I had my surgery on December 4 with the understanding that I would be totally non-weight bearing for six weeks - which meant I would be non-weight bearing through the holidays. Let me tell you - six weeks is a LONG time to have to maneuver around on crutches or in a wheelchair!
I've been through post-op bandages, a week with a splint (and bandages), and two different casts (one green - over Christmas - and one blue - for the first 2 weeks of January).
I had to go with the wheelchair (instead of a knee scooter) because I had arthroscopic surgery on my right knee in June (for a degeneratively torn meniscus) and so I couldn't put that kind of pressure on the knee (that knee also has some moderate arthritis).
Stairs have been a big challenge. I can't do them on my crutches (not recommended by my surgeon). So, to get in or out of the house I have to get down on my hands and knees and crawl over to the door to the garage and then go down the steps (3) into the garage on my behind. To come back up the stairs, I scoot up on my behind and once I'm in the kitchen, I crawl over to the family room sofa and pull myself up into a sitting position on the sofa. Once seated, I can use my crutches to get myself upright and over to my wheelchair.
Needless to say, I haven't done much outside of the house in six weeks except necessary doctor appointments, the occasional Sunday morning church service, and two trips to my office (courtesy of my husband, the chauffeur). I also braved the out of doors to go visit with a group of lady friends for my once-a-month card crafting get together.
Just trying to get ready to get out of the house is exhausting!
I've also had a grand total of 3 showers in six weeks (yech). Everything else has been sponge baths and washing my hair in the kitchen sink because the bathroom with the shower is upstairs!
Even just trying to put a meal together for myself (when my husband is at work) takes a lot of effort. If you stand up with crutches to get to the cupboards, then you have the issue of how to carry things to the table (hard to do while crutching). If you use the wheelchair to get to the cupboards and the refrigerator, the wheelchair interferes with how close you can get and what doors you can open! I've developed my own techniques over the past six weeks. But again, everything takes longer and more energy.
I originally planned to be off work for 1 1/2 weeks, but the reality was I was off for just over 2 weeks and then I had vacation time to the end of the year (that was planned) for almost another two weeks. All told, I was off work for nearly 4 weeks! My first day back at work was actually January 2 (working from home). I've been at work since January 2 (except for doctor visits) but most of that has been telework. I've only made it physically back to my office 2 days (one day each in the last 2 weeks). Since I can't drive, my husband has to take me to the office and pick me up at the end of the day. Since the drive to work takes about 40-45 min. that's a lot of commuting my husband has to do on my behalf.
Monday, January 20, 2014
Sunday, January 12, 2014
First Post-op Visit
Six days after surgery, on December 10, I went for my first post-op visit. I 'thought' I already had a splint on but found out at the appointment that actually, all I had were my post op bandages. All that came off and I got the first look at the scars on my ankle - eww!
Surgeon said that all looks well and that the incision looks good (and will be barely noticeable - in a year's time!). So, he turned me over to the ortho tech, Charles, to get a splint put on. After wrapping my foot with lots of cotton batting, he wet several rolls of fiberglass and molded them under my foot and up the back side of the leg to just under my knee. He held that in place until the fiberglass set up a bit and then wrapped the whole leg in ace wraps.
So, all re-wrapped, Dr. S. said my next appointment would be to get the splint off, stitches out and get a real half-leg cast. Given his office and holiday schedule, we set it up to have my regular podiatrist do the stitch removal and casting on December 19 at my health plan's office in Gaithersburg (MUCH closer to my home).
Every time I get out of the house (going down steps on my butt and crawling back up the same way) I exert all kinds of energy that I don't have! So I was pretty tuckered out by the time we got home and I was able to send my husband off to work.
My life, at this point, still consisted of mostly hanging out in my 'sick bed' in the livingroom, with small excursions up for bathroom breaks and meals. My world has shrunk to essentially 3 rooms on the first floor of my house.
So, all re-wrapped, Dr. S. said my next appointment would be to get the splint off, stitches out and get a real half-leg cast. Given his office and holiday schedule, we set it up to have my regular podiatrist do the stitch removal and casting on December 19 at my health plan's office in Gaithersburg (MUCH closer to my home).
Every time I get out of the house (going down steps on my butt and crawling back up the same way) I exert all kinds of energy that I don't have! So I was pretty tuckered out by the time we got home and I was able to send my husband off to work.
