Monday, 25 February 2013

12 weeks! Moans and milestones.

Wow! Today is a special day. It is the 12-week "anniversary" of my operation. Is it me or has that three months gone slooooooowwwwwwwly?

I'll start with some positives.

I'm still able to drive and finding it gets easier, although sometimes if I have to use the clutch too much it makes my foot hurt. But it is so nice to have the freedom that driving brings.

Other than that, there's been nothing major. I'm still doing my exercises, which I still need to photograph/video for you, and still hobbling around.

That's my moan - that my left foot is still very painful following being yanked by Emma of orthotics, and I've decided to put in an official complaint about her as I feel she's set my recovery right back.

I limp on that foot and it is still extremely painful along the top of the foot, in a line down the centre of the toe and along the foot itself.

I've noticed that whereas a few weeks ago I was thinking about how to move or do things, I am now doing things without thinking.

While that is definitely progress, it does mean that sometimes I do something my feet don't like - and they really let me know!

I'm continuing to massage my scars every day, and they still look much as they did a few weeks ago.

In fact, I can see now why so many bunions blogs start to peter out around this stage of recovery.

There just isn't much to say!

That, and life begins to get busy again as you get back to normal and there's less time for blogging.

But I really do want this to continue to be a resource for people, so I'm determined to carry on blogging and updating you.

Tomorrow I go back to the hospital and I'm hoping to see Mr Nugent. If I don't get to see him I plan to ask for another appointment so that I can.

As I have very little to say, I thought I'd leave you with some pictures of my feet in socks, with the spacers in and without, so you can see the difference the spacers make, and the shape of my feet with no orthotics or spacers.

They're not quite as straight as I hoped, but I still think they're pretty good!

Here they are with the spacers (taken in daylight):

And without (using flash):

Remember, if there's anything you want to ask me, or ask me to write about, you can message me via the comments section below each blog post. I love to hear from my readers so feel free to write me a comment. I try and reply to all comments, although it may take me a few days.

Sunday, 17 February 2013

Progress at 10 weeks 6 days

Despite today's blogfest, which has no doubt overwhelmed you with posts to read, I thought it was time for a specific progress update.

Incredibly, it's been two weeks and four days since I posted my video updates, and three weeks and a day since the last non-video progress report, so it's definitely overdue.

However, I think it's important to remember that the casts came off at seven weeks and one day, so it's not been that long since then.

If you want to catch up then click on the "progress" tab in the labels cloud to the right and they will come up, or find them in the archive, also to the right.

At seven weeks I was able to walk but only slowly, and I could go up on tiptoe between 2.5 and 3 inches

At eight weeks I was walking on stairs using alternate feet, and had slightly improved tiptoe-motion.

Now, I don't even think about what I'm doing on the stairs, and I have started going up on tiptoe to do things like reach into cupboards and get out of the bath, without even thinking about it, which is great.

Walking is getting a bit quicker, although I've been set back a bit by the orthotics lady who has made my left foot really painful with her yanking of my big toe.

The biggest bit of progress has been getting back behind the wheel.

As I live in the UK, I drive a manual car (aka a stick shift, as it is hilariously called in the US) so I have to be able to use the clutch safely.

Yesterday, I had a go at driving home from Tesco and I managed it! I did need the seat a bit closer to the wheel than usual, to avoid overstretching my toes, but I managed it.

I don't think I could cope with too much clutch control, like in heavy traffic, as they did ache, but I can definitely do short trips that don;t have too much stopping and starting.

However, I managed to crock myself a bit with the Tesco trip. What was supposed to be a half-hour shop turned into an hour and 90 minutes with hubby and the Little Lady and it was just too long to be on my feet, especially on my new orthotics.

My legs, especially my knees, really ache today and I've had to elevate them all day and try and rest.

Half an hour would have been fine I think, though, and it's all progress.

So there we are. I'll do some pictures of the tiptoes test and my exercises this week.

Wobbles and worries

Something I know from previous times I've had surgery that alters my appearance, is that at various points along the road to recovery I end up having moments of severe anxiety.

