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As I write this, I am two full weeks out from having surgery on both feet to remove Morton's neuromas. Let me just say first that I am doing great. But I will start at the beginning...
I am a 52-year-old woman (almost 53), 5' 4" tall. My weight fluctuates between 128 and 133 regularly. I'm in overall good health. I've exercised regularly and faithfully for the past 21 years. I have never smoked. I did not drink alcohol at all until the age of 43. And I drink alcohol moderately/socially today (a glass of wine, a margarita, a girlie martini). I have no other health conditions other than silent reflux. And I tell you all this because my doctor told me that complications are more likely to occur in heavy smokers and patients with other health issues; like diabetes. I would venture to say that being overweight could make this surgery more difficult, as well.
I have never been a runner. (I ran the 50 yard dash in 9.7 in sixth grade. I was not born to run, you might say.) And I'm not athletic. I burn calories and increase my heart rate simply for health and weight control; usually indoors while reading or watching TV. If I have abused my feet, it has been by wearing the wrong shoes. I spent much of my life wearing very high heels on a regular basis and shoes that were cute rather than sensible. I remember shopping with my mom while I was still in my twenties and making fun of her for the shoes she was trying on. She was in her forties. And she said, "One day you will stop wearing those heels and buy comfortable shoes, too. Just wait." She was absolutely correct. Nothing is as important to me as comfort today. But the damage was already done.
A few years ago (within the last five, but I can't remember precisely when), I started to notice weird pains in the ball of my foot when walking. I have always liked to walk around barefoot in the house. It just feels comfortable to me and my mom always made us take our shoes off in the house. So it felt foreign to keep my shoes on inside as an adult. But I remember when I started to feel these shooting pains and sensations going into the third and fourth toes. The best way I can describe it is that it felt like my toes were cracking as I walked. It was a weird sensation. There was tingling and numbness (which later evolved into sharper pain). Initially, I just thought I had aging feet. But when that toe stuff started, I got worried that something more was going on. So I got online and Googled my symptoms. That was the first time I had ever heard of Morton's neuroma.
I asked friends for foot doctor recommendations and several people urged me to see Dr. James Yu at Tennessee Orthopedic Alliance in Nashville. I was also urged to skip going to a podiatrist and only consider a medical doctor who specialized in the foot. That seemed like good advice to me (no offense intended to podiatrists). I saw Dr. Yu the first time a couple of years ago. At that point, my left foot was giving me more problems than my right. And I tried my first cortisone injection. It was not as awful as I expected it to be. Not pleasant, but I was impressed with how well I endured it (since I consider myself a little wimpy when it comes to pain). I got some relief for a while. But not nearly long enough. I still wasn't ready to consider surgery, though.
Over time, the pains and weird sensations increased in both feet. I knew I was going to have the surgery at some point, but I was still trying to avoid it and put it off. When I did it, I wanted it to be at the end of winter so I would have months of sandal wearing ahead of me while my foot was still sore. Part of my procrastinating also had to do with my high deductible and forking over the cash. LOL.
This past Fall my pain increased a little more. Cold weather seemed to worsen my pain. One night during an important event, I had to sit down because the pain was so severe in both feet. And I was wearing shoes that had previously been some of my most comfortable. But for several minutes, I could not have walked to save my life. It was terrible. And all I could do was sit and massage my feet (in public). I knew that nobody comprehended the level of pain and I felt like a prematurely old lady. Since I have always made fun of myself and called myself a baby, I assume nobody thinks my pain is as bad as it is. I'm beginning to think I'm not as wimpy as I believe I am. I'm just very expressive and I talk about whatever I'm feeling (bad AND good) more than the average person. I also don't try to appear tough by downplaying anything. I tell it like it is (from my perspective, of course).
My right foot was the worst when I went back to Dr. Yu in early January because I had a trip to Disney World planned with my kids and grandkids (5 and 6). I was a little concerned about how my feet would hold up, but knew the weather would be warm enough for me to wear my most comfortable shoes and sandals. I also thought cortisone injections in both feet would probably be a good idea. This time my injections were given by Dana Duff, Dr. Yu's PA. Wow. All I can say is, if you live in Nashville and need a cortisone injection, he is your guy. I did not feel pain. I was absolutely amazed at his skill.
I suffered with frozen shoulder for about six months this past year and while in physical therapy for that, I had mentioned my neuroma issues. My therapist suggested I go to Target and buy WalkFit orthotic inserts. I did and they helped take pressure off the ball of my foot. But I could not insert them into all of my shoes. I did, however, have one pair of recently purchased shoes that were absolutely perfect for the orthotics. (Does anyone know why this word is spelled both orthotics and orthodics? I've seen it both ways and both appear to be correct spellings.)
