HUGE APOLOGIES! I thought I'd published this but it was still in my drafts. Sorry! I think I was going to add some pictures, but instead I'll just get this posted and do pictures for you another time. I do have videos I've been doing but I have so much trouble getting them uploaded to YouTube I may give up on them. Anyway, hope this is still useful/interesting and I'll get writing more I promise.
*should have been published a month ago, whoops*
It's been three weeks since my last update, and I'm now 21 weeks post-surgery.
Last week I picked up my new, custom, orthotics from the hospital. That marked the end of my hospital appointments at the Royal Berks, apart from when I need the orthotics replacing in about two years' time.
The orthotics are as slim as they can make them. You can see from the picture that they are really thin, but the curve of them where they support my arch and heel means that they push my foot up, which means I need to be careful what kind of shoes I wear.
I am working on a post looking at shoes, but basically my orthotist would like me to wear big, clunky shoes with very rounded toes, either completely closed or with a wide strap, and generally pretty ugly.
So far I've found I can wear my orthotics in my flat ballerinas, which have a rounded toe, because although they have no strap they grip the back of my heel and my heel doesn't slip out of shoe when I walk, which is often a problem with very open shoes.
I also wear a pair of sporty styled shoes with two velcro straps over the foot.
As the weather warms up, I probably won't wear the orthotics as often as I should, because you cannot wear them in sandals, but I do make sure that I am conscious of my foot positioning and pronation, and I hope that will be enough to make up for it. I'll definitely wear them all winter.
Right now, I can't wear them the whole time anyway. The orthotist told me I had to build it up by wearing them for half an hour the first day, then an hour the next day, and two hours the next, and so on.
I find they do make my feet and legs ache, because the muscles are adjusting to the new positioning, so I'm still working on increasing the time. I can't wear them in the house unless I wear shoes inside, and I usually wear slippers, so it's taking me longer to build the time up, but I think that's OK.
I also saw my physiotherapist again. I know Ed has been reading the blog, so "Hello Ed!" *waves*
I had to admit I've not been doing my exercises as much as I should have been, because they make me hurt, so I have promised that over the next month I will do them regularly, and wear my orthotics, and hopefully when I go again he will discharge me.
I did go back to yoga and have done two sessions now. Surprisingly, it wasn't as hard as I expected.
During my recovery I have been making sure I did foot exercises, and calf stretches, and I found I was no where near as stiff as I thought I'd be. My teacher, Minna (who also reads this so "Hi Minna!" *waves again*) does try to tell me to take it easy but I like to push myself and I never do anything that is painful.
As expected, it was a challenge to roll over my toes to go from all fours into downward dog, for example, but I either do it one foot at a time, or I do both together but put a lot of my weight onto my hands and arms.
Over time, it will definitely get back to normal, I'm sure.
I am actually really pleased with my recovery; with my range of motion and with my lack of pain. I know I've worked hard on my recovery but I also feel very lucky and blessed.
I do still have the problem with my toenail on my left foot, but I can now see that there is a new nail growing under the old one, and the old one is growing out, so in six months that is going to be back to normal. It's irritating, but a temporary annoyance.
So there we are! I'm still doing my exercises, building up my general stamina for walking and standing, and sometimes overdoing it a bit! Some days I'm fine, some days my legs and feet really ache, but the progress is in the right direction and soon, in terms of medical appointments, I'll be flying solo!
As usual, please ask any questions or make any comments below.
Showing posts with label exercises. Show all posts
Showing posts with label exercises. Show all posts
Monday, 27 May 2013
Sunday, 7 April 2013
Exercises
I thought it might be helpful to have a post with all the exercises I have to do.
Currently, I do a mixture of things my physio has given me, and some that I have found/invented myself.
1 - the elastic band
Take an elastic band, a reaonably thick one, and hook it round the big toe from below. allow the band to pull the toe up, then use muscles to pull toe back down next to the others. Repeat 20 times.
Move band so it is hooked from above. Use other foot to hold it on ground then lift foot so big toe is pointing down and other toes are not. Use muscles to pull the toe up, next to the others. Repeat 20 times.