I'm sure this is just a normal part of the process. Having surgery is a major thing in itself, but add in the fact that you want certain results from it, both functional and aesthetic, and there is huge potential for worry.

My main aim with having my bunions done was to end the pain, but I also wanted to get rid of the unsightly bumps on the sides of my feet, and have pretty feet that I wasn't ashamed of people seeing.

I've had a couple of moments of worry, one of which is happening now, and they are both about the same thing - are my big toes really fixed or are they bending back over?

Now, you've seen the pictures, so you know that in reality the toes are much straighter than before. But I have times when I think they are shifting back over again. And there are times when it really does look like that, but then I wonder what other people's feet look like, and I reckon mine, now, probably look like most people's.

Or at least, most people who habitually wear shoes. It wouldn't be helpful to compare my feet to unshod peoples', which look very different (and presumably much more like all feet should naturally look).

As you can see, the shod foot looks like what we would call a 'normal'foot, whereas the shoe that hasn't worn shoes (quite possibly, ever) has more spread-out toes. I'm going to revisit this in a blog post at some point; I find the whole barefoot movement facinating and very appealing.

Anyway, what's been happening is that occasionally I look at my feet (first thing in the morning and in the bath are particular flashpoints) and think "oh my goodness! Look at my toes!! the big toes have gone back to where they were before! They're touching my second toes! It's all gone wrong!" and I feel like crying.

I'm sharing this only so other people who have this surgery will know that this reaction is normal and to be expected. It is also not rooted in reality.

Here's some pictures to show you what I mean.

When my feet have been resting for a while without the spacers, such as overnight, or in the bath, they tend to look like this.

Which does look horribly like the big toes have moved back toward the other toes. However, this picture is of the feet in mid air, not on the ground, plus some of what is happening is that the other toes have moved into a straighter position now the big toe is not constantly shoving them over to the side, so filling the space I've grown accustomed to seeing next to my big toe, especially when I have the spacers in.

Here is the foot placed on the ground.

I don't think the actual toe placement is any different, although the right one may have moved slightly, but being on the ground somehow makes the big toe look straighter, so my theory is that the pressure from the floor alters the shape of the rest of the foot. (And yes, I do seem to be holding my left foot at a funny angle, it's probably because it hurts, thanks to Emma of orthotics.)

And here are my feet after I walked (well, limped) around the living room, then stood still.

It's a subtle difference between this picture and the first one, but the toes have spread out slightly from the weight on them and the action of walking, and they look much more how I would want them to look (although never as straight as with the spacers, sadly).

So, I hope this shows how wobbles and worries are just that, and shouldn't be taken too seriously.

And if all else fails, I just have another look at my before picture.

Yep. Surgery definitely worked!

The osteopath gets her hands on my feet

The last time I went to see my osteopath, Jane Kaushal of Hands On Health, she seemed rather keen to get her hands on my feet!

I felt too nervous last time, but in the last fortnight my feet seem to have improved a lot so I thought that yesterday I'd allow her to have a go at them.

Because the orthotics woman had really hurt my left foot (see this post for details) Jane decided just to look at my right foot.

She massaged the arch of the foot, or more specifically, the plantar fascia muscle that runs under the foot. I know that muscle is really tight as just pressing on it with my finger is painful, so it was good to have her expert hands on it.

She spent a few minutes on it at the end of my usual session, so it was only a quick massage, but it made a big difference - my feet felt really different afterwards.

Encouragingly, Jane said she felt that my midfoot was much more flexible than she had expected. I'm hoping this is because I've been doing my exercises and looking after my feet, but it may simply be because I am highly flexible.

The midfoot is the blue section in this picture. The grey section is the bit of the foot up to where the toes start, which I guess is called the forefoot, and the white bit is is the toes. I assume medical people also call those toes, lol. (You can read about foot anatomy here.)

I have borrowed this picture from this website. If you click on the link, you may notice, as I did, that the foot used in the video on the page has a bunion! They are EVERYWHERE and I plan to do a post on that at some point as the more I look at feet in magazines and images, the more I see bunions.

But I digress.

So, Jane was generally happy with how my feet are recovering, which is great to hear as I really respect and value her opinion. I also plan to let her loose on my feet again, and hopefully both of them, as it made a big difference to my right foot and I think will help speed my recovery.

