9 Year Foot-aversary

It seems as though the last time I posted about my feet was seven years ago for my two year foot-aversary. Whoops!

I generally don't think about my feet very often as they are still so much better than before my operation. Plus work and life keep me busy and we also moved house last year. I usually commemorate the foot-aversary on Facebook but that's about it!

So, the update... My feet have been so much better since the surgery, it really was life changing and I often say to my husband that it is the best thing I ever did. We have had some brilliant holidays and my new feet have walked me around Disney World, San Diego Zoo, along trails at the Grand Canyon, Zion, and Yosemite National Parks among many other things which I could not have imagined doing before the surgery. I do still get a bit of hard skin build up, especially under my fourth toes but I try to keep on top of it with filing, foot cream and visits to the podiatrist. The big toe nail on my right foot has also never really grown properly since the surgery. I can see I mentioned it seven years ago and in the previous post and it is still growing extremely thick and kind of gross looking! However, it very rarely causes me pain (only sometimes if a shoe is a bit tight on it) so I don't really mind.

My feet today, nine years post surgery

Recently, I have found some pain and stiffness in the fourth toe on my right foot, along with an increased build up of hard skin underneath it. As mentioned above, the hard skin never really went away but it was definitely getting worse. The toe itself seems to have lost the 'floppiness' that the toes have since the operation and no longer really moves. This stiffness has also made the second and third toes drift and they often push underneath the big toe. I showed my rheumatologist last time I saw her (last summer) and though she agreed with my suggestion that maybe the toe has re-fused, I first had to have X-rays and an ultrasound prior to a referral to my original surgeon.

I was very excited when I got the referral letter through finally and also excited when I realised the appointment fell on my nine year foot-aversary! I was looking forward to seeing my surgeon again after so long and excited about having this dodgy toe fixed (though, admittedly also slightly anxious at the prospect of more surgery).

And then of course came the Coronavirus. I received my shielding letter and so am advised to stay at home until 15th June. Even before I'd received that, I'd had a letter saying my appointment was cancelled (along with a cancellation letter for my rheumatology appointment earlier in April). So, as I don't get the chance to speak to my surgeon about this today, I'm posting it here instead. I will update again when I get to see her again (whenever that may be!). I hope anyone reading this is coping OK in this strange time that we find ourselves in.

6 and 9 Weeks Post-Op

10th September
The last few weeks have been punctuated with weekly visits to the Occupational Therapist. I have been exercising my hand regularly and massaging it too. Last week was a bit disappointing as the range of movement I had was still not very good and the OT did seem slightly concerned. She suggested we stop using my dynamic splint a bit early and allow my hand to be out of any splint at home. She encouraged me to start using my hand more as this would help my range of movement. Due to my fingers being especially bad at moving down (using my new knuckles), she also gave me two different resting splints: one which would hold my fingers straight and one which holds them down in the bent-at-the-new-knuckle position. I was to wear them alternate nights in bed and perhaps in the afternoon to rest my hand if it was tired.

However, after a day of being out of my splint, I noticed that my fingers were drifting away from my thumb (the direction they used to drift) and I was a bit concerned by this. When making my splints, the OT had gone to a lot of trouble to ensure my fingers were held in a good, straight position and definitely not drifting away from my thumb.

I gave her a call and she said that I should resume wearing the dynamic splint but continue to try and use the hand as well as continuing with regular exercises and massaging.

When I returned this week, she could see some good progress in my movement and also said that the massage to loosen then skin and scar is having a good effect. She gave me a new, soft splint that I can wear when using my hand if it starts to drift or become tired.

I have finished with the dynamic splint now and should have my hand out and being used all the time at home. We did discuss that when my hand was not being used I should use a resting splint to ensure the fingers stay in  good position. She also mentioned that I may be able to drive again in a couple of weeks but did say that would be down to the surgeon to confirm.

13th September
Today I visited the surgeon and physiotherapist. The surgeon was very positive and had no problem with me returning to work next week. He was especially pleased when he looked at my hand. I was really pleased as he knew how bad it was before! He said straight away how much better the fingers were at extending which was the main difficulty I had before. I have been booked in for a follow-up in six months where I will also have x-rays taken.

The physiotherapy appointment was less useful, unfortunately. She spent a while taking the history of the procedure and my arthritis, then examined my hand, took measurements and suggested exercises. However, all the exercises she suggested are ones I'm already doing because the Occupational Therapist told me to! I have a follow up appointment with her in a month's time.