The shoes were Merrells I found at TJ Maxx. They have a rubber sole, but not much padding (room for the inserts). They are a loose fit with a fabric upper and a zipper up the center. And they were the first shoe I was able to wear after surgery...
Cortisone and comfortable footwear got me through the week at Disney World. I was so pleased when the five and six-year-olds complained of being tired long before I felt tired. Yay, Grandma Shari! LOL.
The same day that I got my cortisone injections, I made an appt. for a surgery consultation with Dr. Yu as soon as I was back from WDW. The catalyst for ending my procrastination was our upcoming move to West Virginia. The timing just seemed perfect. I could get all of my packing and unpacking done, then have surgery and rest for a while. I knew I had one of the best surgeons and I didn't want to go to a new place needing foot surgery. So in those first few weeks while John was needing to devote all his time and energy to his new Honda store, I decided to have the surgery in Nashville and stay with a friend for the initial recovery. That turned out to be a wiser decision than I could have imagined. My friend was a Godsend to me. I could write a whole post on what a great caregiver and friend she was. I told her she struck the perfect balance between being attentive and nurturing (she anticipated every need I might have and made me so comfortable in her home), and yet never hovering over me. I had plenty of solitude (which I enjoyed) and plenty of attention (which I enjoyed). But I also told her I would not brag too much about what a great caregiver she is because she obviously doesn't want to go into business as a caregiver.
I had surgery on March 6. We arrived at Baptist Ambulatory Surgical Center at 6:00 am. I didn't feel too nervous. But my blood pressure was a little higher than normal for me, so maybe I was. Being the Facebook junkie I am, I was taking pictures with my phone while awaiting the procedure. After asking me if I still wanted surgery on both feet, the nurse wrote "yes" on each.
I was not given general anesthesia. I was given IV propophol (yes, the same drug Michael Jackson received for sedated sleep). It was great. It worked fast. The last thing I remember is feeling some discomfort in my IV and thinking maybe it was not in position. I mentioned it to the anesthesiologist and he said it was the medicine going into my vein. I don't remember anything after that until they ceased the drug and I woke up post-op 30 minutes later. The surgery itself was a breeze. And I was not in pain when I woke up.
My friend Connie teases me that the anesthesiologist had to wait for me to finish giving the nurse my sangria recipe before he could explain that I would feel the propophol as it went in through the IV. That's why I had to ask what I was feeling. I didn't shut up soon enough for him to tell me in advance.
I was alert enough to immediately ask for my phone so I could take pictures following surgery. This is what my post-op feet looked like...
The first actual pain I felt was when I hobbled into my friend's house after surgery. We had to make two stops on the way home; to pick up my prescription for pain and also for a couple of pillows I wanted at Bed Bath and Beyond. I had forgotten to bring my pillows from home and my neck is still not completely back to normal after frozen shoulder. I wanted to make sure I didn't develop neck problems recovering from foot surgery. But by the time we got home, whatever pain relief I had left over from surgery was wearing off. And I hadn't taken my first pain pill. So I got to a chair just as quickly as I could after entering the door. But within 30 minutes, I began to feel relief from the hydrocodone. And I only took 5 mg. (along with 500 mg. acetaminophen). I believe this combination is a Lortab.
Dr. Yu said to stay off my feet (except to hobble to the bathroom) for the first two days. I assumed Day One was the day of surgery. Then, on the third day, he wanted me to start moving around more. He explained that I could not do any damage to my feet. But I could cause swelling if I tried to do too much too soon. And while there is no way to completely avoid swelling after surgery, it could affect how well the incision healed (cosmetically) if I caused a lot of swelling. He said the surgery went well and I should only need pain meds for the first couple of days. He said that the nerves would be sent to pathology to confirm they were damaged. Then he assured me that he had never removed a nerve that had not turned out to be damaged. Prior to surgery, that had been the only concern I'd had; that he wouldn't get the nerve that was causing the problem. I didn't want to be his one exception. So I was very relieved when the nurse told me a week later that the pathology results were positive for Morton's neuroma in both.
I took my pain pills every four hours the first two days and was amazed how little pain I experienced. I was uncomfortable, and walking was definitely a challenge (if you can call it walking). You feel like Frankenstein at first. Obviously, it was more challenging because I had surgery on both feet simultaneously. But never at any time in my recovery have I regretted doing both feet. I have been so glad I made that decision. I hobbled around on my heels and on the sides of my feet better than I imagined I would. And because my doctor said I wouldn't need pain pills by the third day, I attempted to stop taking them. I have a mental condition I call model patient syndrome. Just like I was obsessed with getting A's in college, I was determined to be a star patient and not fall short of the goal. I did so well all day that Thursday (Day One being Tuesday) that I decided not to even take a pain pill that night. My friend suggested that I take it even though I was not in pain and was feeling sleepy without it. I told her I really would take it if I needed it. But I fell asleep without it. I later realized it wasn't the best decision and was motivated by my model patient syndrome. Although I can't say I was in a lot of pain during the night, I did not sleep as soundly. I had a harder time getting comfortable (because you can't really use your feet to position your body). And there was more discomfort involved when I did have to hobble to the bathroom. It would have made more sense to take it.