So far, my recommendations for good recovery are:

Decent trainers (*sad face*)

Toe spacers

Exercises (see here and here)



Plenty of rest for the first weeks/months

Gentle mobilisation when you are ready

And most important - LISTEN TO YOUR BODY and do what it tells you. Don't push it too far.

One final point. Jane felt it was important for me to spend some time without the spacers in. I do already take them out at night (keep meaning to post about that) but now I'm going to incorporate some spacer-free time in the day too, and walk around without them. Jane said it would help with the muscle mobility, which may be hindered by using the spacers all day. (Jane, if you're reading and I've not explained that very well, feel free to email me a better explanation I can post on here.)

Saturday, 16 February 2013

Two hospitals, one day, and three orthotics.

Thursday was a busy day, and not just because it was Valentine's Day and I was sorting through my large pile of cards from admirers for the best part of the morning.


Actually, I did end up with three cards - one from the hubby and two from the Little Lady, bless her - but I was busy because I had two hospital visits.

The first was at the Royal Berks to the orthotics department. You may remember I'd asked to be referred when I had my casts off, and the appointment came through very fast.

It turns out that it came through too fast, and I have to go back in a month, but I did have a full appointment anyway.

I saw someone called Emma. I'm not sure what her title was because I didn't catch it (does anyone ever? They just rush their name and title at you as soon as you walk in and I'm lucky if I remember their name) and she isn't listed on the department's web page so I can't look her up.

What can I say about her? She was young, probably mid to late 20s, she was Scottish...oh yes, she nearly crippled me.

Obviously she needed to examine my feet, but she took hold of my left big toe, grabbed it and then YANKED it up towards the ceiling!

I nearly hit her!

It was so painful, but she didn't feel the need to apologise. She just carried on.

I did ask her to be more gentle, and we managed the rest of the examination without incident, although afterwards she said "I thought you were going to assault me". If I had, I'd only have been returning the favour!

I wasn't very impressed with Scottish Emma, which is a shame as we share both a name and a heritage, but she told me all about how bunions are not caused by anything at all, and are not only purely genetic (that bit's true) but "just happen". Hmmm. Not what almost every other medical professional will say, but she certainly seemed to believe it.

Another medic to add to my "do not believe" list I guess.

I came away with some insoles for my shoes, with added-on bits supposedly making them a bit more tailored to my feet.

When I go back they will see whether I need custom-made ones, which was what they were going to make for me this time but can't. The ones I was given cost £50 while the custom ones cost £150, so I imagine they'll try to avoid making some for me if possible.

This is what they look like.

The coloured bits are the added-on sections.

And this is the box, in case you're interested. Emma told me that it is cheaper to buy them direct from Talar so if you want to get some then this is the box to look for. I had a look on their website and am not sure which ones are mine exactly, but they definitely are cheaper direct.

Emma told me to wear them for short periods and build up to a full day because the foot has to get used to a new position. I figured that I am a) not walking much and b) getting used to new foot function anyway, so I'd just wear them whenever I wear my trainers.

That appointment done with, and a new one booked for next month (at which I hope I get someone else), I went to my local hospital in the afternoon for a physio assessment.

Townlands Hospital is a cute community hospital which has been saved from closure numerous times, although much of it has been shut down, including the maternity unit. These days if you want your child to be born in the town then you have to have a home birth (which is exactly what I did, although not for that reason).

We still have one building left, which houses the minor injuries unit (like a mini A&E, very useful) and the physio department, plus X-ray facilities, and other things such as clinics. My first appointment with Mr Nugent was at Townlands; it's an excellent facility to have.

Enough eulogising!

My appointment was with Ed. Unlike the RBH physio bit I went to while on Hunter ward, which was like a storecupboard, Townlands has a large room filled with equipment, although there was only Ed and me there.

We chatted about my history and operation, and Ed had a look and tested my mobility.

Sadly, because nobody measured my mobility before my op, we don't really know how much I have lost. Ed says there's no 'normal' so it's impossible to say, which is a shame really.

