Extreme Bunions

Velocity - The End of An Era

From now, through March 27th, Velocity Dance Center is moving.  The old studio digs, in Seattle's Oddfellows Building, are about as dreamy as one can find for a dance center.  Lofty ceilings, big open spaces flooded with natural light, a larger studio that also converts to a theater, plus all the charm of an historic building.  What will the new space be like?  We'll know, soon enough.

For me personally, and for Velocity, it's like the end of an era.  For years, Karn Junkinsmith's Saturday AM ballet classes have been my reason to get up in the mornings.  Her energy! The fresh contemporary approach to ballet! The Music! (live accompaniment, the talented Jeff Junkinsmith, spanning a range from classical romanticism to jazz to amusing renditions of Nirvana tunes)  The afore-mentioned studio ambience, the inspiration of dancing with some of the other talented ppl who attend class....it has been a beautiful experience. It was also one of my first forays back into the dance studio this year, since my surgery.  Leaving that space forever, it definitely feels like an emotional demarcation.  The end of the pre-bunion era.

Karn, Jeff, everyone, thanks for being the Raison d'etre for this girl on Saturday mornings for so so long.  Even in the dead of winter dreariness, you are always there, and it is much appreciated! I hope we find an even better vibe in the new space.  (And of course, I hope I can get back that last 20 degrees of demi-pointe on the left foot real soon ;)

For info on the studio move, to help, or to participate in the week-long festival of free classes and events, more info here:

http://velocityforever.blogspot.com/

http://www.velocitydancecenter.org/

One Year Later

 
It's been a year since my bilateral bunionectomy, Scarf-Akin procedure.

On the eleventh day post-op, it was time for a followup visit.  They x-rayed my feet, and removed swathes of bandages to expose a set of purple-blue-black-and-green hoofers complete with stitched-up taped-up incisions, healing "nicely" (according to the doc and the pt).

The surgeon's office is co-located with the physical therapy practice, so I was immediately walked over (hobbling in my surgical sandals, now fitting slackly without all the mounds of cotton and gauze that had encased my feet for 10 days) to my first pt appointment.  There were 6 different exercises, for each foot, with repetitions anywhere from 10 to 25 each, to do 3 times daily, for the next 4 to 6 weeks.  Apparently the red TheraBand was to be my new best friend for several weeks to come.  Carmen, a motherly type of woman with a kind face and a deceivingly sweet voice, dished out the torment with unflinching calm.  I hooked my big toe inside the elastic loop to create resistance for a sort of "toe curl," and damn near came to tears at the sharp pain that ensued.  I held my Frankenstein feet in my own hands one at a time to manually flex and curl the 'great toe'  as far as I could, and then Carmen urged me to do a bit more. I flexed and pointed, flexed and pointed.  She measured, poked, tested, and instructed me...recording R.O.M. numbers before and after the session.

Next, she helped me into my shoes.  My old favorite, New Balance.  I had brought cushyfluffy socks for this occasion, only to discover that no way in HELL would my swollen feet fit in these shoes while wearing such thick socks AND the gel-pad scar cover.  Carmen suggested I find some thinner socks soon and, for now, simply do with the gel-pad sock.  Slowly, 1/4 inch at a time, in disbelief (should I REALLY be doing this if it hurts like S**T to flex that toe joint that way?), I got into my shoes. 

The main purpose of wearing one's own pre-worn gym shoes after this procedure is to reduce swelling.  I was to be allowed to stand or walk only up to 10 minutes at a time, followed by 1 to 2 hours of rest and elevation,throughout the day. No more than 1 hour per day on my feet, during week 1.  Week 2, 2 hours.  Week 3, 3 hours.  And so on, to tolerance with the goal of minimizing swelling.  At the end of our appointment, Carmen got me standing upright, had me walk a bit this way and that, and congratulated me on my performance. 

And then, she gave me a stern warning.  It was the only time during our whole interaction that her voice dropped to a tone of consternation.

"Now, remember.  To the outside world, you look completely normal, but you have just had a major medical procedure.  You have a lot of recovery to do.   Your bones are securely fastened with the pins and screws, but will need a full 6 to 12 weeks to truly knit together.  People will bump into you, and could even step on your foot.  Keep your distance.  Remember to protect yourself.   Take precautions, especially in public places." 

Little did I know at the time that her warning foreshadowed certain events in my personal and professional life for the coming year. 