Do 2-3 sets of these twice a day.
2 - the resistance band
Hook resistance band around something heavy, like a table leg. Place foot inside band loop, with band on big toe side of foot. Move foot till it is swung out to the side by the resistance. Then scoop the foot against the resistance even more, as though you wanted to look at the sole of your foot. Repeat 10-20 times.
Do 2 sets 2 times a day, building up to 3-4 sets once a day.
I found some pictures of this. The first one shows how I've been doing it, using the kitchen table leg to hold the band out to the side. I used to sit on a chair but it makes my knee hurt so now I sit on the floor like this guy is:
Picture courtesy of www.physioadvisor.com.au.
And then I found this picture:
Picture courtesy of https://healthy.kaiserpermanente.org
Which shows using the other foot to hold the band so you can hold it with your hand, meaning you can do it anywhere. Revelation! I'll be doing it like that from now on.
3 - toe curls
Various things to help the toes curl up and back, like tiptoeing but not while standing.
a) Lie in bed on your front. Curl toes under and use mattress resistance to help you bend them until it begins to feel uncomfortable. Stop and breathe through discomfort, then increase the stretch.
b) Face a wall, a little way away, and place palms on wall, leaning forward, as though to do a calf stretch, but then go on toes to curl them back. Do both at once if possible, one at a time if not. Increase stretch by moving further away from the wall.
Personally, I find this one scary and painful, and so I do it one at a time, but Ed says I should do it both together ideally.
c) Stand facing a stair (or wall). Position yourself so your toes are up the stair and your sole on the floor. The closer you are to the stair, the bigger the stretch.
4 - tiptoe exercise
Go up on tiptoe, either using your hand to support yourself on a table or sofa, or freestanding, and allow your weight to go through the toes. Go as high as you can.
5 - toe bends
These are to help your toes bend down, and to counteract all that tiptoeing.
a) Sit down and use your hand to bend all the toes over and down, stretchng as much as possible. Then do each toe one at a time.
b) Stand up, and tuck the toes of one foot under so the nails are on the floor. Put some body weight through until the stretch is uncomfortable, then hold.
6 - toe V-bends
Using your hands, pull the big toe out, away from the other toes, to create a V shape. Hold at your maximum stretch for a while, then release.
Currently, these are all the things I am doing, as well as massaging my feet generally, and my plantar fascia muscle (the arch of the foot) specifically, as that gets quite achy.
It's a lot, and that's why they don't all get done every day, but they do all get done over a week, usually. It is hard work, but that's the only way that the mobility can be regained - it won't come back on its own, you do need to work at it.
Currently, I do a mixture of things my physio has given me, and some that I have found/invented myself.
1 - the elastic band
Take an elastic band, a reaonably thick one, and hook it round the big toe from below. allow the band to pull the toe up, then use muscles to pull toe back down next to the others. Repeat 20 times.
Move band so it is hooked from above. Use other foot to hold it on ground then lift foot so big toe is pointing down and other toes are not. Use muscles to pull the toe up, next to the others. Repeat 20 times.
Do 2-3 sets of these twice a day.
2 - the resistance band
Hook resistance band around something heavy, like a table leg. Place foot inside band loop, with band on big toe side of foot. Move foot till it is swung out to the side by the resistance. Then scoop the foot against the resistance even more, as though you wanted to look at the sole of your foot. Repeat 10-20 times.
Do 2 sets 2 times a day, building up to 3-4 sets once a day.
I found some pictures of this. The first one shows how I've been doing it, using the kitchen table leg to hold the band out to the side. I used to sit on a chair but it makes my knee hurt so now I sit on the floor like this guy is:
Picture courtesy of www.physioadvisor.com.au.
And then I found this picture:
Picture courtesy of https://healthy.kaiserpermanente.org
Which shows using the other foot to hold the band so you can hold it with your hand, meaning you can do it anywhere. Revelation! I'll be doing it like that from now on.