My life, at this point, still consisted of mostly hanging out in my 'sick bed' in the livingroom, with small excursions up for bathroom breaks and meals. My world has shrunk to essentially 3 rooms on the first floor of my house.
Tuesday, January 7, 2014
Surgery Day - Peroneal Tendon Surgery
The big day finally arrived on Wednesday, December 4, 2013. After some last minute craziness about what time I was supposed to show up, my husband Carl and I headed out to the ambulatory surgery center (ASC) in Largo, MD around 10:30 a.m.
I checked in just after 11:30 a.m. and at noon a nurse came out to take me back to the pre-surgery area. I got established in a little cubicle and told to get out of all my clothes and put on the surgical gown, fuzzy booties and a hair net. This is the new kind of surgical gown (sort of paper fabric) that has ports in it to connect air hoses to blow in warm air (a really great innovation).
Nurse took my vitals - including temp and blood pressure (multiple times) and took a baseline EKG (so that, as she explained it, there would be something for comparison in case there was a problem during surgery.
After that, Carl was allowed back to keep me company. I was visited by several different individuals, including my surgeon - who reviewed with me again what the surgery plan was and told me he had one surgery ahead of me. He had an intern with him (whose name I have long since forgotten) who was tagging along and was going to be in the surgery suite as well. Then I got a visit from the anesthesiologist who went over what she would do to put me out for the operation - nice drugs in the IV line to put me out to start and then gas to keep me deeply asleep in the operating room. She said, depending on how long surgery lasted it would take from 15-30 min. for me to come out of anesthesia at the end. After she disappeared there was a long break when Carl and I were left alone. Then another nurse (male) popped his head in and said it wouldn't be too much longer (around 2 p.m.) and asked if I wanted to watch TV. TV? I didn't know I had a little digital TV in my stall (essentially a computer monitor on a flexible arm), so we got that set up - although there's nothing on daytime television worth watching. Around 2:30 p.m. things started moving again and nurses got me ready to go into the operating room.
I got rolled into the surgery suite just before 3 p.m. A lot of people there - my surgeon, the third year resident, the secondary surgeon that Dr. S. asked to be in attendance, a nurse or two and the anesthesiologist. They got me moved from gurney to the operating table; strapped me in; got my arms extended; plugged warm air hoses into my gown (the operating room is COLD); and then we all stopped for a "time out" to make sure we were all in agreement with what was about to happen - surgery on my right foot!
One of the nurses or the anesthesiologist (not sure which) put a gas mask over my nose/mouth and told me to breathe normally and that's the last thing I remember until I woke up 3 hours later in recovery!
Had a little trouble coming out of anesthesia - was weepy for some reason (not in any pain). My foot was all wrapped up and the surgeon and Carl came back to see me
. Dr. S. told me what he'd done, but prefaced it by saying I wasn't likely to remember any of what he said (he was so right) but the bottom line was that surgery was more extensive than originally thought (tendons were badly torn) but he got everything fixed. I was offered juice (yes) and crackers (no - didn't feel up to crackers) and within 10 min. or so, the nurse was having Carl help me back into clothes. He went off to bring our car around and a nurse got me wheeled down to the exit. I was apparently last patient of the day and they just wanted to get finished up and go home!
I got loaded into the car o.k. and we had smooth sailing on the beltway - until the last 5 miles. Then we hit a back up due to an accident coming off the ramp we needed to take and lost a good 10 min. or more.
To get into the house, I needed to negotiate steps in our garage (no way to enter the house without some stairs) up into the kitchen. I managed to scoot up the stairs on my behind but the problem was getting from a sitting position to a standing position once I was in the house. We called on a friend (pre-arranged) and when he showed up, with Carl on one side and our friend on the other, they got me upright and I got into the wheelchair (another one of those things I was working to arrange pre-surgery) and got over to the converted sofa sleeper in the livingroom - which is where I've been living/sleeping for the past 5 weeks.
I checked in just after 11:30 a.m. and at noon a nurse came out to take me back to the pre-surgery area. I got established in a little cubicle and told to get out of all my clothes and put on the surgical gown, fuzzy booties and a hair net. This is the new kind of surgical gown (sort of paper fabric) that has ports in it to connect air hoses to blow in warm air (a really great innovation).
Nurse took my vitals - including temp and blood pressure (multiple times) and took a baseline EKG (so that, as she explained it, there would be something for comparison in case there was a problem during surgery.
