Day 14: 2 weeks + A day full of firsts

*2 week surgery anniversary*

I made it...2 weeks post-op!

As a graduate student, the days of sitting at home being unproductive have been killing me. Today, that all changed.  I went back to school!!!

Today was the first time I bathed and clothed myself (without any help!) and wore a "real" outfit.

Today was the first time I drove my car.

Today was the first time I parked in a handicapped spot at my school.

Today was the first time I loaded and unloaded my wheelchair by myself.

Today was the first time I wheeled myself anywhere in my wheelchair.

Today was the first time I used the handicap button to automatically open the door to the lab I study and work in.

Today was the first time I taught my class this semester.  My students were great and really understanding of the limitations I will have this semester.

Today was the first time that only a few hours of school zapped all of my energy.

Today was the first time that I rode my road bike (made stationary by my bike trainer).  I had to switch out my clipless pedals for traditional pedals, and use my crutch to move the left pedal.  Nothing made me happier to return to some form of physical activity.  I could only tolerate a 5 minute bout this morning, but made it 10 minutes this evening.  I also did a short push-up and ab workout.

The road to recovery is long...but today I made some major progress.

Day 13: First Post-Op Appointment w/ new foot pictures!

January 28th has been on my calendar for quite a while.   It was something I looked forward to because I knew that my first post-op appointment would be my first major step in the direction of progress.

All Sunday night I anxiously tossed and turned in my bed and imagined what the appointment would be like.  I also searched for as many images of cool colored casts I could find because of course I was excited by the idea of designing a hard cast.

The appointment...

First, I was 15 mins early, and did not get called back until an hour after my original appointment time.  By that point, with the car trip included, my foot had spent over 2 hours not elevated.  Any time my ankle is not elevated, my ankle starts throbbing on cue.  When I finally got called back, a student, not sure what kind, unwrapped my surgical bandage.  I am a major supporter of education, but considering the extent of the surgery I had and how much pain I have been under since the surgery, I certainly expected an expert to be unwrapping it. To the student's credit, she was very careful with unwrapping and it didn't hurt as much as I expected.

Here is the progression:

Here we go...5 incisions, 4 closed with stitches, 1 closed with staples.

My surgeon's initials, still on my surgery leg.

What is left of my calf muscle...

After the stitches and staples were painfully removed, steri-strips were placed to keep the incisions in place.  Surprisingly enough, the incisions were mostly healed already.

Next up, x-rays.  It was so painful to hold my foot in the proper positions for them to take the images.

Pre- foot:

Notice how flat my foot is.

Post-foot:

Notice the nice triangle shape in my arch area. Also notice the line where they cut my heel bone and shifted it, and where they wedged the extra bone in. Both screws are in my calcaneus, so eventually the bone will reform into one piece again.  The screws are there for life.  Neither one of the screws cross over a joint, so my foot will be free-moving once it heals.

Pre- foot:

Notice how my foot is curved in the arch area towards the inside and how the talus bone is creeping out of alignment with the navicular.

Post-foot:

Notice how my calcaneus was cut on the lateral side and how they wedged a bone in and used a screw to secure it.  Also notice how straight my foot is, with the talus happily tucked into the groove of the navicular bone.

After x-rays, I was off to the cast room.  I was anxiously awaiting my color choice.  And then...my world stopped for a moment.  I asked the technician what my color choices were.  He replied with, "We don't have any colors."  Only white...ONLY WHITE!!!!  With a surgery like mine, there isn't much that you get to look forward to.  Having the coolest cast ever was high on my silver lining list.  With the stress of the appointment so far, I just lost it.  Tears started rolling down my face.

So there it is...my ugly white cast.

As soon as I got out of my appointment, I continued my struggle with the durable medical equipment company to get a wheelchair.  Luckily, around 5 pm that afternoon, I finally got a lightweight wheelchair and a 3 in 1 toilet delivered to my apartment.

My life has been exponentially easier since the arrival of these two items.