3 - toe curls
Various things to help the toes curl up and back, like tiptoeing but not while standing.
a) Lie in bed on your front. Curl toes under and use mattress resistance to help you bend them until it begins to feel uncomfortable. Stop and breathe through discomfort, then increase the stretch.
b) Face a wall, a little way away, and place palms on wall, leaning forward, as though to do a calf stretch, but then go on toes to curl them back. Do both at once if possible, one at a time if not. Increase stretch by moving further away from the wall.
Personally, I find this one scary and painful, and so I do it one at a time, but Ed says I should do it both together ideally.
c) Stand facing a stair (or wall). Position yourself so your toes are up the stair and your sole on the floor. The closer you are to the stair, the bigger the stretch.
4 - tiptoe exercise
Go up on tiptoe, either using your hand to support yourself on a table or sofa, or freestanding, and allow your weight to go through the toes. Go as high as you can.
5 - toe bends
These are to help your toes bend down, and to counteract all that tiptoeing.
a) Sit down and use your hand to bend all the toes over and down, stretchng as much as possible. Then do each toe one at a time.
b) Stand up, and tuck the toes of one foot under so the nails are on the floor. Put some body weight through until the stretch is uncomfortable, then hold.
6 - toe V-bends
Using your hands, pull the big toe out, away from the other toes, to create a V shape. Hold at your maximum stretch for a while, then release.
Currently, these are all the things I am doing, as well as massaging my feet generally, and my plantar fascia muscle (the arch of the foot) specifically, as that gets quite achy.
It's a lot, and that's why they don't all get done every day, but they do all get done over a week, usually. It is hard work, but that's the only way that the mobility can be regained - it won't come back on its own, you do need to work at it.
18 weeks - progress and an update
We are so overdue a post, and I have not told you about quite a few appointments, that I almost don't know where to start with this. Which is partly why I've not posted, because I'm one of those people who becomes overcome with procrastination when I am behind with things. Even though that just makes it worse! I know, I'm weird.
Anyway, it's been six weeks since I last updated. Then, I was finding driving challenging, limping on the foot the orthotist had yanked the toe of, getting more mobile, and due to go back to the hospital.
Now, I have been discharged from the hospital, I've been back to the orthotist (who was nice this time!) and had my feet cast for custom orthotics, and had two physio sessions.
At my discharge appointment I was very disappointed that, once again, I did not get to see my surgeon! So I haven't seen Mr Nugent since he changed my casts at 2 weeks, and won't get to see him ever again!
Is it just me, or is that weird? I really wanted to hear how HE felt it had all gone, but that's not going to happen. I did consider phoning his office and arranging to see him, but I never got around to it (see, it's that procrastination again) and now I guess I can't see the point. But it would have been nice.
Going back to the orthotist was interesting. Mainly because I spent hours beforehand trying to buy some shoes that would fit my standard orthotics, only to be told by her that I should wait till I got my custom ones. Just as well I didn't buy anything!
She had a really good look at my feet, and commented that I have good control over my tendency to overpronate (roll my feet in). I do work hard to remember to hold them straight, and it's starting to become a subconscious thing now, so that's good, as I believe that will also help my knee problems a bit.
I'm waiting for my custom orthotics to be made. They cast your feet using oasis - the stuff florists use - in a shoe box. They just just push each foot into it and then make a cast from that, then use that cast to make the orthotics.
It hurt a bit doing the oasis, because she pushed my foot down first and my toes bent up a bit, so on the next foot I asked her to push the toes down at the same time, which was much better.
I go back to get them on April 22 and then I will have to try and find some vaguely attractive shoes that will accommodate them! I've been researching already, and will do another post on that.
As for physio, Ed is very patient with the fact that I don't do my exercises as much or as often as I should! He actually is a really great physio and listens to my silly worries and then works with me to see what we can do about them, which is fantastic.
I really need to video and photograph all of them, but I already told you about the one with the elastic band in this post, and now I also have a resistance band that I have to use to work the muscles that lie along the sole of my foot and around my ankle.
I hook it around a leg of the kitchen table, then put my foot in it with the band around the big toe side, and kind of scoop my foot. The instructions say "as if to look at the sole of your foot". I'm supposed to do this 10-20 times, two times, and twice a day, building up to three to four sets of 20, once a day.