After that, Carl was allowed back to keep me company. I was visited by several different individuals, including my surgeon - who reviewed with me again what the surgery plan was and told me he had one surgery ahead of me. He had an intern with him (whose name I have long since forgotten) who was tagging along and was going to be in the surgery suite as well. Then I got a visit from the anesthesiologist who went over what she would do to put me out for the operation - nice drugs in the IV line to put me out to start and then gas to keep me deeply asleep in the operating room. She said, depending on how long surgery lasted it would take from 15-30 min. for me to come out of anesthesia at the end. After she disappeared there was a long break when Carl and I were left alone. Then another nurse (male) popped his head in and said it wouldn't be too much longer (around 2 p.m.) and asked if I wanted to watch TV. TV? I didn't know I had a little digital TV in my stall (essentially a computer monitor on a flexible arm), so we got that set up - although there's nothing on daytime television worth watching. Around 2:30 p.m. things started moving again and nurses got me ready to go into the operating room.
I got rolled into the surgery suite just before 3 p.m. A lot of people there - my surgeon, the third year resident, the secondary surgeon that Dr. S. asked to be in attendance, a nurse or two and the anesthesiologist. They got me moved from gurney to the operating table; strapped me in; got my arms extended; plugged warm air hoses into my gown (the operating room is COLD); and then we all stopped for a "time out" to make sure we were all in agreement with what was about to happen - surgery on my right foot!
One of the nurses or the anesthesiologist (not sure which) put a gas mask over my nose/mouth and told me to breathe normally and that's the last thing I remember until I woke up 3 hours later in recovery!
Had a little trouble coming out of anesthesia - was weepy for some reason (not in any pain). My foot was all wrapped up and the surgeon and Carl came back to see me
. Dr. S. told me what he'd done, but prefaced it by saying I wasn't likely to remember any of what he said (he was so right) but the bottom line was that surgery was more extensive than originally thought (tendons were badly torn) but he got everything fixed. I was offered juice (yes) and crackers (no - didn't feel up to crackers) and within 10 min. or so, the nurse was having Carl help me back into clothes. He went off to bring our car around and a nurse got me wheeled down to the exit. I was apparently last patient of the day and they just wanted to get finished up and go home!
I got loaded into the car o.k. and we had smooth sailing on the beltway - until the last 5 miles. Then we hit a back up due to an accident coming off the ramp we needed to take and lost a good 10 min. or more.
To get into the house, I needed to negotiate steps in our garage (no way to enter the house without some stairs) up into the kitchen. I managed to scoot up the stairs on my behind but the problem was getting from a sitting position to a standing position once I was in the house. We called on a friend (pre-arranged) and when he showed up, with Carl on one side and our friend on the other, they got me upright and I got into the wheelchair (another one of those things I was working to arrange pre-surgery) and got over to the converted sofa sleeper in the livingroom - which is where I've been living/sleeping for the past 5 weeks.
Saturday, January 4, 2014
Lead up to surgery
Had the first visit with my surgeon , Dr. "S", on October 7, 2013. He took a look at the MRI, did some manipulation of my right foot/ankle (ow!) and said "yup - definitely need surgery to fix the ankle."
You should know that I belong to an HMO, so all of the doctors and even the surgery center mentioned in this blog are all part of my HMO's system. I'm generally pleased with my HMO and it's practitioners - except for the long waits for specialty tests (like MRI's) and getting surgery dates scheduled.
Dr. "S" recommended that until surgery, I wear my figure-8 ankle brace to help prevent further damage. He said based on the MRI findings and his exam, he planned to:
1) scope my ankle during surgery (to assess extent of damage)
2) stress test the ankle (he said he could do things to the ankle while I was under
anesthesia that he can't do while I'm awake - oh goodie!) and
3) see to the tendon repair.
He confirmed for me what the podiatrist had indicated in that BOTH peroneal tendons were damaged (brevis and longus).
Having both tendons torn is a bit unusual. Most of the blogs I checked were about tears to one or the other (most often the brevis). The other thing I noticed in most of the blogs is that the tendon tear was accompanied by problems with the tendons sliding out of ankle groove (a problem known as subluxation) which often requires deepening the groove as part of the surgical repair - I did NOT have any subluxation - my tendons were just plain shredded).
I left the doctor's office with the understanding that a surgery schedule would call within the next 2 weeks to set a date for surgery. Well - it was 2 plus weeks before I heard from the scheduler. She was having trouble getting a date because she needed to coordinate schedules for both Dr. S and a second surgeon that Dr. S. wanted present to help with the surgery (Geez - damage must be pretty bad to need 2 surgeons). When I asked Dr. S. about this, he said he always likes to have another set of hands available for "major hindfoot surgeries."