When my friend came in to check on me Friday morning and saw the pill still laying on my bed table, she shook her head and said, "You're hard headed." John calls me Hard Head sometimes (playfully). And I don't think of myself this way. But all through frozen shoulder, I tried to be brave and not take pain pills except when I could not bear the pain. For some reason, I have a need to prove to myself that I'm not a baby. I imagine that the people around me think I'm exaggerating my pain. I'm not sure why. Perhaps it's the way I grew up.
So I decided to stay ahead of the pain a little bit longer, regardless of what the doctor's expectations were. I was able to take them six to seven hours apart, but I took them on schedule for the fourth and fifth days. It was a good decision and one I recommend to others. If for no other reason, the pain pills made me more comfortable as I got up and down, spent more time on my feet, and ensured a good night's rest. I continued taking them before bed as needed for another week.
I did not venture out of the house until the seventh day. And when I did go out, a friend picked me up and took me to lunch. I was feeling so good that I decided to walk into Victoria's Secret and pick up some lotion I like. That night I could tell I had walked more. My feet were quite sore. But I wouldn't call it pain. I could tell they were a little bit swollen by the way they felt. They didn't look so swollen, but the bandages felt just a little bit snugger. Not tight. Just a little snug. I never unwrapped my feet until my stitches came out. So I never saw my incisions during this time.
Bathing was another challenge, but not as hard as I anticipated. I like to soak in the tub. So what I did was step into a dry bathtub, sit down and hang my feet over the side. Then I ran the water. My friend had a great hand held shower head. I just had to remember to take it down before running the water. I soaked, cleaned up and washed my hair all by myself with no problem. When I was done, I let the water out, then put the bath mat inside the tub, stood up (weight on my heels), stepped out and dried off. It went smoothly every time. And it was refreshing. But it did use up a lot of energy.
Except when I was up and moving, I kept my feet propped up at all times. Sitting in restaurants, I propped my feet up on a chair or in the booth. Sitting at the kitchen table, I propped my feet up on another chair. I even slept with my feet elevated on a large pillow. I was comfortable that way. It wasn't a problem.
I went out a little bit every day the second week. I went to lunch Monday and Tuesday. I was able to keep my scheduled appointment for hair cut and color Tuesday afternoon. I went out to dinner with friends Wednesday night. My friend and I went for a massage Thursday afternoon. I went to get my stitches out Friday morning. But I cannot imagine doing any more than I did. Being taken to lunch and keeping appointments for pampering are much different from returning to work. I would not be ready to go back to a job yet. And I'm thankful that I don't have to.
I had the most foot discomfort (mild pain) on Saturday night and Wednesday night (which would have been Day Six and Day Nine). I think it was from a little swelling. We had to wait in the bar for our table at Carabba's Wednesday night and I tried to sit at the bar without having my feet up. I was immediately uncomfortable. Thankfully, one of my friends offered her lap. And I accepted the invitation. I then put my feet up in the booth once we were seated.
There were times I could feel my incisions and other times I just felt like the bottoms of my feet were severely bruised, sore and tender. Today, which is Day 15, my feet don't even feel sore unless I'm on them. I am still not putting pressure on the balls of my feet. But I am not having to avoid letting them touch the ground like I first was. They are not as sensitive. Some patients report numbness and an inability to wiggle their toes for a while. I am not aware of any numbness in my foot or between my toes at all. And I could wiggle my toes the very day of surgery. I stretch and wiggle them a lot to increase circulation.
I have had a variety of sensations and minor pains in the ball of my foot since surgery. Most of them are spontaneous and short in duration. But my first thought is always: Is this normal or have I done something wrong? But I found a blog by another MN surgical patient with many comments and was reassured that everything I felt was normal and common. Even though I'm doing so well, my feet have suffered an invasive trauma. Tissue and nerves have been "messed with" in the process of getting to the damaged nerve. There has been cutting and sewing and manipulating. So everything inside is disturbed and needing time to heal. But there were many successful outcomes shared. And I felt very encouraged that I'd made the right decision to have the surgery. I also read about patients taking stronger pain medication and having a hard time walking; needing crutches or canes (with only one foot affected). I know every surgery and every person is different in its recovery process. The surgeon makes a difference. The health of the patient makes a difference. The location and size of the neuroma makes a difference. Caregiving makes a difference. Following instructions makes a difference. And I have tried to follow my doctor's instructions to the letter.