Post-op: Day 11- Marathon Expo

Today, I went to the race expo for a full marathon that I signed up for almost a year ago.  Of course the trip was bittersweet, knowing that had I not been injured and needed surgery, I would be running 26.2 miles tomorrow.

I went to pick up my race number, check out the booths, and meet excited runners.

Luckily, I was able to rent an electric scooter at the convention center for $15.  It was worth EVERY penny, because I would have never been able to crutch around that place.

Even though I can't run the race tomorrow, I did have a blast at the expo.

Being welcomed by the running/triathlon community, even with my injury, motivates me to take my rehab seriously so that I can rejoin them on the road!

Post-op: Days 8-10

My pain level has hovered around 6/7 out of 10 for the last few days.  That is of course only when my foot is elevated.  It screams in pain any time that it is down.

It is interesting to note that I have a lot more sensation in my surgery foot, so I can feel the incisions and selective pain from the areas that were operated on.

I have also learned that getting around on crutches is near impossible while keeping one foot (that has a really heavy soft cast on it) off of the ground.  Both hands are occupied, so you can't carry anything.  Balancing is challenging, and the whole ordeal is absolutely exhausting.

I am in the process of getting a wheelchair because there is no way I will make it through the next few months of non-weight bearing without some wheels.

Post-op: Day 7

*1 week surgery anniversary*

My pain level finally dropped a little, to what I would estimate as a 7 out of 10.

To escape my cabin fever, I went out for the first time for an exciting trip to the grocery store.

Luckily, my local grocery store had an electric scooter that I was able to drive around.  I was so scared driving it thinking I was going to run someone over.

I only left the house for 1 hour, and I was absolutely exhausted when I returned.  Even still, it was totally worth it.

Post-op: Days 4-6

Pain, pain, and more pain.

Nothing more to say, except that I have been much more comfortable recovering at home than at the hospital.

Hospital Daze

I had to stay in the hospital for 3 and a half days!  My surgery was on Tuesday morning, and I did not get released until Friday afternoon.

To be honest, most of my hospital stay was a blur.  Not because of the pain meds, but because of the constant visits by the nurses, doctors, hospital staff, and PT.  The most sleep I ever got was the few and far between 2 hr naps.  Otherwise, I was up pretty much the whole time.  I was absolutely exhausted keeping up with the schedule of vitals check ups, taking medications, having blood taken, doing PT, eating, etc.

My pain remained between 8/9 out of 10 for my entire stay.  I had to stay so long because none of the narcotics worked to relieve any of my pain.  This caused me to have a fever and an elevated HR.  The worst day was Thursday morning, when they removed my IV pain drip and switched me to oral meds.  The highest dose of percocet that they could give me did absolutely nothing for me.  That morning my pain peaked at a 10.  The rest of the day, they ended up injecting dilaudid through my IV in combination with taking percocet.

I had to get an ECG and an echocardiogram done before they would release me to rule out a heart problem causing my tachycardia.

My heart passed these tests with flying colors, so around 3 pm on Friday, January 18th, I was finally released! I was so happy to bust out of jail.

I am so grateful to my friends that visited me and brought balloons, stuffed animals, flowers, and goodies that made my stay go by much faster!

Surgery Procedure Details and Soft Cast Photo

My surgeon reported that the surgery went really well and that he had to do every single one of of the proposed procedures.

My Surgery Procedures

Left hindfoot posterior tibial tendon debridement and tenolysis (cut out the bad portion of the tendon and clean up the remaining tendon)

Flexor digitorum longus tendon transfer (transfer the tendon that flexes the little toes to the posterior tibial tendon site)

Medial displacing calcaneal osteotomy (saw off my heel bone and reattach it to the correct position with a titanium screw through my heel)

Lateral column calcaneal lengthening with allograft wedge bone grafting (add an extra bone to assist with rebuilding a normal arch)

Gastrocnemius recession (lengthen my calf and achilles tendon)

Autogenous platelet rich plasma treatment (harvest some of my blood, spin it down to concentrate the platelets, and inject it into my newly transferred tendon to promote tissue regeneration and faster recovery)

My post-surgery soft cast

I have been lugging this heavy surgical dressing around since the surgery.  I do not get to switch it out for a hard cast until Monday, January 28th at my first post-op appointment.