Eventually, though, I got a surgery date of December 4, 2013 on the calendar. Only other 'annoyance' was that the surgery was scheduled in my HMO's ambulatory surgery center out in Largo, MD - a good hour drive from home (even though my HMO also has a surgery center in Gaithersburg, MD - which is only about 10 minutes from my house). Surgery was set for Largo because that's where my surgeon does most of his surgeries.
Prior to surgery I had one pre-op visit and had to have some blood work done. The rest of my weeks of pre-surgery time were filled with hunting up whatever info I could gather on peroneal tendon surgery and recovery.
I found a really good resource at healthboards.com on foot/ankle surgery in general. There is a helpful post on all the things you should think about having in place for post-surgery (everything from stocking your "nest" with tissues, books, electronic devices, TV with DVD's to ordering up leg raise pillow and a seat riser for the toilet - an absolute must!- to making sure you have a clear path to get around on crutches, knee roller or wheelchair). One of the most important things you need post surgery - is someone to be around to help you with EVERYTHING - I had my wonderful husband around to be my nurse, companion, and helper!
The rest of the time, I just worried about staying healthy before surgery and making sure things were in order at work so that I could be off for several weeks following surgery.
You should know that I belong to an HMO, so all of the doctors and even the surgery center mentioned in this blog are all part of my HMO's system. I'm generally pleased with my HMO and it's practitioners - except for the long waits for specialty tests (like MRI's) and getting surgery dates scheduled.
Dr. "S" recommended that until surgery, I wear my figure-8 ankle brace to help prevent further damage. He said based on the MRI findings and his exam, he planned to:
1) scope my ankle during surgery (to assess extent of damage)
2) stress test the ankle (he said he could do things to the ankle while I was under
anesthesia that he can't do while I'm awake - oh goodie!) and
3) see to the tendon repair.
He confirmed for me what the podiatrist had indicated in that BOTH peroneal tendons were damaged (brevis and longus).
Having both tendons torn is a bit unusual. Most of the blogs I checked were about tears to one or the other (most often the brevis). The other thing I noticed in most of the blogs is that the tendon tear was accompanied by problems with the tendons sliding out of ankle groove (a problem known as subluxation) which often requires deepening the groove as part of the surgical repair - I did NOT have any subluxation - my tendons were just plain shredded).
I left the doctor's office with the understanding that a surgery schedule would call within the next 2 weeks to set a date for surgery. Well - it was 2 plus weeks before I heard from the scheduler. She was having trouble getting a date because she needed to coordinate schedules for both Dr. S and a second surgeon that Dr. S. wanted present to help with the surgery (Geez - damage must be pretty bad to need 2 surgeons). When I asked Dr. S. about this, he said he always likes to have another set of hands available for "major hindfoot surgeries."
Eventually, though, I got a surgery date of December 4, 2013 on the calendar. Only other 'annoyance' was that the surgery was scheduled in my HMO's ambulatory surgery center out in Largo, MD - a good hour drive from home (even though my HMO also has a surgery center in Gaithersburg, MD - which is only about 10 minutes from my house). Surgery was set for Largo because that's where my surgeon does most of his surgeries.
Prior to surgery I had one pre-op visit and had to have some blood work done. The rest of my weeks of pre-surgery time were filled with hunting up whatever info I could gather on peroneal tendon surgery and recovery.
I found a really good resource at healthboards.com on foot/ankle surgery in general. There is a helpful post on all the things you should think about having in place for post-surgery (everything from stocking your "nest" with tissues, books, electronic devices, TV with DVD's to ordering up leg raise pillow and a seat riser for the toilet - an absolute must!- to making sure you have a clear path to get around on crutches, knee roller or wheelchair). One of the most important things you need post surgery - is someone to be around to help you with EVERYTHING - I had my wonderful husband around to be my nurse, companion, and helper!
The rest of the time, I just worried about staying healthy before surgery and making sure things were in order at work so that I could be off for several weeks following surgery.
How it all started
My peroneal tendon surgery started with a really stupid injury. My husband and I were scheduled to go on a cruise in late April 2013. The morning of my last day at work before the cruise (a Friday), I got up in the dark to get dressed for work, and tripped over my tennis shoe in the dark! I went down like a ton of bricks and really rolled over on my right ankle. I crawled over to the bed and woke my husband and told him he needed to get me to urgent care!
