2019 – some background info
For the past few years I have suffered from Achilles tendinitis in my left ankle. I assumed it to be a result of over use or wearing poor fitting shoes. After I had refereed a few soccer games on a Saturday afternoon, or been hiking over a weekend, the back of my left ankle would swell and be VERY painful. It was quite common for me to limp or hobble around the house for a few days while my ankle recovered.
I well remember after one Sunday morning after I officiated three soccer games in a row I could barely get out of bed. I decided it was due to cheap poor fitting ref shoes. After some research in the web I purchased a few pairs of Asics gel-venture 6 black running shoes. These definitely made a difference and I though I was done with foot pain. Not so fast sport!
My job often requires me to wear steel toe boots when I am in a factory, and after a few days of wearing these shoes my left foot would be on fire. I tried wearing two pairs of socks and even added a low wedge insert, but eventually even these changes would have no lasting effect.
A second part of my job often requires me to lecture on electrical safety. In early November 2019, after teaching for three days in a row , wearing dress shoes and standing for most of the time, I could barely walk. Excruciating pain in the heel, red and very sore to touch the back of my left ankle. It felt quite swollen. I hobbled and limped for the normal 2-3 days but this time the pain would not subside. At the “nagging” of my family who were tired of seeing me limp and whine, I took myself off to the local Minute Clinic to get some pain pills and anti inflammatory meds. The wonderful nurse practitioner diagnosed me with Postcalcaneal bursitis and recommended I rest, ice and elevate the foot as much a possible. I did this half heartily but made no serious effort at resting the foot. She also prescribed a 5 day course of Medrol dosepak used to treat and control inflammation of the Achilles bursitis.
Thru the rest of November and most of December I limped and generally put no weight on the left foot. Christmas was a week of pain and misery regarding the left foot and so I took myself off to urgent care at the West Chester UC hospital to get an x-ray and different diagnosis. The x-ray showed a clear bone growth coming off the back of my ankle, but the attending doctor really felt the issue was one of calcification of the tendon and suggested better fitting shoes, rest, ice, and possibly going to see a foot specialist or orthopedic doc for more followup.
January 2020
I set up an appointment with a foot specialist in the northern Cincinnati area and limped into the waiting room. I had my x-ray with me and after some discussion with the doctor was advised the issue was one of a weakened/overused Achilles tendon. The proposed solution was to inject the tendon with RENU a single injection, one time nonsteriodal prescription treatment fluid that would help rejuvenate the tendon. The brochure i was given says that RENU may benefit both bursitis and tendentious – two things I clearly have. RENU contains high levels of growth factors and may promote tissue regeneration and healings. Of course since this is experimental it would not be covered by any insurance and I would need to pay the approximately $2000 myself before the treatment could be ordered and prescribed. I certainly feel this might be a good solution for someone with a degenerated tendon, but I just felt my issue was the bone spur and this treatment did not seem to address that. So I passed on this option. This visit and consultation did cost me $50. All well worth it because I was learning more about my issue and possible solutions. As a footnote (get it!) after my surgery I was told that there was quite a lot of scaring, damaged and degenerated tendon that had to be removed. So this RENU could have helped renew the tendon, but I feel the underling issue of the bone spur would still be there.
I did buy a pair of black dress Orthotic shoes for me to wear when I was lecturing. these helped. Bought from Orthofeet via Amazon.
I then went to see an orthopedic doctor in the Middletown Ohio area who looked at my x-ray, felt around my ankle area and told me I had a Hagland’s growth. Advice was rest, ice, elevate etc. He also suggested better shoes ( I had already done this) shoe wedges (already done) wearing open back shoes (think clogs or flip flops) as much as possible. He did suggest I purchase some socks that have a soft gel/rubber built in the back area for padding between the back of the shoe and my Achilles tendon area. I purchased these on Amazon and they made a huge difference. At the conclusion of the visit, the doctor and I agree this was now causing quite a change in my everyday lifestyle. I no longer refereed, I had stopped playing golf and was very much limiting any walking/hiking. As much as neither of us wanted to, we now discussed surgery for the first time. We set up an appointment for me to see another orthopedic doctor in the same practice who actually performs the surgery and he suggested I get a second opinion since this was rather radical surgery with a long recovery time.
February 2020
So I took myself off for a second opinion and went to see Dr David Argo of Beacon Orthopedics in Cincinnati. He again confirmed it was a Hagland’s growth and that surgery was most likely my best option. He did order an MRI. I had this performed at Dayton Open MRI (at about 1/2 the cost quoted by Beacon!). I took the MRI files back to see him at which time he referred me to Dr Adam Miller, a surgeon from Beacon who actually performs the surgery. I went to see and agreed to surgery.