Surgery Day

Today, I am 12 days post-op and I finally feel good enough to return to posting.  I will be recapping the last two weeks in the next few posts. I adjusted the dates to reflect the days that I would have published the posts, had I been able.

Now on to my SURGERY experience!

On Tuesday morning, January 15th, 2013, I reported to the hospital just after 8 am.  I was informed that the surgery before mine had been cancelled, so my surgery got pushed up. Luckily, this made me the first surgery of the day for my surgeon.

After giving away a precious amount of blood for yet another pre-op blood test and my IV being painfully inserted, my bed was rolled to the pre-op staging area.  My surgeon came by for a visit and initialed on my left (surgery) leg.  I also had a consult with the anesthesiologist.

A few minutes later, it was time for what they call a "time-out."  I said goodbye to my Mom, and the next thing I remember is the recovery room.  I had been put under temporary anesthesia, given a nerve block, and then wheeled to the surgery room where I was put under general anesthesia for the surgery.

According to my mother, the surgery only took an hour and a half!  This is really fast for all of the procedures that I had done, but my orthopedic surgeon is very experienced and my case was not complicated by things like old age, arthritic conditions, extensive degeneration, obesity, etc.

When I woke up in the recovery room (around 12 pm), the first thing I remember the doctor/nurse asking me is to wiggle my toes on my surgery foot.  Much to everyone's surprise, I was able to do it.  Since I had been given a nerve block, all sensation and pain should have been blocked for 16-24 hrs after my surgery. When I was able to wiggle my toes, I immediately knew that this meant bad news for me and the pain I would be experiencing.

The next thing I remember is crying due to the excruciating pain I was feeling in my heel.  Of course, it had just been sawed off and repositioned with a titanium screw drilled down the center.  They shot some medicine into my IV and put an ice pack under my heel.  If the nerve block would have worked, I wouldn't have been feeling any pain at this point.

They then curiously inquired about my age, level of fitness, and what sport had caused the injury.  I blurted out marathons....running marathons got me here.  They wanted this information because my resting heart rate was hovering around 115 bpm.  This is extremely high for someone my age (25) and for my level of fitness, which meant I was experiencing tachycardia (high HR).

I ended up staying in the recovery area for several hours because the hospital was really booked that day, and they couldn't find me a room to go to.  So much for all of those pre-planning appointments. Around 3 pm, I was finally wheeled to a room.

By 5 pm that day, I had already been visited by just about everyone that works at the hospital (nurses, doctors, physician assistants, hospital coordinators, social workers, PT, etc).  All I wanted to do was sleep...and I was hungry.  I hadn't eaten anything since midnight the night before.

The physical therapists (PT) came and required me to do a few leg exercises and to crutch a short distance down the hallway and back to my room.  They were surprised that I could get out of bed, stand up, and crutch all on my own.  I reminded them that having one ankle out of the game did not affect the strength in the rest of my body.

The rest of the day, I remained in a state of high pain (approximately 9 out of 10).  No matter how many "breakthrough" pain shots of dilaudid (hydromorphine) or how many times I pressed the button for the pain drip (same drug), nothing could take my pain level down.

The first night was rough as well.  I was only able to get between 30-45 mins of sleep at a time.  In addition to dealing with the pain, all of the IV fluids and liquids they had me drinking caused me to go to the bathroom 16 times between 10:30 pm and 6 am.  Since I was hooked up to the IV pole and I needed both of my hands for my crutches, I had to call the nurse to help me to the bathroom every time!  She was really nice, so I got lucky.

Surgery Eve...