1st October
I totally didn't post this when I wrote it! I did return to work the following week and have been pretty busy getting back into the swing of things. My hand got quite sore when I first started but it is improving all the time and is also starting to get stronger now.

When I visited the Occupational Therapist today, she was again quite pleased with my progress. I shared with her some specific pains I have been having in my index and little fingers and she looked carefully at those joints. She reassured me that there doesn't seem to be any problem and she thinks it will improve with time. She also adjusted my night time resting splints as my hand has changed shape and size since they were made! She has changed them to ensure my fingers don't drift to the side during the night.

I have tried driving and did mange OK but found it made my hand quite achy. I also couldn't put the handbrake on! I'm going to continue to practise this week and hopefully I will be driving properly by next week.

Here are some up to date hand pictures:

18 Days Post-Op Check

Last Monday, I returned to hospital for my follow-up appointments with the nurse and the occupational therapist. The appointment with the nurse was first and she removed the dressing and the Steri-Strips which were holding my incision closed. I was quite pleased with how small the wound was and I was also pleased that she managed to remove all the sticky strips without it being too painful!

 

She did redress the wound and told me that I would be able to remove the dressing after two days and from that point I'll be able to wash the hand as normal but should avoid soaking it too long as that can compromise the wound healing.  Overall she seemed pleased with the way it was healing and didn't have any concerns or any need to see me again. Before I went round to see the occupational therapist the nurse also gave me a sick note to cover the full six weeks of the healing process. I had been hoping that I might be able to return to work for the start of term but the hospital had always been quite reluctant to discuss that idea. From wearing the splints for 2 1/2 weeks now, I can see that the list of things that I cannot do is too big to enable me to return to work. I am a bit disappointed about this but on balance I think it is the most sensible thing to do.  

 

Next, I went to the occupational therapist. She asked me how I was getting on with my exercises and I expressed my worries that I don't seem to be able to do the movements very effectively. I was hoping she could give me advice as to whether this was normal for this stage in the process or whether I should be doing better by now. I also showed her that my dynamic splint is not holding the fingers  very straight and she did end up adjusting it so that their fingers are held in a more straight position now. She observed me doing my exercises and said that I was doing quite well but also said that we could increase the frequency to every two hours from now on. She also explained to me that after I had removed the dressing I need to massage the skin on the back of my hand and around the scar tissue to help with circulation and to allow the skin to move over the joints. This will help me to regain a full range of movement as well, as the scar tissue can restrict the movement of the skin and tendons if the massage is not carried out. 

 

Overall, I was pleased with this appointment and determined to persevere with my exercise is to regain a full range of movement. The occupational therapist measured the angles of movement that I have at the moment so we can compare next time and hopefully see an improvement. My dynamic splint was less comfortable initially, now that the fingers are being held in a straight position, but my fingers have got used to it over the week and it is now pretty comfortable. I go back to the OT tomorrow to see how I'm getting on - hopefully I will show more improvement and a larger range of movement. 

Follow Up and Splints

In between leaving hospital and attending my follow-up appointments, my hand had been feeling okay. I experienced quite a bit of pain the first night at home but I realised this was partly due to my shoulder and arm aching from supporting the heavy bandaging. We made sure after that that the weight was being supported more fully by pillows and cushions and not my weak muscles! I also experienced some pain on my thumb where the bandaging seemed to be really digging into me and felt very hard and almost sharp. My husband used some small sharp scissors to trim away some of the bandaging and peel it back to relieve the pressure against my skin. The skin underneath did look very sore and slightly blistered and I knew that I would definitely ask the nurse about this when I went to my appointment. Other than these specific things, my hand wasn't too painful and I was managing with only one or two doses of codeine each day which I was quite pleased about.

My sore thumb

Five days after my hand surgery, it was time for my follow-up appointments with the nurse specialist and occupational therapist. I was quite apprehensive about the appointment as the first time I saw my feet after their surgery was quite bloody and gruesome. I was also worried as the ward staff had mentioned that I would have my stitches removed today and that was one of the most painful parts of the recovery from my foot surgery.