It is extremely hard work. More so than you'd imagine. And so I'm a bit lax about it which is bad, but I do try and keep up with all my exercises as much as possible. There just seem so many now!
I do have a video of me doing it, which I made a few weeks ago, and I'll upload it to YouTube and get it posted soon.
Last time I went to see Ed, we talked about how scary it is for me to do things like sit back on my heels with my toes tucked under. Like this:
So we talked about some things I can do to improve my ability to do that without the frankly frightening levels of pain it currently causes.
He also measured my progress in terms of being able to go on tiptoe. Previously, I was achieving 35 degrees, but now I have improved to 45 degrees. I'm really pleased with that, and hope to improve it further.
Last time I posted about physio, I said that 35 degrees was two third of what Ed can do, which means he can manage about 53 degrees, by my rudimentary maths. So that's something to aim for, and maybe I could even improve on it?! (competitive, me?)
Finally, in this quick round-up of the past six weeks, I'll end with the letter I received from Mr Sikranth Kodali, the doctor I saw at my discharge appointment at the Royal Berks.
He was writing to my GP, and summed up my progress as: "She is having mild discomfort in her big toes otherwise she is doing fine. I can see her excellent range of motion in the first MTP joint and the osteotomy site is solid. All the X-rays done before are satisfactory. She is not 100 per cent happy as the correction of the big toe is not 100 per cent straight. I explained to her that there is always five to seven degrees of distal interphalangeeal joint angle, but otherwise the overall alignment is absolutely fine.
"She can slowly build up her activities over the next six weeks and I am pleased to discharge her."
That last bit was something of a surprise. I didn't remember him saying that to me, and so I'd pretty much gone back to normal, but from the aching and pain that followed it's obvious I should have eased myself back in a bit more. Although how I'd have done that I don't know - after a while people expect you to be back to normal and the help and support dries up, understandably.
Anyway, as of tomorrow I'm past that magical six weeks and so I'm hoping to see improvements in my stamina. Currently, my feet and knees ache almost constantly again, but more of that in my next post, which will be about all the things I am able to do now. It's a long list, hurrah!
Anyway, it's been six weeks since I last updated. Then, I was finding driving challenging, limping on the foot the orthotist had yanked the toe of, getting more mobile, and due to go back to the hospital.
Now, I have been discharged from the hospital, I've been back to the orthotist (who was nice this time!) and had my feet cast for custom orthotics, and had two physio sessions.
At my discharge appointment I was very disappointed that, once again, I did not get to see my surgeon! So I haven't seen Mr Nugent since he changed my casts at 2 weeks, and won't get to see him ever again!
Is it just me, or is that weird? I really wanted to hear how HE felt it had all gone, but that's not going to happen. I did consider phoning his office and arranging to see him, but I never got around to it (see, it's that procrastination again) and now I guess I can't see the point. But it would have been nice.
Going back to the orthotist was interesting. Mainly because I spent hours beforehand trying to buy some shoes that would fit my standard orthotics, only to be told by her that I should wait till I got my custom ones. Just as well I didn't buy anything!
She had a really good look at my feet, and commented that I have good control over my tendency to overpronate (roll my feet in). I do work hard to remember to hold them straight, and it's starting to become a subconscious thing now, so that's good, as I believe that will also help my knee problems a bit.
I'm waiting for my custom orthotics to be made. They cast your feet using oasis - the stuff florists use - in a shoe box. They just just push each foot into it and then make a cast from that, then use that cast to make the orthotics.
It hurt a bit doing the oasis, because she pushed my foot down first and my toes bent up a bit, so on the next foot I asked her to push the toes down at the same time, which was much better.
I go back to get them on April 22 and then I will have to try and find some vaguely attractive shoes that will accommodate them! I've been researching already, and will do another post on that.
As for physio, Ed is very patient with the fact that I don't do my exercises as much or as often as I should! He actually is a really great physio and listens to my silly worries and then works with me to see what we can do about them, which is fantastic.