So here we are...the eve of my ankle reconstruction surgery.  I got a call from the hospital this afternoon assigning my surgery arrival time of 8:30 am tomorrow, Tuesday, January 15th.

8 months of suffering from this nagging running injury will all be over tomorrow.  Unfortunately, it will be much worse recovering from the surgery and having to re-learn how to walk again, but the surgery gives me hope.  I will definitely be able to return to a moderately active lifestyle and hey, I may even be able to run again.  I try to stay focused on what my life could look like a year from now: being able to start each day without having to figure out how to complete my daily schedule with the least amount of walking and standing, not having to match my professional clothes to tennis shoes, returning to competing in triathlons, and having elite level fitness.

Surgery Procedures

Left hindfoot posterior tibial tendon debridement and repair (cut out the bad portion of the tendon)

Flexor digitorum longus tendon transfer (transfer the tendon that flexes the little toes to the posterior tibial tendon site)

Medial displacement calcaneal osteotomy (saw off my heel bone and reattach it to the correct position with a titanium screw through my heel)

Autogenous platelet rich plasma treatment (harvest some of my blood, spin it down to concentrate the platelets, and inject it into my newly transferred tendon to promote tissue regeneration and faster recovery)

Possible: gastrocnemius recession (lengthen my calf), lateral column lengthening (add an extra bone to assist with rebuilding a normal arch)

Wish me luck!

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I gotta go.  Final surgery prep is calling my name.  I have to shower with sterile soap and go stuff as much food and water in until midnight, because I won't be able to eat or drink after that.

What the heck is PTTD and why do I need surgery?

PTTD Defined

PTTD stands for posterior tibial tendon disorder/dysfunction.  The posterior tibial tendon provides stability and support for the arch of the foot.  When the tendon gets inflamed or torn, the entire arch structure can be compromised, resulting in a flat foot deformity. 

Minor cases may be treated with orthotics, braces, periods of rest (stabilized in walking boots or casts), and physical therapy.  More severe cases require surgery.  

Want more information? -->  Ortho Info

My Case

April 2012-  The first sign was unusual swelling of my ankle about 8 hours post a 12 mile long run.  I was about 4 weeks out from running a full marathon and I was 2 weeks away from running a half marathon.  I rested my ankle for the remaining weeks up to the marathon, while diligently icing, compressing, and elevating. Being the athlete that I am, there was no way that I was going to pull myself out of my upcoming half marathon for a little ankle pain.  Oh how hindsight is 20/20.

April 29th, 2012- My last running race, a half marathon (13.1 miles).  I woke up at 4 am on race morning to the sound of heavy rain.  I refused to let my ankle or the weather stop me from running this race.  This was the moment that I knew that I was a "real" runner, because I was ready to run rain or shine.  I was hopeful that the rain would stop at some point, but it rained the ENTIRE race.  I finished the race and literally collapsed at the end, after setting a PR, of course.  Some of my tri friends have a saying, "PR or ER." I accomplished both with this race.   Minutes after I finished the race, I experienced a rush of pain in my ankle while checking the computers for my race time, and then out of nowhere, my ankle gave out and I was on the ground.  The EMT/Firefighters had to carry me over to a table to check out my ankle.  Since I wasn't able to put any pressure on my foot, I ended up getting a thrilling ride to my car on the emergency vehicle.  When I returned to my apartment, I literally ended up crawling around the rest of the day because my ankle would simply not function.  Of course I had a million things to do the next day (a Monday), so luckily I was able to rent a pair of crutches from my health center.  

May 2012-  After a few days of crutching around, I knew that there was something really wrong with my ankle.  Even as the post-race swelling went down, putting pressure on my ankle was really painful.  I went to an urgent care hospital for some X-rays.  At the time, the doctor was really stunned as to what could be wrong with me, but he did suspect an accessory navicular bone.  They sent me home with crutches I could keep, yay!  I returned the rental crutches the next day, and convinced the health center to prescribe me a walking boot.  After 5 days, I had already had enough of those stinking crutches.  Both the health center doctors and the urgent care doctor recommended I see an orthopedic surgeon for more clarity.  