But what I do have is the ability to bend my toe 35 degrees, which is about two-thirds of what Ed can achieve, so I'm not doing too badly. I am pretty hypermobile, so I probably had much more than that, but average will suit me fine.

Apparently my toes are weak and stiff, but that's only to be expected really. Thankfully, Ed approves of all my exercises (see here and here) and just added in one more, which uses an elastic band (very high-tech!) as a resistance band for my big toes.

Basically I have to use the band to pull my toe in one direction, like towards me, then use my toe to push against that the other way, then swap and do it in the other direction. This will build up my strength in my toes.

Ed also had a look at my orthotics, and devised me a different one, for my most painful foot. It's a short-term fix for my pain when walking. The idea is that my other toes are lifted up so that when I propel off from my toes the big toe doesn't have so far to travel.

In the short-term this will help me learn a new gait or way of walking that is correct, as at the moment I'm tending to either walk stiffly, or to propel off the side of my foot.

This orthotic looks like this:

It's basically made from thin foam board (probably not the proper name for it) like the stuff you can get for crafts, and some cut up pieces of that padded sticky stuff (also not the proper name) that you can get from Boots, like this.

All very Blue Peter, but it does work.

One thing you might notice is that it has been cut to my actual foot shape. Yes, that is my actual foot shape! Amazing. I'm so pleased.

I see Ed again in a couple of weeks. Our goals are to maximise mobility and minimise pain, so we shall see if we can manage it.

Ed did say he might read the blog, so if you are reading Ed, then hello!

Sunday, 10 February 2013

A letter from my surgeon

You may remember the rather unsatisfactory dicsussion I had with a doctor the last time I went to hospital, to have my casts removed.

If you don't, then you can read about it here, but basically he told me I could wear any shoes I wanted from that point on, I could drive within a few days, and didn't need to do any exercises or have physiotherapy.

I was deeply unhappy with that advice because I felt that it was, not to put too fine a point on it, wrong.

So I called my surgeon's secretary, who was lovely and agreed to print out an email from me and give it to Mr Nugent.

So I did that on the Wednesday after my Tuesday appointment. On Friday afternoon I realised I'd had a bounceback to my spam folder (doh!) so I resent it. And then I waited.

It took a long time, due mainly I think to the actual time it took for the letter to be posted, but last week I received a letter with some responses to my questions.

I had asked:

Should I be wearing trainers?

Can I walk barefoot in the house? Or should I wear the velcro shoes?

Should I be doing some exercises? The doctor yesterday said no but I have heard of just gently moving the toe up and down, and raising the foot on the toes, to increase the range of motion, and if appropriate I would like to do that - is it OK?

The doctor also said I could drive next week but I don't feel I'll be ready. When is normal to go back to driving?

My middle left toe is very red, swollen and feels bruised, and kept me awake with agonising pain last night despite me taking two codeine tablets. I think the cast has been pressing on it and has bruised it. Is this likely and should I be doing anything?

The doctor told me I could rub Bio Oil on my incisions to help the scars, so I am doing that. Is there anything else I should be doing for scar management?

How much walking should I try to do? I feel very unstable and sore, and not sure how much would be too much?

Also, the skin on my foot where the cast was is very tender, feels gritty and is a speckled red, is that OK? I rubbed all the dead skin off by hand in the bath last night so maybe I was bit enthusiastic?

Can I take the spacers out when I have a bath or do they need to be in 24/7?

My right spacer is very uncomfortable under the adjacent toe when I walk - can I cut it to make it less lumpy or is it possible to get a new one made?

So many questions! But in my opinion they should all have been answered at the appointment, without me having to ask. I'd say they are fairly basic.

Mr Nugent was comprehensive in his reply, which I've photographed removing my identifying information. I hope you can read it. I think that if you click on each picture it will open up an enlarged version for you.

He has said everything I expected to hear, really.

Yes, I need to wear trainers.

Yes, I need physiotherapy.

No, I can't drive immediately.

Yes, I can trim the spacers. Although I didn't expect to be told I could stop wearing them at nine weeks. I'm choosing to continue to wear them.

