The Surgery

Pre-Op

As instructed, I arrived at the hospital at 9:00am.  The procedure was scheduled for 11:00am.  I brought a LARGE book and settled in for the wait.  Wasn't necessary.  I was quickly escorted to the pre-op staging area.  Here's what happened next:

• A nurse dropped off paper underwear and a hospital gown
• After I removed my clothes (and dignity), I was asked a series of questions (a Series of Questions):
• What is my name, first, middle and last?
• What is my birth date?
• What procedure am I having?  On what foot?
• How tall am I?  How much do I weigh?
• Am I allergic to [anything under the sun]?
• Is anyone in my family allergic to [anything under the sun]?
• Have I ever been sick?
• Has anyone in my family ever been sick?
• Do I smoke? Drink? Take drugs?
• Etcetera
• A physicians assistant (PA) arrived.  The PA asked me a Series of Questions.
• Another nurse stopped by.  She washed and shaved (!) my foot.  Then she asked me a Series of Questions.
• The anesthesiologist stopped by.  She asked me a Series of Questions.  She also said that I would be partially anesthetized before getting a spinal block.  After the spinal block, I would get additional anesthesia.  She predicted I would remember none of this.  She was right.
• The doctor stopped by.  Same Series of Questions.  I'm confident they've got it now.
• I walked into the operating room under my own power.  Big lights.  Lots of people.  Lots of cutting tools.  For the first time I feel a pang of anxiety.
• The anesthesiologist said that she's added anesthesia to my drip.

Post-Op

I remember nothing after the anesthesia was added to my drip.  I woke up in the recovery room, listening to a couple of nurses discuss how long it would take for me to come to.  When I settled that for them, my brother joined me bedside. 

Until the effects of the spinal block wore off, I had no feeling in my legs -- left or right.  After 60 - 90 mins., the feeling had returned and my left leg was strong enough to get out of bed and head home.  It's around 2:30pm.

I took two oxycodone pills as the spinal block wore off.  Pain was manage-able.

Removing my bone spurs

Why, why, why

Doesn't any blog have to begin with "why?"  As in "why burden the world with details of my life?"  I've got two reasons.  First, I just had surgery to remove bone spurs from my right foot.  The left foot is next.  I want to document my experience to help me through stage 2.


Second, while debating this course of treatment, I searched the web for practical information on my hallux rigidus (more on that later) and, in particular, the effectiveness of various treatment options.  I didn't find much, so I want to help address that problem for others.


I did, by the way, find one great blog by Bob Peters -- an avid outdoorsman suffering from hallux rigidus.  You can find his blog at:

http://www.epicski.com/a/bob-peterss-excellent-toe-surgery-adventure




Thanks Bob!

What is hallux rigidus?

Hallux rigidus (Latin for "stiff big toe") is a condition caused by wear and tear at the base of the big toe.  It is most likely to affect those who are active and regularly participate in sporting activities.  Shaq had hallux rigidus.  See: 

http://www.thefreelibrary.com/SURGERY+GOES+WELL+FOR+SHAQ+SLIGHT+CHANCE+HE+CAN+BE+READY+FOR+SEASON...-a091499203

Bob's blog has a lot of information on hallux rigidus.  The 30-second explanation?  Bone spurs grow on the knuckle of your big toe, enlarging it and interfering with the mechanics of bending the toe.  As a result, there is damage to the soft tissue and (permanent) erosion of the cartilage.  Bummer.

Hallux rigidus impacted me as follows:

• It hurt to bend my toe and the pain got worse as the condition developed
• Range of motion in the toe was increasingly limited
• My behavior adapted in subtle ways to avoid bending my big toes, e.g.
• I wouldn't squat to pick something up
• I let my toes hang off the edge of the stairs when descending
• Although I played soccer -- I have to play soccer -- I favored kicking with my instep rather than my laces and I shied away from challenges that might engage my toe
• After soccer games, I hobbled around for days (then played again)
• I stopped running in training (switched to cycling) and limited my walking
• Near the end, I slept with my feet uncovered because the weight of the comforter made my toes bend

Hallux rigidus doesn't happen overnight.  It developed in my left toe over 3 - 4 years.  It started in my right toe more recently, but the deterioration has been much more rapid.  The right toe is now the worst of the two.

Treatment

There are several treatment methods:

1. Orthotics -- A stiff sole insert to reduce bending of your toes.  It does help to reduce the pain, but does nothing to correct the underlying problem
2. Steroid injections -- Steroid injections are supposed to reduce swelling and thereby reduce the pain.  The injections hurt -- a lot -- and didn't do much to relieve my pain
3. Cheilectomy -- Surgery to remove the bone spurs.  This is the procedure I had a few days ago.
4. Joint replacement -- Replacing the toe joint with an artificial toe joint.  My doctor was skeptical: Unlike a hip, the toe bones are too small to secure an artificial joint
5. Fusion -- A last resort (and potentially still in my future.)  The cartilage is removed from the toe and the whole apparatus is screwed / fused together.  After fusion, the pain is gone, but you're not able to bend your toe.  Bob had this procedure and seems pleased with the results.

I had a cheilectomy (and Moberg osteotomy) on Sept. 2, four days ago.