When we arrived, first of all we went to see the nurse specialist. I asked her straightaway exactly what was happening today, and she explained that she was just going to remove the bandage and check the wound and the stitches would be removed at a later date. I was very relieved by this and it did line up with the timeline of when my stitches had been removed following my foot surgery. As she removed the bandaging, it was quite difficult for her to cut through the cloth and peel it away from my skin due to the amount of blood that had soaked into the bandage and dried leaving it quite crusty and hard.  I also showed her the blistered skin on my thumb and she agreed that it looked sore but was not concerned by it.

Finally, she removed the bandage and revealed some sticky plasters holding the wound together. I was surprised by how small and un- gruesome the incision was! She also told me that it looked like the surgeon had used dissolvable stitches to close the cut and that would mean no painful stitch removal! She told me she was pleased with the way the wound was healing and then applied a clean sticking plaster over the whole area as well as a small plaster over the sore skin on my thumb and then sent me around to meet the occupational therapist.

The occupational therapist was lovely and made me a resting splint to wear all the time for the next two days and then, after Thursday, for me to wear at night time and if my hand became sore. She also gave some simple exercises to start practising immediately, moving the other joints in my fingers to keep them more mobile. She showed me one of the daytime 'dynamic' splints and it does look quite interesting and unusual with hammocks and elastic. She also emphasised the fact that I must not use my hand for six weeks after the operation. I am worried that this will definitely mean I won't be able to return to work for the start of the new academic year but we shall have to cross that bridge when we come to it.  I was able to choose the colour of the Velcro with my splint so I chose fluorescent pink!  (They didn't have purple!)

Two days later, I returned to get my dynamic splint. It took the OT about an hour to make as it is quite intricate with moving parts. It's hard to describe so here are pictures instead.

She also gave me exercises to do which exercise the replaced joints a little, using the dynamic splint to work against. They do make my fingers a bit sore but not too bad. The splint itself is quite comfortable but does make my hand ache after a while. I'm allowed to take it off overnight and also if my hand feels tired. I managed about 8 hours on day one and 11 hours today which I didn't think was too bad.

Overall I was very pleased with these appointments. The nurse specialist was particularly helpful, clarifying questions which the ward staff had left uncertain in my mind, such as how long I needed to wear the compression socks for. Now to work on my exercises until a week on Monday when I have my next appointments with the nurse and OT.

Knuckle Replacement Day!

On Thursday, we set off to the hospital bright and early for the check in time at 7:15. Due to a slight mix-up, we went to the wrong hospital first but ended up in the right one only a few minutes late (in my defence, the hospital we went to first was the place I have been for all my consultations). Thank goodness for my husband and I having a tendency to be early everywhere! I went through the check in procedure with the nurse, met with the anaesthetist and also had a final meeting with the surgeon. Luckily, they didn't make my husband leave so he was able to stay with me for most of the morning. The anaesthetist explained that I would be having a general anaesthetic and also a nerve block which would numb my entire arm through the procedure. The nurse told me that I was second on the list for my surgeon but as it turned out I think I was second out of two! I did wait for quite a while before I went in just before midday to replace the knuckles on my left hand. 

I woke up a few hours later in recovery. It took me a while to come around fully and when I arrived back on the ward I was sick. I had been hoping that I would not be sick this time from the general anaesthetic but unfortunately I was. I felt pretty rubbish after the operation and don't remember a lot until my husband came to visit at 6pm. At this point I had been sick a few times and my husband asked the nurses to give me an anti-nausea injection, the same I had received after my foot operation, which made me feel much better. My left arm was heavily bandaged and being held in an elevated position by a blue sling on a hook. It felt very strange. Although my arm was elevated next to me, it felt as though it was resting on my stomach; nerve blocks feel quite unusual! 

My post-op bandaging. Particularly attractive blood stains, I thought!

The surgery had been planned to be a day case and so I was expecting that my husband would take me home that evening. However, there was some confusion about me needing to see a physiotherapist before I was discharged and I was told that I had to stay in until the following day. As it turned out, that wasn't the case but on balance I feel it was best for me to stay in overnight as I was quite woozy and confused from the general anaesthetic and some morphine that I had been given to help with pain relief. 

I slept really well that evening, with my arm still held in the elevated position. The next morning, my arm began to get a bit painful as it had been taken down from the sling but it wasn't too bad and the codeine they gave me helped. Following clarification of the confusion about the physiotherapist, my husband was able to bring me home at about 11 o'clock. Before I left, I was given follow-up appointments with the nurse specialist and occupational therapists the following week. I was told that I would also be getting an appointment to see the physiotherapist at a later date. Overall, I was very glad to be going home as it had not been particularly pleasant stay in hospital. The ward that I was on was full of patients and it was quite a different experience than my previous stay in hospital when my feet were operated on.  Last time, I would have described the care I received as excellent whereas this time the strains and the nurse to patient ratio seemed to be less conducive to a very caring environment.