Yes I need to exercise although walking should be sufficient. I'm choosing to do some specific exercises as detailed in these posts, though, because I think they are useful.

So that's good to know. But I think that such basic information should be in a printed sheet and handed out at follow-up appointments so people don't have to ask, be misinformed, and chase.

Imagine if I'd followed the other doctor's advice? I could easily have ruined my feet. That's not good for anyone; me, or the NHS. I really do think it's time the follow-up care matched the quality of the surgery.

Frustrated and achy at 9 weeks 6 days

Sorry for being a bit AWOL recently. I usually aim to write something every four days max, but I've been a bit busy and a bit miserable and so after posting my videos over a week ago I've been MIA.

I'm feeling quite down about my feet right now. Some of it is not really to do with my feet. Partly it's because it's winter and I get a bit of Seasonal Affective Disorder (SAD) which you can read about here. I have had depression on and off since I was 13, and although I've been free of its worst ravages for a few years now, I do find winter a VERY hard time.

It's also partly because had I not lost my last pregnancy, I would have been a new mum with a two-week-old right now, and that is obviously a really difficult milestone to face. Especially as I have lost five babies in pregnancy, to first-trimester miscarriages caused by my Factor V Leiden, which you can read about in older posts here.

So it's been a tough time.

Add to that the fact that my feet ache all the time, and I often get some sharp throbbing along the incision sites, and you can see why posting hasn't been my top priority.

But I have promised this would be a no-holds-barred account, and so it's only right that I explain my absence.

Over the last week and a bit, my feet have definitely entered a new phase of recovery. Sadly, it's a really difficult and frustrating stage that brings with it new aches and pains.

I've gone from my feet being mostly OK, to them hurting pretty much all the time. In the main it's a dull ache in the big toes, and under the foot in the arch, as well as generally in the soles.

If you have a read of what makes up the arches of the feet, it's easy to see why this is happening.

My feet have been totally reshaped by the bunion removal. Bone has been cut, shaved and moved, tendons have been moved and adjusted, and now my entire leg needs to work in a new way, which puts strains on pretty much all the muscles in the legs and feet.

So my hips ache, my knees ache and click (because they always have clicked at times, it probably wont happen to you!), and my feet hurt as well.

Seriously, I'm trying to be upbeat but I am struggling because I feel so miserable!

I have managed to see my osteopath. Last weekend I had my first appointment with her since the surgery, and it was great!

She was amazed at the new shape of my feet, and also at how tight my entire body is! Clearly, all this inactivity and new ways of using my body have taken their toll - my back was so tight she couldn't finish it off in the session, and my head and jaw muscles (the reason I go to her in the first place) were so bad I need another session really soon.

But she was quite keen to get her hands on my feet! I said no because the thought of it made me go cold, but since then I've been thinking how nice a good massage that properly remvoes the tension in my feet would be, so next time I think I'll let her.

I definitely wouldn't let someone without her level of knowledge do it though - no massage therapists for sure. My osteopath is Jane Kaushal (see her website here) and she has good knowledge of anatomy and is highly skilled.

The main frustration is that I expected to be much more mobile by now. I thought I'd be able to walk about almost normally, so that a short trip into town or on the preschool run would be feasible, and while I thought I'd need to rest still I didn't expect a short baking session with the Little Lady to completely wipe me out.

But I'm nothing if not adaptable. So I've arranged for my lovely mum to come and stay next week (half-term!) to help out with the Little Lady, maybe do a little bit of cleaning for us, and generally ensure I'm not trying to do too much, which I definitely have been this last week and I'm suffering as a result.

And I'll probably be leaning a bit more on my fabulous friends again, to do school runs and help me entertain the Little Lady. I know I owe so many favours right now, but I'll happily pay them back because everyone has been so amazing.

This week I have a hospital appointment to get fitted for some orthotics, which are shaped insoles for my shoes. I had asked about those at my last appointment and the date came through really quickly, so hopefully they'll be made in the next few weeks.

My plan for the future is to wear orthotics and spacers as much as possible, to help maintain my foot shape and hold off recurral of the bunions.

So that's me at the moment. Little Miss Miserable! Let's hope I'm Little Miss Sunshine again soon.