I was a little surprised when the nurse removed my bandages to take out my stitches. Because my pain wasn't bad, I thought maybe the incisions weren't very big. It looked worse than it felt. But she said the incisions looked great and I was healing well. She said the biggest pitfall for people who come through it as well as I have so far is that they tend to overdo. She urged me to give my feet lots of rest for a full four weeks, no matter how good I felt. She said I could try wearing shoes any time, as long as they were comfortable. And that my feet would let me know what shoes to avoid. One stitch had some skin grown over it and removing it involved a little gentle digging with a tweezer. It hurt, but wasn't any big deal. And it was only a minute or two. It was kind of like a stubborn splinter. The other ones came out with no problem and only stung a little. I did take a pain pill one hour prior to my appointment, as advised, to take the edge off. But I could have done it with nothing.
When I told Julie (Dr. Yu's nurse) that I had needed the pain pills a little longer than two days, she laughed and said all the doctors tend to dismiss the recovery as nothing. She said men seem to have a harder time than women. And she always tells patients what to realistically expect. She also said every foot, every patient, every surgery and every surgeon is different. She told me I had one of the best and that patients come to him from several other surrounding states because of his reputation. That was really nice to hear.
I wore the protective boot/sandals exclusively until Sunday afternoon, Day 13. I liked wearing them because it alerted observers to injury or surgery. I felt like it would make people more aware and more cautious around me. It also served as an explanation for why I walked like Frankenstein when I looked otherwise fine. I stood a lot more than I probably should have Saturday evening because I attended a special event (my son's ordination) and was 100% in the moment (feeling no pain). I could have sat down more, but I felt fine. Only later on did I feel some repercussions of standing so much. My feet were very sore. But I think that is probably to be expected as activity is increased. I had some visible swelling when I took my socks off that night, but it wasn't alarming swelling. After a night of sleep, the swelling had gone down.
I am spending my third week trying to stay off my feet a lot; letting them rest and heal. I don't need to be anywhere or do anything. So there is no reason to push myself. I know. I'm very fortunate to be able to sit around for as long as it takes. And fortunately I am not the type of person who needs to be doing something every minute. If I have my laptop, books, programs recorded on TiVo, I'm good to go. And the most discomfort I have currently is in my back, shoulder and neck.
My sciatic nerve is bothering me. I assume it's from walking abnormally for the last two weeks, messing up the alignment of my body. And it could also be from sitting so much. And I think I have strained something in my shoulder this past week. I am freshly recovered from frozen shoulder (six months) and when you cannot use your feet to reposition yourself, you overuse other parts of your body. My left shoulder is a little sore. But it's nothing compared to the pain of frozen shoulder. Actually, I would rather go through this surgery and recovery ten times than have frozen shoulder again. That pain was excruciating day in and day out for months. And the three months of physical therapy were agony; especially in the beginning. At one point, I couldn't even talk about the pain without crying. My nerves were so shot from the chronic pain. In comparison to that, this surgery and recovery has been an absolute walk in the park.
I can get my feet wet now. But I still find it easier to sit in the tub rather than stand in the shower. I'm not supposed to soak my foot in the tub yet, so I still prop it up on the side. But I can wash the bottom and run water over my whole foot, which feels good. I cannot, however, put even gentle pressure on the ball of my foot. I have to touch it lightly or else I trigger what feels like electrical impulses running through the foot. It is still sensitive to pressure. A couple of times I have had some shooting pains. But they went away as quickly as they came. Mostly what I have is soreness and tenderness.
I have bruising. But the incisions are healing so well. Julie said to use sunscreen or cover them with bandaids when wearing sandals or going to the beach. As long as I don't expose them to too much sun, they should disappear into fine little white lines eventually. I'm going to be extra cautious, I think, and cover them with bandaids when I go to the beach in June. But even if I wound up with ugly scars, I wouldn't care. I just want relief from the neuroma pain. It will be a while before I even try on a pair of heels. Wearing high heels isn't important to me and I don't want to cause another neuroma to form by abusing my feet. I look at women in those really high heels now and want to warn them. But we all have to make our own mistakes. On the other hand, I will enjoy being able to wear a pretty pair of shoes with low to medium heels on occasion after I am fully healed. But I'm not even thinking that far ahead. I am more eager to be able to exercise than I am to wear heels.
I'm going to share some pictures at the bottom of this because you may or may not want to look at them. I thought I would make it easier for someone to skip the pictures by doing it this way. I want to stress that the incisions look more painful than they actually are. I'm sharing to show you what a successful procedure looks like and what is normal as far as bruising. Of course, I don't know at this point if I will get complete relief from pain simply because I am healing so well. I know some people do not have successful outcomes and are still in pain after having this surgery. But I do know that two nerves positive for MN were removed successfully from my feet and my recovery has been uneventful thus far. So I have every reason to expect the best results. I'll let you know if it turns out otherwise.
I'm looking forward to a much needed pedicure and some pretty polish on those toes.