Gwen's Hand

I mentioned several months ago that my fingers were not really straightening properly. The issue is only affecting my left hand and means that my fingers can curl up to make a fist but cannot come up straight to make a flat hand (to give a high five, for example).

My fingers showing how well they can bend.

Their attempt at straight.

 

In addition to the lack of movement, my knuckle joints were getting sore more often and especially in cold weather. The pain was the main motivation for me to try and address the problem, although the lack of movement was also getting pretty annoying (being unable to put on gloves easily, for example).

I mentioned the problem to my rheumatologist last year and it resulted in several referrals. I saw an occupational therapist, a physiotherapist and a surgeon. The OT offered me some generic hand exercises and some advice on carrying things carefully to not hurt my hand. I didn't find it especially useful to be honest but they did say they could make me some splints if I felt I needed them in the future. The physio appointments were slightly more fruitful. The therapists looked carefully at my hands and the movements I was able to make and gave me some specific exercises for those precise joints. He measured the range of motion I had and compared this with new measurements at each appointment. Following some promising progress initially, the overall outcome was that the exercises weren't going to be able to get my full range of movement back and so the appointments stopped. The physio did recommend that the next option to look at would be surgery and that worked out pretty well as I had already had my appointment come through to meet the surgeon.

When I went for the first appointment with the surgeon, I was straight away sent for X-rays. Unfortunately, they didn't quite show clearly enough and I had to go for an ultrasound. After I had had that and returned for the second appointment with the surgeon, he told us that I would be a good candidate for knuckle replacement. The surgeon explained that the tendons were not damaged so would be able to be realigned once the knuckles had been replaced. He recommended that we think about whether we want to go ahead with the surgery before we made a decision. I decided quite quickly that I would like to go ahead with the surgery and so the operation was scheduled for 1st August.  

 

The surgeon explained that after surgery I would be in a cast for a fortnight and following that would need to wear two different splints, one during the day and one resting splint for night time. I was also told there would be quite a lot of physiotherapy to regain full movement of my hand. The surgeon seemed unsure as to whether I would be able to return to work, expressing concern about the complexity of the daytime splint and how I would get on teaching wearing it. However, I decided to try not to worry too much about exactly what would happen after the surgery and be more open to go along with whatever happened when it happened. I did speak to my headteacher and he said we would have to discuss it when we knew more about the splint, how I felt and whether I would be able to acquire a fit note from my GP or the surgeon. I went through periods of feeling quite eager for the surgery and confident that it would be really manageable compared to my feet and also periods of feeling really apprehensive and thinking I didn't want to have it done! Luckily the apprehensive thoughts were outweighed by the ones telling me it would be a good idea!

2 Year Foot-aversary

Today marks two years since I had my foot surgery! I am so pleased with my feet, it has made a dramatic difference to my life. Since having the surgery I have:

• Lost 3 and a half stone (50lb)
• Walked around Chicago and New York with no forefoot pain
• Bought new shoes without it being a total disaster and rediscovered old shoes that I can now wear pain-free!
• Been able to walk barefoot and also been able to go swimming again
• Started Pilates classes

I am so pleased with my new feet and the new things they have allowed me to do. My feet are currently looking like this:

You might notice that the right foot toe nail, which I mentioned last time was growing strangely and very thick, has now partly fallen off! I saw a different podiatrist, who filed across the face of the nail and about a week later, the top section just fell off! I was a little disturbed by this but it seems as though the nail is doing quite well and that top section wasn't really connected to the live nail anyway. I am continuing with my tea-tree oil and it seems to be growing through a bit healthier. The scars are fading but still visible (which I'm quite pleased about actually - I want proof of what I went through!) and the toes are much less wobbly and floppy now - the joints seem to have stiffened up a bit. Here are the bunion wounds:

 

You can see they look great too. Even though the bunion bone does protrude a little bit it has not caused me any pain so I'm totally happy.

When you compare them to my old feet, you can really see the difference:

 



Overall, it's been a great two years and I am so pleased that I made the decision to have the operation.