I had to wait 2 weeks before I could get an appointment.  These two weeks were the absolute worst.  Since I didn't know what was wrong, I did absolutely no exercise out of fear of injuring my ankle further.  I went from running ~40 miles a week with additional spinning and lifting workouts as cross-training to NOTHING.  When I finally got to see an orthopedic surgeon, he took more X-rays and concluded that I didn't have an accessory navicular bone.  He theorized that I likely had a few hairline fractures and a badly inflamed posterior tibial tendon.  He wanted me to spend an additional month in the boot. :/  The good news was that he did permit me to swim and bike for fitness.  Being that I hadn't done either since probably middle school, I had a lot to learn!  

June 2012-  I had a follow-up appointment with my orthopedic surgeon.  He looked at my ankle and was happy with the progress.  After 6 weeks, he freed me from the jail sentence with my boot and approved me to slowly return to running.  He recommended I run a block, walk a block, until I felt comfortable running again.  After the boot, my ankle felt much better than it did when I initially injured it, but deep down inside, I knew something still wasn't right.  I did feel like if I really slowly returned to running that I would be alright.  

For the rest of the summer, I focused primarily on swimming and biking, but I did try to run/walk approximately 20 mins, 3 times per week.  At this point, I was hooked on the combination of the three sports.  I decided that there was no better time to convert my training identity as a runner to a triathlete.  I invested in the right gear, and signed up for my first race .

August 2012- School started again.  I am a graduate student and that meant that my daily activity increased exponentially from the summer.  Bad news for my tendon.

September 9th, 2012-  My first triathlon!  It was a sprint distance (400m swim, 10 mile bike, 3.1 mile run).  I had an absolute blast!  My ankle didn't bother me too much, but I also did not push myself during the run portion.  After this experience, there was no question that I was born to compete in triathlons (hence my pen name).  I was smiling ear to ear every minute of the race.  Of all the running races I have completed, I can not list one that I had that much joy doing.

Rest of September 2012- Since I had some residual tingling and pain up the posterior tibial tendon, I decided to schedule a follow-up appointment with my orthopedic surgeon.  He checked out my ankle, and out of nowhere, he told me that I would never be able to run again!  Soon after, I found myself balling tears in his office.  I could not believe that what I thought was a minor ankle injury could take me out of not only running, but my newfound love, triathlons, FOREVER!  I was in absolute shock and disbelief.  He wanted me to get an MRI to confirm and come back and see him in a couple of weeks.  In the meantime, he prescribed me another 6-week sentence in the boot.  

The MRI results were inconclusive at best.  I had mild inflammation of the posterior tibial tendon and some partial tears around my ankle.  Much to our surprise, my MRI also revealed a cartilage tear.  He gave me two options.  He said that I could get a cortisone shot and see if that helps or finish my boot sentence and see if it gets better on its own.  I chose the boot sentence, because I didn't want to risk the shot compromising the integrity of my tendon.

October 2012- Immediately after being told that I would never run again due to this injury, I did hours and hours of research on this condition and what could be done to remedy it.  I started investigating the diagnostic techniques and analyzing my ankle to the standards.

I first noticed that I had a major problem when my foot presented the "Too many toes" sign.  It is when you can see your smaller toes when looking at your ankle from behind. The tendon can become so weak that it allows the ankle bones to completely collapse inward on the arch.  This is a picture of my feet from behind.  If you compare my ankle to the illustration in this post, it is a match for hindfoot valgus and a flat foot deformity.

I had my follow-up appointment with my orthopedic surgeon, which was one of the most frustrating days of my life.  At this point, he had been treating me for over 5 months, and he literally threw his hands up in the air and said that he didn't know what to do.  He then referred me to a foot and ankle specialist.