March 2020
Beacon has a position called patient advocate, and their role is to handle questions, get insurance pre-approvals and just be a singe source of information for the patient. I had regular phone contact with my advocate. One thing I was told that there would be three separate bills. One from the doctor, one from the surgery center and then one from the anesthesiology group. Seems fair. What did surprise me is that I have received a letter from some outfit called IPG Integrated Surgical Solutions informing me that since Dr Miller would be using some of their supplies/equipment in the surgery I can expect an invoice from them. ( I am guessing this is for the titanium anchors that are now inserted in my heel). Whats next? I get an invoice from the gown maker because I worn their gown for an hour in surgery. Or maybe a furniture maker sending me a bill because I parked my bum in their chair in the waiting room?
Monday March 16th.
It’s sort of amusing. They want you there 2 hours before surgery to get checked in etc. but the paperwork takes about 10 minutes then you sit and wait in the waiting room over an hour! But soon enough I was back in the surgery prep room putting on the gown (you can keep your underpants on thankfully!) and answering the same questions to yet another person. Whats your name? Whats your date of birth? Where are you having surgery done? etc. I felt like telling them just to check with the last 14 people who have just asked me these questions, but I realize they are just doing their jobs. Dr Miller stopped in and signed the left foot, followed by the anesthesiologist and the surgery nurse who all autographed my cold foot! The right foot had a large grey sock on it so as not to get confused. The most painful part was when they stuck an I V needle into the back my left hand for medicines etc. Not sure exactly what went in. All good I am sure. I was given a nerve blocker for pain in the left leg, Then I was wheeled back to the surgery room. I remember putting on a breathing mask and being told they were going to give me some oxygen to get my levels up. That’s the last I remember till post surgery.
I came too in the post surgery room and was helped back into my clothes and sat in a wheelchair. They gave me a few cups of ice water. Wow did they taste great. They wheeled me out where my wonderful wife was waiting to drive me home. They had gone over all the prescriptions and instructions with her during my surgery. Dr Miller had also spoke my wife immediately after surgery to say all went well. And so we drove home. I used crutches to get from the car to the front room of our home. I felt good.
My left foot was wrapped in a HUGE bandage and my instructions were to not get it wet for 2 weeks till my next visit with Dr Miller. We had set up a recliner in our living room and rearranged our dining room to be a “work from home” center for me for the next few weeks. Little did we know the entire country would be working from home a practicing social distancing within a few days. I must be a trend setter!
My foot prior to surgery
I felt no pain that first evening and night. In fact the nerve blocker only started to wear off mid afternoon on Tuesday.
Tuesday March 17th – one day post surgery
I woke up feeling good. Crutched from my bed to the recliner and spend most of the morning drinking good coffee and working using my laptop.
I did my first round of medications – Hydrocodone one or two tablets every 6 hours for pain, 500 mg Vitamin C to be taken once a day, 5000 IU Vitamin D3, Hydroxyzine Pamoate to be taken for itching. I took this day one and then not again. I have not had itchy issues! I was also given Ondansetron HCL for nausea. But have not needed to take this either. I also take an aspirin daily to keep the blood thin.
Dr Millers office staff called in the morning to see how Ii was doing and then later that afternoon Dr Miller himself called to check in. All good stuff.
After a few slow and awkward trips in the house using the crutches, my wife suggested I look into the whole knee scooter thing. In a flash we had rented a knee scooter from The Medicine Shoppe. $25 a week or $80 for a month. What a great thing. Easy to get around, no long crutches to deal with and it has a basket on the front to carry my phone, laptop etc. I can operate it one handed and carry a cup of coffee in the other. Well done wife!
Wednesday March 18th and Thursday March 19th – two and three days post surgery
No issues today. Very mild pain and I took all medications except the pain killers. Good days. Was able to work from home easily doing computer work from my desk or recliner.
Friday March 20th – three days post surgery
OK so today the pain showed up. Feels like someone has taken my foot and rotated it in a circle wile keeping my leg stiff. Lots of pain at the top of the foot and down the outside. Loaded up on the pain killers. Surprisingly no pain where I assume the incision to be. (At the back of the heel). Difficult sleeping due to throbbing pain that pulsates with every heart beat. Worked from home attending a few webinars and corporate meetings via Zoom. Of course everyone is now working from home so I am not the odd one out. I did question myself and this whole surgery thing since the pain was intense at times. Maybe I should have just lived with a bone spur and moved to the beach where I could wear flip flop sandals the rest of my life!
Saturday 21st March – four days post surgery
Still some pain during the course of the day. Was an overcast rainy day so spend it inside working from my computer. Took pain killers at night when headed to bed.