I really need to video and photograph all of them, but I already told you about the one with the elastic band in this post, and now I also have a resistance band that I have to use to work the muscles that lie along the sole of my foot and around my ankle.
I hook it around a leg of the kitchen table, then put my foot in it with the band around the big toe side, and kind of scoop my foot. The instructions say "as if to look at the sole of your foot". I'm supposed to do this 10-20 times, two times, and twice a day, building up to three to four sets of 20, once a day.
It is extremely hard work. More so than you'd imagine. And so I'm a bit lax about it which is bad, but I do try and keep up with all my exercises as much as possible. There just seem so many now!
I do have a video of me doing it, which I made a few weeks ago, and I'll upload it to YouTube and get it posted soon.
Last time I went to see Ed, we talked about how scary it is for me to do things like sit back on my heels with my toes tucked under. Like this:
So we talked about some things I can do to improve my ability to do that without the frankly frightening levels of pain it currently causes.
He also measured my progress in terms of being able to go on tiptoe. Previously, I was achieving 35 degrees, but now I have improved to 45 degrees. I'm really pleased with that, and hope to improve it further.
Last time I posted about physio, I said that 35 degrees was two third of what Ed can do, which means he can manage about 53 degrees, by my rudimentary maths. So that's something to aim for, and maybe I could even improve on it?! (competitive, me?)
Finally, in this quick round-up of the past six weeks, I'll end with the letter I received from Mr Sikranth Kodali, the doctor I saw at my discharge appointment at the Royal Berks.
He was writing to my GP, and summed up my progress as: "She is having mild discomfort in her big toes otherwise she is doing fine. I can see her excellent range of motion in the first MTP joint and the osteotomy site is solid. All the X-rays done before are satisfactory. She is not 100 per cent happy as the correction of the big toe is not 100 per cent straight. I explained to her that there is always five to seven degrees of distal interphalangeeal joint angle, but otherwise the overall alignment is absolutely fine.
"She can slowly build up her activities over the next six weeks and I am pleased to discharge her."
That last bit was something of a surprise. I didn't remember him saying that to me, and so I'd pretty much gone back to normal, but from the aching and pain that followed it's obvious I should have eased myself back in a bit more. Although how I'd have done that I don't know - after a while people expect you to be back to normal and the help and support dries up, understandably.
Anyway, as of tomorrow I'm past that magical six weeks and so I'm hoping to see improvements in my stamina. Currently, my feet and knees ache almost constantly again, but more of that in my next post, which will be about all the things I am able to do now. It's a long list, hurrah!
Sunday, 17 February 2013
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)
Physiotherapy
Osteopathy
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.)
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)
Physiotherapy
Osteopathy
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.
Lol.
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!
Lol.
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:
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.
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.
Thursday, 31 January 2013
Progress report 8 weeks 2 days, VIDEOS!
I was walking down the stairs yesterday when I had a bit of a revelation - that I was WALKING DOWN THE STAIRS!
Sounds dullsville but it was the first time I have managed the stairs without having to put my heel down first, and without needing to put one foot down, then put the next foot on the same stair, like a child does.
This was so exciting I felt that pictures just wouldn't cut it. No still picture could possibly convey the amazingness (yes, it's a word) of me walking down the stairs. So I did a video.
And then I got carried away and did a few videos for you, of my exercises and walking, and just a general look at my feet and scars.
So...all the words today are in the videos, here for your viewing pleasure. Enjoy!
(By the way, don't my toes look fantabulously straight in that opening still!)
I'll tell you what, though, it takes at least half an hour for each one to upload to YouTube, so it's definitely not an option for a quick update. The third one took over 90 minutes to upload!
Let me know if you like them - leave me a comment here on the blog. If videos are popular, then I can do more. No weird requests please!
Sounds dullsville but it was the first time I have managed the stairs without having to put my heel down first, and without needing to put one foot down, then put the next foot on the same stair, like a child does.
This was so exciting I felt that pictures just wouldn't cut it. No still picture could possibly convey the amazingness (yes, it's a word) of me walking down the stairs. So I did a video.
