday! So tomorrow, Friday, I'm going in for a preop appointment with the anaethetist. Then I'll get sorted for the op and find out what to expect.

Ouch!

A month ago I started to develop pain in my ankle and a burning sensation at the back of my heel. The pain is around the end of the scar where my ligament was resectioned. It's always been really painful to touch at that point, massage was torture, but now it hurts even when I'm not touching.

I've gone back to doing my physio exercises and get some relief when I do the eversion exercises, like it pops back in place.  It's pretty similar to the pain I had due to the split but further up my foot. I'm hoping I haven't split it again! The screws are feeling more evident, that's the burning sensation but its copeable at the moment so I'll give it a while longer before I ask for removal. Unless things get more sore, then it'll be NOW!

I'm presuming it's not caused by my running again because I was told it was fine to do. Since I have my year planned out training for New York I'd rather not have anytime off my feet unless absolutely necessary. I'll give it a month and then if it's still not responding to physio and massage I'll have to bite the bullet and follow up. The earlier the better, I guess.

Who operated on my ankle?

It seems weird that at this point in time the only discomfort I have is in my ankle. It's verging on feeling like a sprain. It also feels really stiff but actually has normal rotation. I put it down to being six weeks in a cast and not being totally conscientious with some of my physio exercises because when I'd get home and look at the drawings I'd sometimes forget what I was actually supposed to do.

The last lot given to me I remembered and they were actually quite fun. I've even graduated from balanced on a folded towel to balancing on a pillow. I have my discharge review with the surgeon in ten days time so I'm hoping I'll be much looser by then. 

I have discomfort walking down stairs and I tried a pair of limousine shoes on today and could barely step forward with my right foot. When I rotate my ankle in a clockwise direction it clunky-clicks at the nine o'clock position but doesn't when I turn it anticlockwise, go figure!

I bought a new pair of running shoes yesterday and was so excited because I got a normal fit pair. With my wider previous foot I had to buy wide fitting but now the heel is all realigned I fit a normal pair.

They are also very pretty so I should fly in them. I did a 25 minute run in them today and was really happy. The laces didn't need re tightening or any adjustment. I still can't understand the whole being able to run comfortably but still walking awkwardly business. I guess I'll just accept it.