November 2012-  I had my first appointment with a foot and ankle specialist at a Sports Medicine Orthopedic practice.  I absolutely LOVED this new doctor.  He tested my ankle in ways the general orthopedic surgeon had no idea how to do.  He provided extraordinary detail in what exactly was wrong with my foot and why all of this happened.  At this appointment, I failed the single limb heel raise test.  I could not go up on my toes on my left foot.  I was shocked!  

The doctor suggested that I get custom orthotics and see if that helped me any and that I come back and see him in a few weeks.  At the time, he wanted me to avoid surgery at all costs.  He said, "If it were me I would give up extreme exercise and do less strenuous activity like yoga and cardio classes at the gym."  I couldn't believe this man.  He is obviously not a runner.  He only suggested surgery if I couldn't do activities of daily living without pain.

Guess what?!?! Not long after the appointment with this doctor, my activities of daily living started to become impossible.  I could not walk more than 50 feet without pain or stand longer than 10 minutes.  Showers became the worst part of my days, and still are, because I can't have any type of orthotics or shoes on my feet in the shower.  I could no longer tolerate the standing it took to cook food, walking around campus, standing while waiting in lines, grocery shopping.  None of that.  I started to feel like my tendon was shredding with EVERY SINGLE STEP OF EVERY SINGLE DAY.  The active girl that was running 40 miles a week, was now completely sedentary!  Swimming and biking became increasingly difficult as well.  I couldn't survive longer than a 30 min workout of either, and I would have to recover for 2 days before even thinking about my next training session.

I did a lot of soul searching and I knew that I could not live like this for the rest of my life.  25 years old is too young to quit living an active life.  I knew that I had to start seriously looking in to having surgery.  I scheduled another appointment with my doctor.

December 2012-  I convinced my doctor that I needed to have the surgery.  He did his very best to try to make me back away from the ledge, but nothing he said made the realization of what my life has become and its future prognosis any better.  Not even the fear of the pain and the long recovery of the surgery is bad enough to continue living like this.  Based on my life timeline, it made the most sense to have the surgery in January.  As a last ditch effort, he prescribed more severe orthotics and had me try Mobic, an NSAID, anti-arthritic medication to see if I had any improvements.   Big surprise...it didn't work!

January 2013-  I ended up switching to another surgeon in the same Sports Medicine Practice a week before the surgery upon recommendation of my former doctor.  It has been a crazy shake-up, especially considering that I have only met the surgeon that is going to do the procedure 1 time.  The good news is that he is more experienced at flat foot reconstruction surgery and typically works with younger athletes.  

I have been poked and prodded and given all of my blood away to complete the pre-operation procedures.  I have also been preparing my apartment and my life for many months of crutches + splints/casts/boots/ankle braces.

My surgery is on Tuesday, January 15th, 2013.  I will not know the time of the surgery until tomorrow afternoon.

This post is long enough!!!! On my pre-surgery eve...tomorrow, I will detail the surgical procedures I am having.

Good night!

About Me

Hey Everyone!

Welcome to my blog.  I have scoured the internet for all the information I could find about PTTD when researching my injury, and it helped me greatly.  To give back, I started this blog to provide information to any current or future PTTD sufferers, especially for those that are active and want to return to activity after surgery.

When I started this blog (2013), I was a 25 year old female marathon runner and triathlete finishing up a PhD in Exercise Physiology.  Now, you can officially call me doctor and I'm a college professor, a swimmer, cyclist, triathlete, and occasional 5ker.

My story begins in April of 2012 when I hurt my ankle after running 2 half marathons and a full marathon in a 4 month span.  Crazy...I know!  For those of you that are also runners, you can understand how addictive racing can be.

I spent 8 months of my life between numerous doctors, crutches, two different boots, X-rays, MRIs, medications, and custom orthotics.  None of the non-surgical treatments worked for me, so here I am starting this blog with Stage 2 PTTD with a flat-foot deformity, 6 days away from full reconstructive surgery of my left ankle.

In my next post, I will explain exactly what PTTD is, and what procedures I am having done to correct my ankle.

:)