Sunday 22nd March – 6 days post surgery
Very limited pain today. Spend the day inside. Very boring day now there is no sports due to COVID19. What a guy supposed to do when he is chair bound with no European soccer, XFL or golf to watch. Bummer!
Monday 23rd March – 7 days post surgery
Wow a week down. Taking just a few pain pills as needed. Have some shooting pains in my left buttock. I assume it is associated with nerves to the left foot. Ramped up my natural food supplements such as raw garlic, turmeric capsules and ginger teas. Still taking lots of vitamin C and D3. Feeling pretty good.
Tuesday – Thursday
Minimal foot pain. Pretty much stopped taking pain pills. Was able to sit outside in the sun when the sun was actually shining and the wind was not blowing. Read that some doctors are treating Coronovirus with very high dosages of vitamin C. Decided to take a few more myself. Just to help my immunity and my healing! Sleeping very well. Working from home is going fine. Lots of virtual meetings, emailing and phone conversations.
Friday March 27th
Had my first post op visit with surgeon. Cut off the bandaged splint. Wound looks ugly but all is good. Decision is made to leave sutures in another week. No real pain. Did take a post op x-ray. Bone spur/bump is all gone! Left the office with foot in an ace bandage. Got fitted and brought home a walking boot complete with three large (think high) wedges. Plan is to start to wear this boot but I am still not allowed any weight on this foot for a few more weeks. Still cannot get foot submerged or direct water for another 10 days.
Friday April 6th
Second visit to doctor. Removed sutures. Still no weight on this foot. Just hanging out at home using the knee scooter. Wound still very red but really no pain. Was able to maneuver myself wearing the boot onto my riding mower and got outside to mow the grass. Felt good to be outside doing something. On Saturday and Sunday I had a sore and swollen foot, quite painful. I attributed it to stitches out and now in a boot and doing some movement. I had to take a few pain pills at night because the pain while lying in bed was serious.
Monday – Friday April 6th – 10th
Quite week at home. Still using knee scooter and minimal travel. Foot is still swollen but not very sore. Did go see Christy S, a physical therapist at Beacon and discussed my options and therapy plans. She gave me some home exercises. Basically range of motion (ROM) to start in 10 days time. Plan is to do these 3 times a day for a few weeks before seeing her again. Was finally able to get the incision wet, so I enjoyed a hot shower. Much better than the hand basin baths I have been giving myself for 3 weeks.
Saturday 11th. For the second time I climbed aboard my riding mower and mowed the property.
Sunday my foot was on fire! Possibly the most pain I had had since surgery. Lots of pain at the top of the foot where the foot and leg meet. Any movement of the foot results in MAJOR sharp pain deep inside the foot. Foot is swollen, red and very tender. Almost impossible to find a comfortable position. Everywhere is just sharp pain. Very difficult sleeping due to pain. Took lots of pain pills but still suffering.
Not sure what has happened but I will call doc and see if he has any ideas. Actual incision point is fine. No drainage. I do not have a fever or high temp.
Wednesday 15th. Doc was not able to see me until Friday but he gave me a prescription for Gabapentin (generic for Neurontin). Doc feels it is a nerve issue and not an infection.
Thursday 16th. First full day of Gabapentin. Pain is reduced big time. Foot still swollen and tender, but not on fire!
The next week or so the foot pain reduced wonderfully and I am back to normal. I stopped taking the Gabapentin and any kind of pain killer. Started to use crutches and apply very limited weight on the left foot. My wife was the one who associated the two intense foot pain episodes with mowing. Both incidents flared up 24 hrs post mowing. I have a riding zero turn mower and both feet sit on the wowing deck just inches above the turning blades, bearings, belts pulleys etc. We believe the vibrations transmitted into the foot and caused the inflammation and pain. Decision is made to hire someone to cut my yard for the next month.
Monday 27th April – 6 weeks post surgery. Today I took one of the three wedges out of my boot. Great progress I think. I am still using the knee scooter as convenience but really I am quite able to get around with both (or times just one!) crutch. Wound continues to heal. The skin is all peeled back around the wound site, but no issues. Went for a car ride to our local farmers market and CSA to pick up veggies etc. Bought two sweet cherry tomato plants and planted them when I got home. I am not yet driving. That is still at least 3 weeks away. I need to be in shoes, not a boot to drive.
I am doing daily doses of PT. Mainly rotating foot, doing heel/toe up and down motions. The range of motion is increasing every day. I can stand upright on both feet, but cannot yet stand just on the left foot. Weather is getting better, so I am enjoying hours outside sitting in the sun getting a few rays! Hobbled to my raised garden beds and planted onions, garlic, carrots, kale, spinach and lettuce.