No one informed me that the year of the Fabulous Foot Repair would also include some traumatic home remodeling, a big disappointing breakup, the need to divorce a few "friends," the worst economic times seen in the US since the Great Depression, the worst year I've personally had in business in 10 years, a year of double work and zero dating, and a sort of "early mid-life-crisis" in my career. :|  Of course, the year also included some fantastic moments; shopping for flipflops with my sister in NY, dancing in dresses and sandals during summer, feeling my big toe planted firmly on the ground and the awesome muscle contraction I can get in my quads now (it's all related), New Year's Eve dinner parties in a dress and heels...

I really wouldn't change a thing about this surgery, other than to have done it 10 years earlier. 

Pre-Surgery Shopping List

You never know what you'll need.

And it's true - whatever plans you make, they will change.  Whatever preparations you make, you'll find later that you were somehow unprepared.

Still, here are some fairly universal ideas that should be helpful for anyone who's about to go through pretty much any type of bunion surgery.

#1 Freezer Pack.  This will be your best friend during those crucial times between meds or as you shift away from meds.

#2 Rolling chair or wheelchair - or better yet, an ottoman with wheels on it so you can kind of drag yourself around the house with just your heels and get some core exercise at the same time.

#3 LapDesk - for those endless hours in bed with the laptop, trying to get your work done.

#4 Pepsid AC - to counteract the evil side effects of the meds you'll be taking.

#5 Press-N-Seal - to create fabulous custom bandage or cast coverings for showering.

#6 Handicap-Accessible Room at the Marriott Residence Inn - complete with kitchenette and the sit-down shower!  (HOWEVER - Accessible Designers please take note - most of the kitchen cabinets and some of the appliances were not REACHABLE from the wheelchair, nor were the curtain pulls.)

#7 Pilates Matt DVD's - the only exercise that seems effective without using your feet.

#8 Hand Sanitizer.

#9 Lotions & Potions - especially anything with vitamin E oil, or cocoa butter lotion, to start taking care of those scars as early as possible.  Later on, after 8 weeks of healing, I switched to alpha hydroxy products to deal with all of the excess skin that needed sloughing off.

#10 Housekeeping.

#11  VARIETY of socks, shapes, fit, weights (big fluffy may not be the best answer as you thought.  I was not able to wear ANY but the THINNEST socks inside my sneakers during the 3rd/4th week).

#12  Swimming - soon after, a membership to a swimming pool is a nice bonus.

Living And Dancing Without Pain

Somewhere around the 6th or 7th month after bunion surgery, some amazing things happen.  At first, there's just the gradual decline in the swelling, and the sensitivity around the scar area diminishes.

Then, eventually, one day you get through an entire day and realize;  "MY FEET DON'T HURT."  Not only has the pain from surgery dissipated; but the PRE-SURGERY bunion pain is miraculously.....absent. 

Another impressive testament to the human body's power to heal itself:  nerves regenerate.  I had, for at least 3 years, lost about half of the sensation on the skin on the side/edge of my big toes.  Strangely, it's coming back.  THAT's something I really didn't expect. 

WOW.  So far, so good.  This past weekend, I made it out to a salsa-dancing event and had a lot of fun with only mildly sore feet the next day. 

Samastitihi: Equal Standing

Yoga again.  Is it worth it at this point?  It's right around 12 weeks after surgery. I decide to give it a try, in my living room.  Courtesy of yogatoday.com.  Downward Dog is doctor-approved; though Plank Pose is not.  Transitions are tough (I skip the transtions that common sense tells me are a bad idea). 

My Word, I've become so weak.  How is it that I've become so weak, with all of the Pilates floor exercises I continued from like 5 days post-surgery?  With all of the tread-milling and stationary biking and weight-lifting I've been carrying on for the past month?  Though the scale says I've lost a few lbs (muscle, for sure); my body feels heavy moving through the poses. 

"Equal Standing" is taking on a revolutionary new feeling in my "new feet."  Without thinking, I snug the left foot right up next to the right foot and stand tall.  Scar-to-scar.  Kinda gives me the heebiejeebies.

Your Personal Decision

Right now, I'm a post-bunion surgery patient.

I've had a Scarf-Akin bunionectomy, bi-laterally, 11 weeks ago.

Since about 7 or 8 weeks after surgery, I was able to walk normally, do gym workouts with low-impact treadmill walking, swimming, and all of the normal daily functions I needed to accomplish in my life and work.  Albeit, slowly, and with Celebrex.

I'm not a doctor. I'm not a podiatrist or an orthopedist.  But I am , at this point, a very educated patient.  I'm also very satisfied thus far with my surgical outcome.

With all of that being said, I want to reply to one reader's comments, in this post.  This story shared by A. is VERY similar to my story. 

