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.


  1. Be interesting to know what the physiotherapy involves. Mine was electric shocks to the feet and walking on a piece of wood for balance. I was also told never to wear arch supports.

    1. Hi. sorry I've beeen a few days in getting to reply to you. I went for my physio yesterday and will be doing a whole post on it soon, when I get a minute, but basically the physio approved the exercises that I have been doing, gave me another one involving an elastic band (for resistance) and made me an interesting orthotic that won't help with mobility but will help with walking pain until I get a bit more mobility. No electric shocks in sight! That sounds barbaric. Did it work?

  2. I've really enjoyed reading your blog, which I stumbled upon last night, and I'm surprised it hasn't attracted more comments. I had the same procedure, but on one foot only, on the 7th December. I also had my second toe shortened. I was told I'd have a better recovery if I had surgery on one foot at a time, even though both need doing.

    My left foor is still very swollen - from top to bottom rather than side to side - which is why I'm not in my own shoes yet. I have two screws and a pin in my foot but I didn't have a plaster cast on, just lots of bandages and a podalux shoe. I came out of hospital the following day having had walking and stair climbing lessons from the physiotherapist. I was allowed to walk with the shoe on, but only for "tea, toast and toilet". We borrowed a wheelchair from the Red Cross which was marvellous. I could use it in the house and propel myself backwards using my good foot.

    Intead of a spacer I wear a splint at night. Many of my experiences mirror yours, and although I live "up north" now I had two of my children in The Royal Berks.

    Keep up the good work blogging.

    1. Hi! I'm glad you're enjoying the blog and thanks for sharing your experience. How interesting it is that some surgeons use casts and some don't. I wonder what the difference is in healing or if it's just their personal preference?

      When you say splint, do you mean one of those devices made of plastic and elastic? How do you find it? I've started taking my spacer out at night and it is so nice to have bare feet in bed again. Before I had to wear socks so my spacers didn't fall out overnight.

      What a coincidence that you are from this area! It's such a small world!

  3. Mine was bandages too, but I had both feet done at the same time, wore mocassins and was back at work after three weeks using crutches and walking sticks. Anon 2...what was the reason for toe shortening? My second toe is long and hits the end of a shoe half an inch before my big toe meaning I have to buy longer shoes ( that then slop)

    1. My second and third toes were heading off to the side - as if they were running away from the big toe. Surgeon talked about "releasing the capsule" to let the second toe swing back in the hope that the third would follow it. It was also heading towards becoming a hammer toe. Whatever he did it's much straighter now. I was expecting to have a wire sticking out of my toe but I think he shortened the metatarsal instead. Although my bunion was "very bad" and there was talk of fusing my big toe, once I was "on the table" he did the scarf procedure.

      I think, based on what I've gleaned from the internet, having a long second metatarsal can cause foot problems.

      I have a long scar on the side of my foot and two short ones, one either side of my second toe. I was surprised at how little pain I experienced after surgery, as, like you, I'd been warned that it was very painful. Taking the tablets and keeping the foot elevated seem to be the answer.

      The biggest drawback is the recovery time. I had been well warned about that but I thought I was going to be superwoman and do it faster. No chance. It takes as long as it takes. Fortunately a friend had it done before me so I knew what to expect.

    2. Are you the original anonymous (who posted on Feb 14)? Or are there three of you?! :)

      I can identify with the superwomen thing! I thought I'd allowed plenty of time to recover but it has been much slower and harder than I thought.

      It's great to be able to share our experiences and hopefully help other people who will go through this. Knowledge is power!


  4. It's me, Sella Vee, the anonymous from the 13th and the 15th. I think there might be 3 of us! I wear a night splint like the one you posted a picture of (credit Amazon) though mine is a rather fetching shade of blue, rather than flesh coloured. It's OK, but I'm glad to get it off in the morning. My big toe does keep drifting back, but I notice that when I put my foot on the floor and bear weight it straightens up quite a bit. Surgeon said he didn't make it perfectly straight because if he did I wouldn't be able to get shoes on comfortably.

    I've bought some men's shoes, 3 sizes bigger than I normally take, so that I have something to go out in. I saw someone looking at my feet the other day and I could tell she was thinking "Ah, bless, she's got odd shoes on." When you have one foot at a time done you only get one surgical shoe and since none of my other shoes are exactly the same height, not only do I have odd shoes, I have a limp as well. C'est la vie!

  5. anon here on 14th feb is the anon that had the op 35 years ago and posted 1st and 2nd of Feb
    I was told my big toes were fused but nothing else so really no idea what was done, or could be done in the future, things were very different back then. I woke from the op and they put an ashtray next to the bed, I had a ciggy and was sick. lol Then they made me stand up, it was agony. I fainted. Then they gave me an injection in my leg for the pain.

    1. A ciggy on the wards! That sounds mad now doesn't it!

      Fusing is definitely different. I've read about it and I think that now it is done for very severe deformity or where you need more stability of the joint for some reason. It may just have been how they used to do it - things move on don't they?