And then I got carried away and did a few videos for you, of my exercises and walking, and just a general look at my feet and scars.
So...all the words today are in the videos, here for your viewing pleasure. Enjoy!
(By the way, don't my toes look fantabulously straight in that opening still!)
I'll tell you what, though, it takes at least half an hour for each one to upload to YouTube, so it's definitely not an option for a quick update. The third one took over 90 minutes to upload!
Let me know if you like them - leave me a comment here on the blog. If videos are popular, then I can do more. No weird requests please!
Sunday, 27 January 2013
Progress at 7 weeks 5 days and some other updates
One of the reasons for writing this blog is so that people considering the surgery, or booked in for it, or who had their surgery after mine, can see my progress and get an idea of how they will progress.
Obviously, everyone is different, and as a result we will not only all have different experiences of the surgery but also of the progress afterwards.
But I hope that this will give at least some idea of how the pain and mobility might be at certain points along the journey.
I realised that I forgot to mention a few things in my previous report because there was so much else to say.
Importantly, I wanted to mention that it took about 48 hours (two days) after the casts were removed before I could put my foot and toes totally flat on the floor without any pain.
I was surprised at how even that simple action was sore and difficult, but by two days afterwards, I was able to place the whole foot flat on the floor without difficulty, and put my weight through the whole foot too.
The first day I could, with effort, put my toes down, but there was no way I was going to put my weight on them! But the day after, I could do that too.
Now, at five days after the casts came off - I'll call it C-Day - I'm able to put all my weight on them happily, but I'm still wary of bending them as I walk, so I have a tenative way of walking that is slow and laboured.
But it's all progress, which is great.
I've labelled this post 7 weeks 5 days, which is actually yesterday, because I wanted to share yesterday's exercise pictures.
This one shows me pushing up on my toes on both feet. I have tried to hold a ruler so you can see how high I can get currently, but it's my black Filofax one and doesn't really show up well. I think I'll make a clearer one from cardboard for future pictures.
It's also not very accurate because the measurement doesn;t start at the edge of the ruler, but taking that into account you can see my heel comes up about 2.5inches.
This is just the left foot. I'm not sure if this one has more range of motion or if it's easier to push up on one foot at a time, but you might be able to see that this heel is around the 3-inch mark.
I promise I'll make a better ruler for next time!
Obviously, everyone is different, and as a result we will not only all have different experiences of the surgery but also of the progress afterwards.
But I hope that this will give at least some idea of how the pain and mobility might be at certain points along the journey.
I realised that I forgot to mention a few things in my previous report because there was so much else to say.
Importantly, I wanted to mention that it took about 48 hours (two days) after the casts were removed before I could put my foot and toes totally flat on the floor without any pain.
I was surprised at how even that simple action was sore and difficult, but by two days afterwards, I was able to place the whole foot flat on the floor without difficulty, and put my weight through the whole foot too.
The first day I could, with effort, put my toes down, but there was no way I was going to put my weight on them! But the day after, I could do that too.
Now, at five days after the casts came off - I'll call it C-Day - I'm able to put all my weight on them happily, but I'm still wary of bending them as I walk, so I have a tenative way of walking that is slow and laboured.
But it's all progress, which is great.
I've labelled this post 7 weeks 5 days, which is actually yesterday, because I wanted to share yesterday's exercise pictures.
This one shows me pushing up on my toes on both feet. I have tried to hold a ruler so you can see how high I can get currently, but it's my black Filofax one and doesn't really show up well. I think I'll make a clearer one from cardboard for future pictures.
It's also not very accurate because the measurement doesn;t start at the edge of the ruler, but taking that into account you can see my heel comes up about 2.5inches.
This is just the left foot. I'm not sure if this one has more range of motion or if it's easier to push up on one foot at a time, but you might be able to see that this heel is around the 3-inch mark.
I promise I'll make a better ruler for next time!
Friday, 25 January 2013
I like to move it, move it
One of the main concerns in my recovery is getting full range of motion back in my big toes, so that I can walk, run, do yoga and, ahem, wear heels.
