My Left Foot

Several years ago I had the bunion on my right foot, created by bad shoes and arthritis, removed, the bone shaved.  I swore I would never go through that again.  It was incredibly painful, and I was incapacitated for quite a long time, first by the pain of standing, then by the bulky boot I had to wear on that foot that precluded driving.

But my left foot had recently gotten worse, and having had an X-ray, which showed deterioration of the join to the extent that the bone could not be salvaged, I was convinced that I needed to go under the knife yet again.

Unfortunately, circumstances had changed.  I no longer have a spouse who could help me limp to the bathroom, who could drive to appointments and work.  Even my children live out of town.  So I depended upon friends, and my daughter on the weekend, for help for the first week.  After the initial downtime, as this is my left foot, which is not needed for driving an automatic car, I was able to drive. 

Diagnosis

Hallux Limitus is due to a premature wearing down and tearing of the cartilage in the first metatarso-phalangeal joint.  As the cartilage begins to wear down, the proximal phalanx of the big toe, and head of the metatarsal begin to rub against each other.  Without the protection of the cartilage between these bones, each time the toe is moved, friction and pain occur.  Each step that is taken causes more deterioration of the joint cartilage. Continued deterioration of the cartilage results in the bone trying to regenerate and replace worn down areas. This leads to an over-growth of bone called bone spurs.  These spurs can be felt, and sometimes seen, all around the big toe joint, especially on the top of the joint.

Osteoarthritis, or degenerative joint disease, is a term that is used to describe the progressive deterioration of the cartilage in a joint.  Therefore, Hallux Limitus can be thought of as osteoarthritis of the first metatarso-phalangeal joint.  

Operative Procedure

Keller bunionectomy with implant.  An incision was made over the first metatarso-phalangeal joint of the left foot.  This incision was deepened with care to preserve the neurovascular structures.  The Bovie was used as necessary.

Electrosurgery is performed using an electrosurgical generator and a handpiece including one or several electrodes, sometimes referred to as an RF Knife. The apparatus when used for coagulation in surgery is still often referred to informally by surgeons as a “Bovie,” after the inventor.

Once the capsule was identified, a capsulotomy was performed exposing the first metatarso-phalangeal joint.  The joint was inspected and there was very clear evidence of a severe amount of articular surface destruction.  The cartilage was gone centrally measuring a 2-cm diameter area of cartilaginous loss.  There was also evidence of bony excrescences around the periphery of the joint.

The decision was made to proceed with the plan to remove the joint and to insert an artificial joint.  A power oscillating saw was used to remove the dorsal and medial prominences of bone followed by using the cutting guide to remove the head of the first metatarsal and the base of the proximal phalans.  Once this was taken out, addition bone was removed so as to keep the toe in a rectus position followed by creating 2 square holes in the medullary canal of the first metatarsal and of the proximal phalanx.  Once these holes were made, a sizer was inserted followed by flushing the wound and inserting a Primus double-stemmed flexible hinged toe implant into the first MPJ.

The Primus Flexible Great Toe is an implant for supplementation of first metatarsophalangeal joint arthroplasty. The implant is constructed from medical grade silicone elastomer and includes titanium grommets.

Florence Nightingales

Friend N took me to the hospital and returned me home that Thursday, and brought me meals.  (As the bedroom is downstairs, and the kitchen upstairs, I needed that help for the first week.)  I was surprised I was feeling so good that first day, but that was because the local anesthesia didn’t wear off until midnight.  I suggested that N bring her 7-month, 65-pound puppy over, as she needs lots of attention, but the cat was not appreciative, reacting to a sniff at the chair she was napping under by chasing the dog out of the room, with ears back, hair up, and tail fluffed to thrice its size.   Poor Luna didn’t understand.

R and L brought meals for me Friday.  My daughter and family took over the chores on the weekend.  My grandchildren were quite solicitous and we kept the dog away from the cat.  My daughter helped me take a shower with my bandaged foot bagged and up on the built-in bench, but it was still difficult.

The recovery from this operation went extremely well.  I only needed the Oxycodone for the first three days.  After that I got off of it because of the unpleasant side effects.

Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine.  (Thebaine is an opiate alkaloid. A minor constituent of opium, thebaine is chemically similar to both morphine and codeine, but has stimulatory rather than depressant effects.)  Side effects of Oxycodone include constipation, dizziness, drowsiness, and nausea.

Das Boot

As well as bringing tons of delicious food, B took me to the doctor’s office on Monday for my post-op, but that was difficult.  Hopping with my walker in over 100° heat, just to the exterior elevator from the curb, was way difficult.  B had to fetch me a wheelchair to get through the extremely hot exterior entry and down the long hallway to the office.  After that I was fine, with my new boot.

The FP Walker is a cost-effective Aircast pneumatic cam walker that provides full-shell protection with outstanding support. Each has a low rocker sole bottom for added comfort and ease of ambulation, and a wider foot base with plenty of room for dressings without sacrificing comfort. This product has a lightweight, durable, semi-rigid shell that supports the limb while providing protection. Housed inside the foam liner are two adjustable air cells that provide compression and support to both sides of the ankle. The FP version air cells can be individually inflated using the hand bulb (included) for a customized fit and optimal comfort and support. Changes in limb dimension can easily be accommodated throughout the healing process by adjusting air cell inflation to ensure stability and immobilization.

M tended to me on Tuesday, and then I was on my own.  The doctor had said that I could start walking, and I found the stairs no problem with the very heavy boot giving me stability.

So I am up and about, but not jogging.   I had my stitches out yesterday, and was able to bathe my foot, scrubbing off the orange sterile prep and the ink designation that this was the correct foot.  My foot is still bruised and swollen, but does not hurt anywhere like the right foot had, and that ache is handled with ibuprofen.  The only problem is getting to sleep at night.  I get to take the boot off in two weeks, and see the doc in three so that he can admire his handiwork.

To friends and family – thanks!

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9 Responses to “My Left Foot”

  1. Jim & Erda Says:

    What an excruciating ordeal. We were fascinated by your knowledgeable description. Happy you are through the worst of it; sorry you had to go through it all. With our love, Jim & Erda

  2. Lynn Shore Says:

    Well you have had quite an experience this summer. I have had total left hip replacement done. Lots of fun, let me tell you. Learning to walk again can be quite frustrating can’t it? Hope you continue to improve. I only limp now if I get too tired.
    Fortunately, I had a husband and daughter who took great care of me. And some wonderful friends who brought meals in for us the first two weeks after I came home. Gene was very thankful for this.

    • lynne Says:

      A friend here in town had a Birmingham hip resurfacing:

      Unlike a total hip replacement (THR), the BIRMINGHAM HIP resurfaces the joint. The worn cartilage and damaged first layer of bone are removed and a fresh, low-wearing metal surface is installed. Total hip replacements require the removal of the upper segment of bone, the hollowing out of the upper half of the leg bone, and a large spike fixed to this upper bone, replacing the top part of the femur.

      For either procedure, the socket is prepared by shaving off the damaged cartilage and the first layer of bone. An appropriately sized replacement socket is pressed into the bone. For the BIRMINGHAM HIP, this socket has a new low-wear metal surface on the inside. For a THR, the socket often will instead accept a liner made of plastic, ceramic or metal.

      To prepare the head, or ball, of the hip for a BIRMINGHAM HIP head, the cartilage and first layer of bone are shaved off as well. The appropriately sized head is pressed onto the prepared bone, with bone cement used to fill any gaps and holes in the bone.

      For a THR, the head and neck of the leg bone are removed. A cavity is opened up in the upper portion of the leg bone to fit the stem of the THR. The stem is pressed into place and a ball is placed onto the stem. This new head is often much smaller than the patient’s original head.

  3. N Says:

    Most interesting…happy to be of help. BTW, Luna is 8 months/70 lbs. Your cat did kick her butt ^/^

  4. Jim Says:

    MD’s are just now leaning about the crucial roles of exercise and diet.
    I wish you a speedy recovery, Lynne.

  5. Price K. Says:

    Blair:

    Lucky to have B, L, N, and R in town. Appropriate time for another visit to & convalescence in San Diego. House is almost rebuilt. Yard still looks like the surface of the moon, but plants should be in tomorrow.

    Price

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