Her situation mirrors the situation I had:

#1: IM Angle 18 degrees on one foot, 19 on the other.

#2: Hypermobile with flat flexible arches.

#3: Pronation.

"Well, I visited the doctor again and discussed with him the procedure in question and he said that with my severe IM angle (18 degrees) he believes any other procedure than the lapidus would fail. The main reason being that my feet are very hypermobile. I do not have structured flat feet but rather my arches are fairly high when I sit but when I stand they flatten out. This is referred to as excessive pronation. I have read a lot of articles online that support the idea that a high IM angle with hypermobility needs to be corrected with a lapidus procedure. Did you face the same issue, Lynn, and do you think that the Scarf-Akin procedure will hold up long-term? By the way, he did offer to give me Mederma for the scars. Oh and another thing--he stated that he doesn't advise having surgery done bilaterally because from his experience one foot always seems to heal better than the other. What were you told about this?"

These are GREAT questions.  There's no such thing as a perfect foot.  Everyone has different variations of feet; and there are a lot of different ways to correct bunions surgically.  As patients, we have to rely on the OPINIONS of our podiatrist or orthopedic surgeon in selecting the "correct" bunion surgery procedure.  It can be very difficult to have a discussion with a doctor, and really differentiate between what part of what they're telling you is opinion, vs. what part is fact.  Many will express strong opinions, and because they are The Doctor, we the patient take this as fact.  For instance your doctor says "It has been my experience that xyz....."  Then we the patient may hear this as a golden fact.

I was told pretty much exactly what you were told by 2 out of 4 docs.  Here were my questions in response, and the facts I gathered in my pre-surgery doctor visits:

Q: Will the Lapidus correct my pronation? 

A: No, that's a different problem.

Q: Will the Lapidus correct my flat arches?

A: No, but it will help make your feet "more stable."

Q: Will the fusion of the Metatarsal-Cuneiform joint as performed with the Lapidus cause a limitation in my range of motion in my feet; can this restrict my activities, or *might* it cause other biomechanical dysfunction at a later date; eg, back pain, knee pain, heel pain, etc.

A: Maybe. We don't know.  It's possible.  Range of motion in the mid-foot can be diminished 30%.  It's possible you don't need that range of motion anyway unless you're a ballerina.

Q: Will I still have to wear orthodics after a Lapidus OR Scarf bunionectomy?

A: Yes. You will have some shoe-gear restrictions for the rest of your life.

Q: Will you guarantee me that if I have the Lapidus, my bunions will not return?

A: No.  No surgeon can promise zero recurrence with any bunion surgery.

Q: Can I have the Scarf-Akin done bilaterally (both feet at once)?

A: Yes.

Q: Can I have the Lapidus done bilaterally?

A: No absolutely not.

Q: Can a "failed" Scarf-Akin be re-done with another Scarf, OR with a Lapidus later in my life?

A: Yes.

Q: Can a "failed" Lapidus fusion be "un-fused?"

A: No.

Q: How likely is "failure," or "recurrence," in numbers, according to studies?
A: We don't know.

The only question I can answer here that concurrs with your doctor's answer: BILATERAL Lapidus bunionectomy is ill-advised, assumably because you'd have to have a cast on both of your feet for 6 to 8 weeks.  That's just a huge ordeal to go through, both physically and mentally.  One podiatrist said to me "Well I might consider it, if you bring me the signed letter written by the person who's going to carry you to the bathroom every day for 6 weeks."

The thing is, as happy as I currently am with my experience and surgical outcome, I am not qualified to answer your question about whether or not the Scarf-Akin surgery will last me the rest of my life!  Before I had my surgery however, I did speak with 2 patients of my surgeon who had undergone the Scarf-Akin procedure, bilaterally.  One had the surgery 5 years prior, another had the surgery 4 years prior.  Both had experienced bunions for a long time (like 20 years) and both were still happy with their results.

On the flip side, in my personal life, I had met 2 patients who had the Lapidus procedure.  One, within the last 5 years.  The other, about 18 years prior.  Both feet, separately.  Both were experiencing secondary pain and complications which may or may not have been relative to the operation.

Perhaps my decision was swayed by the stories I heard from these people.  Perhaps the fact is I'll be faced with bunions again in 15 years.  My followup-podiatrist in Seattle doesn't seem to think that's the case.  Maybe you can wait 10 years to have your surgery, and then ask me how I'm doing?  I'll bet you MONEY that in 10 years there will be better statistics on the topic, because right now there seems to be an ongoing controversy regarding the best practice in bunion surgery.  Read some articles on Podiatry Today.  You'll be amazed at the conflicting opinions expressed.