I did ask the doctor (not my surgeon) at the hospital when the casts were removed about exercises, but he said I didn't need to do them.
However, I know from reading other people's experiences that in America especially, people get given exercises to do, and it makes sense to me that it would be beneficial to do some, even if the NHS doesn't deem them necessary.
The main exercises I can find online pretty much all seem to be the same as these ones here.
The timings on the sheet are different, because it seems that in America people get their casts off really soon, after a couple of weeks. I'm not sure why that is as the standard bone healing time here in the UK is six weeks - if you break a bone, you get a cast for six weeks - so it seems odd to me that they'd take them off sooner than that.
I'm glad I had mine on for seven weeks as I feel it gave my bones a really good chance to heal in the right place.
Anyway, ignoring the timings, I am now trying to do the same exercises every day.
So I hold my big toe near the operated-on joint and move it up as much as I can without crying, then hold for ten seconds, then do the same thing moving it down and hold for ten seconds.
Then I put my toes on the floor and lift up as though going on tiptoe, putting weight through the toes, as much as I can without weeping in pain, and hold for ten seconds.
It really hurts.
I am careful not to push beyond discomfort into agony as that would be counterproductive, but I have learned from yoga that it's important to breathe through mild pain and listen to your body so that you challenge it, but at the same time don't push it too far.
Yesterday I took some pictures so that a) you lot could see how little I can move and b) I can chart my progress over the coming months.
This picture shoes how far I can currently lift my feet from the floor. It's not so bad - I could definitely get some low heels on lol.
The same exercise with just the left foot. Probably I should do this with a ruler for future pictures, but it looks about three inches?
This is me pointing my toes. I feel like they don't move at all when I do this!
Applying pressure to the toe to move it as far down as possible. Which is probably about one millimetre!
Overall I think that the progress is OK. Even in the last few days I've gone from it being painful to get my feet into the trainers, to being able to do it without pain, albeit gently and slowly.
You just don't realise how much you bend your toes in daily life until you can't do it easily. I have a new respect for elderly people now, I can tell you.
I did ask the doctor (not my surgeon) at the hospital when the casts were removed about exercises, but he said I didn't need to do them.
However, I know from reading other people's experiences that in America especially, people get given exercises to do, and it makes sense to me that it would be beneficial to do some, even if the NHS doesn't deem them necessary.
The main exercises I can find online pretty much all seem to be the same as these ones here.
The timings on the sheet are different, because it seems that in America people get their casts off really soon, after a couple of weeks. I'm not sure why that is as the standard bone healing time here in the UK is six weeks - if you break a bone, you get a cast for six weeks - so it seems odd to me that they'd take them off sooner than that.
I'm glad I had mine on for seven weeks as I feel it gave my bones a really good chance to heal in the right place.
Anyway, ignoring the timings, I am now trying to do the same exercises every day.
So I hold my big toe near the operated-on joint and move it up as much as I can without crying, then hold for ten seconds, then do the same thing moving it down and hold for ten seconds.
Then I put my toes on the floor and lift up as though going on tiptoe, putting weight through the toes, as much as I can without weeping in pain, and hold for ten seconds.
It really hurts.
I am careful not to push beyond discomfort into agony as that would be counterproductive, but I have learned from yoga that it's important to breathe through mild pain and listen to your body so that you challenge it, but at the same time don't push it too far.
Yesterday I took some pictures so that a) you lot could see how little I can move and b) I can chart my progress over the coming months.
This picture shoes how far I can currently lift my feet from the floor. It's not so bad - I could definitely get some low heels on lol.
The same exercise with just the left foot. Probably I should do this with a ruler for future pictures, but it looks about three inches?
This is me pointing my toes. I feel like they don't move at all when I do this!
Applying pressure to the toe to move it as far down as possible. Which is probably about one millimetre!
Overall I think that the progress is OK. Even in the last few days I've gone from it being painful to get my feet into the trainers, to being able to do it without pain, albeit gently and slowly.
You just don't realise how much you bend your toes in daily life until you can't do it easily. I have a new respect for elderly people now, I can tell you.
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