Xrays in urgent care showed no bone breaks but they diagnosed a pretty severe sprain and set me up with an appointment with my podiatrist later in the morning. The podiatrist also diagnosed a severe sprain. So then I asked the important question - could I still go on my cruise? The doctor recommended I use crutches and keep the foot elevated for 2 days and then think about using a wheelchair on the cruise, as well as an ortho boot and/or ankle brace. That's exactly what I did.
After the cruise, I wore the ortho boot for a couple of weeks and then the podiatrist put me in to physical therapy (to re-strengthen the ankle ligaments).
In the meantime, I was also dealing with knee pain in the right knee from a degenerative tear in my meniscus. Between ankle pain and knee pain I was not a happy camper!
I had to stop PT for the ankle when I got scheduled for arthroscopic knee surgery to repair/remove the torn meniscus in mid-June. I had PT following that surgery to strengthen the knee, but we weren't doing anything for the right ankle.
By August, when I was mostly recovered from the knee surgery, I could tell that I was still having a lot of pain and instability in the right foot, so I went back to the podiatrist in August. We did another set of xrays (still no indication of any broken bones) and then he ordered an MRI. Took 3 weeks to get MRI scheduled and another 2+ weeks after that before I could get ahold of the podiatrist. MRI revealed:
Xrays in urgent care showed no bone breaks but they diagnosed a pretty severe sprain and set me up with an appointment with my podiatrist later in the morning. The podiatrist also diagnosed a severe sprain. So then I asked the important question - could I still go on my cruise? The doctor recommended I use crutches and keep the foot elevated for 2 days and then think about using a wheelchair on the cruise, as well as an ortho boot and/or ankle brace. That's exactly what I did.
After the cruise, I wore the ortho boot for a couple of weeks and then the podiatrist put me in to physical therapy (to re-strengthen the ankle ligaments).
In the meantime, I was also dealing with knee pain in the right knee from a degenerative tear in my meniscus. Between ankle pain and knee pain I was not a happy camper!
I had to stop PT for the ankle when I got scheduled for arthroscopic knee surgery to repair/remove the torn meniscus in mid-June. I had PT following that surgery to strengthen the knee, but we weren't doing anything for the right ankle.
By August, when I was mostly recovered from the knee surgery, I could tell that I was still having a lot of pain and instability in the right foot, so I went back to the podiatrist in August. We did another set of xrays (still no indication of any broken bones) and then he ordered an MRI. Took 3 weeks to get MRI scheduled and another 2+ weeks after that before I could get ahold of the podiatrist. MRI revealed:
1. Extensive tear of the peroneus longus
tendon and peroneus brevis tendon as described above with tendinosis [damage to a tendon
at a cellular level (the suffix "osis" implies a pathology of chronic
degeneration without inflammation)] and tenosynovitis [inflammation
of the fluid-filled sheath (called the synovium) that surrounds a tendon].
2. Chronic partial thickness tear of the
ATFL [anterior talofibular ligament - the one that wraps around the front of the ankle].
3.
Focal talar subchondral signal abnormality measuring 3mm could represent early
osteochondral lesion formation.
Holy moly!
I asked podiatrist "now what?" He said I could try wearing the ortho boot some more or otherwise I'd probably need surgery. I tried the ortho boot for another 2-3 days, but the uneven gait actually bothered my right knee (the one I had operated on in June). I started doing some internet research and learned that the peroneal tendons, once torn, will not repair themselves - only way to repair is to surgically repair. After an uncomfortable weekend in the ortho boot, I called the podiatrist back and asked for a referral to the surgeon.
What this blog is all about
Hello. I'm starting this blog to document my experience related to repair of my peroneal tendons (both the brevis and longus). Before I had my surgery in December 2013, I searched all over the internet for information on other experiences with peroneal tendon surgery and found them helpful. I am hoping that this blog may be helpful to someone else who is facing this type of surgery.
For the record, I was 59 years old when I had this surgery on my right foot. I am not an athlete (athletes/runners seem to be over represented in the blogs I found on this surgery). I work a desk job for the federal government and I'm a short, overweight Caucasian female.
For the record, I was 59 years old when I had this surgery on my right foot. I am not an athlete (athletes/runners seem to be over represented in the blogs I found on this surgery). I work a desk job for the federal government and I'm a short, overweight Caucasian female.
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