My OPINION is this: Life is for Living.  Once you know all of the facts, and after you hear everyone's opinion, you make the best decision for your health that is amenable to your Life, your work, your love, your family, your goals....and in America, your Finances.  Your decision.

Scar Care

In physical therapy, you'll likely receive some scar massage - and technique instruction.  It's not exactly a feel-good massage, to say the least.  My therapist also does some "scraping" of the scar with a blunt metal object (like the handle of a butter knife). I've heard varying opinions on how often to administer scar massage, from 5 to 30 minutes, 2 or even 3x daily.

The appearance and texture of surgery scars seems to be dependent on each individual's genetics, and the location of your incision(s).

Almost IMMEDIATELY after my bandages were removed (day 11), my doctor instituted the use of this Silipos gel sleeve thing that covered, padded, and moisturized the scars.  I wore it right over the steri-strips, and still continue to wear it now, 2 months post-op.

The gel pad has the added benefit of padding and protecting the sensitive surgical area.  It also provides some compression.  I couldn't have put my feet IN my shoes the first few weeks, without it.  I'm convinced this little gadget has made all the difference in helping me form flat smooth scars.  Only the top end of my scars (the 1/2" not covered by the gel pad) have begun to keloid. 

In about weeks 8 & 9, I started to feel spots of thickening under the skin near the scar.  In other words, even though it may look pretty on the outside, it's going to need constant attention to keep it from forming adhesions on the inside.  Adhesions + stiffness = reduced joint mobility.  Scar tissue can also cause pain. 

Do creams and oils make a difference?  I've read conflicting reports.  Mederma, Vitamin E Oil, Cocoa Butter; does any of it make a difference? After reading product reviews on Skinstore.com, I wasn't convinced to buy anything.  I've stuck with E Oil from the health food store. 

Anyone with unique stories or techniques to share about success with scar massage or general scar care; please enter comments!

Week 9

Week 9 is a bit of a plateau.  There is not much to report, other than less tingling nervy sensations in the toes.  There is a bit of a struggle to get enough flexibility in the big toe joint on my left foot.  I began to feel frustrated at its slower progress.  Then I reminded myself; if I had been required to be in a total cast for 8 weeks, I would currently be MONTHS away from the kind of recovery I've currently achieved (with bilateral Scarf-Akin procedure).

The strangest post-surgical sensation - from the very first time I was able to stand in shoes on day #11 - is having that the big toe is in it's proper place!  Anyone who's had this condition for a long time, with the big toe angling to the middle of your shoe - will understand what I mean here!  Now almost 2 months later, physical therapy has started allowing - slowly, carefully - standing toe raises.  This is a wild new exerience with my first toe firmly on the ground. 

So, overall, I'm feeling a bit like a miracle has occurred.

Week 8

Week 8 after my surgery is like my magic turnaround week in recovery.

Finally, I can work almost a full day, half the day on my feet, and not have to quit early from swelling & pain.   I'll admit, during the 6th week, I had to sign up for another round of Celebrex.  Now, the swelling is on the wane and I have more tolerance for standing, driving, and sitting in public...even went out to the movies last week! 

The first night I went swimming (post surgery) was at the end of week #5.  I regretted it later.  Throbbing pain woke me up intermittently through the night.  This week, though, I've been able to swim, stationary bike, and use leg weights.  Physical Therapy is intensifying - they added some weight-resistance leg exercises, and started me doing toe-raises on a pilates-like "shuttle" machine that uses elastic bands for resistance.  I've found the leg press machine at the gym is a good substitute.  Doctor has got me stretching my achilles on a slant board up to 10 minutes per day.  I still continue the theraband foot exercises 3x daily that were instituted by my physical therapist on day #11 post-op. 

The thing that's the most difficult for everyone to understand, is the TIME.  It requires time to rest and to do all these excercises.  It requires time to sit and flex/curl your big toe joint every day 3 times a day.  All of this crap has to be done, if I want to get my full range of motion back, to be able to roll through a step without stiff painful toes!  Don't expect your friends to understand.  They'll figure that by now, if you can drive, and you can walk, and you can do a full work week, then you should be ready to go hang out at happy hour!

Week 7

The other night I went to the gym and went swimming for the 3rd time since surgery.  It's week #7.   After the swim, relax in the sauna.  WONDerful.  Luxury treat.  I stretched out on one of the higher  benches, slid my feet out of the Chaco flip-flops, and propped my heels up.  Divine.  I peeked down to the toes.  Short of some strategically-placed scars, there's nothing to hide anymore.  Unbelievable.