8+ Months (December 3rd)

Still trying to figure out what makes the back of my ankle where the achilles attaches hurt so much.  Pressing on it does cause a decent amount of pain but it is nothing compared to how it feels trying to walk after.  I applied pressure to different parts of the area with my finger for about 3 minutes (total).  Within an hour, I could barely walk.

Here are some pics of how my ankle and calf look 8 months after the surgery.  In the pictures of my calf, I was flexing to show the indent.  In the pic of my ankle with the arrow, I'm pointing out where something in my ankle is protruding.  It is most obvious when I'm pointing my foot down.

 

8+ Months (November 30th)

It has been a while since my last update.  Not too much has changed.

1.  I am able to go up on my toes using just my surgically repaired foot now.  It's up and down very quickly but still progress.  However, this type of engagement of my calf muscle results in swelling and tenderness where my achilles attaches to my ankle.  It will then be very painful and stiff for me to move around until the next day.

2.  The left side (lateral) is still partially numb as well as the ankle.

3.  I have had to go up 1 shoe size.  I have worn size 12 shoes since I was 18 and now have to wear a 13.  Doesn't make it easy since my non-surgical foot is still a 12.

4.  The ends of 2nd and 3rd toes are very sensitive and painful when walking barefoot on a hard surface.

5.  My ankle continues to discolor after extended periods of engagement (i.e. mowing the lawn).

6.  If I point my toes down and rub my fingers along my ankle, I can feel something sticking out where my doctor fixed the ligaments.  I'm assuming it is some of the wire he used.

7.  99% of the time, when I get up after sitting at the desk or watching tv, my ankle is stiff and sore to start out.

8.  A full day at the office still results in swelling.

9.  Still occasionally need to take pain meds.

I'll take pics of my ankle and calf shortly and upload them.  Still have a nice dent in my calf where the doc cut the fascia.

6 Months (September 26)

It's been over 6 months since my surgery.

Here's all the bad:

I continue to have terrible stiffness in my ankle when I first get up to move around.  Part of my foot (lateral side from heel to half way down foot) is numb or has very little feeling.  The rest of my foot is still very sensitive and stepping on a grain of sand still feels like a needle.  A walk for over an hour results in very sore toes and horrible burning in my plantar fascia.  An 8 hour workday also results in swelling of my foot.  Lastly, the burning pain on the lateral side of my heel and in my achilles has not gone away.  It still happens randomly and is miserable.

Here's the good:

I can almost go up on my toes using just my bad foot/ankle.  I can fly across country with a compression sock and have minimal swelling (only around my toes).  The bottom of my foot is slowly becoming less sensitive.

Still believe the osteotomy was not necessary and only served as a $ maker for my surgeon.  Sure, my foot is now "perfectly" aligned but at what cost?  A surgeon needs to take more into account than just the perfect alignment - age, stage in life, etc.  Perhaps the surgery could have been justified if I was rolling my ankle every month or 18 years old with a very active future ahead of me.

I'm obviously still bitter.

5 Months (August 23)

Had a 5 month checkup with my surgeon today.  Was the exact same as the last visit.  X-rays and then 5 minutes with the doc saying everything looks fine.  Had me stand and face the wall so he could look at my alignment but that's it.  Didn't manipulate my leg or anything.  Really think these guys are just interested in the surgery and then passing the buck.  I told him I was still having quite a bit of pain if I walk long distances or am on it a lot.  His response was to offer me a few samples of a pain killing patch (called the Flector patch which I apply directly where it hurts).  He suggested that I see my internist for pain medicine as he will not see me again for a few months.  I did mention that I feel as if my recovery has stalled and he said it's perfectly normal.  Said there will be ups and downs for the next 6 months.  He asked if I still felt the osteotomy was not necessary and I told him yes.  He still feels it was the right thing to do as it will help my ankle and comfort levels years down the road.  He said if I continue to have problems in a few months or so, we may want to consider taking out the screws.  Sweet.  Lastly, I mentioned that I am still having quite a bit of pain along the entire lateral side of my foot.  He asked if it is still partially numb and it is.  He said the pain/numbness is due to the nerve regenerating/settling and will slowly return to normal.  The one positive thing he said is that I have made tremendous progress since the last time I saw him 6 or 8 weeks ago.  I guess I need to remind myself to be patient.

I did do quite a bit of travelling the last few weeks.  At one point I was on a very rocky beach and I wore some water shoes so I could swim.  It was definitely challenging but my leg handled it well.  I was sore the next day but not too bad.  On a different day where I drove for 6 hours, my foot did swell but within reason.  I did spend all day Saturday walking around the city.  My leg swelled up a bit but nothing too severe.

It's been a while since I've posted pics.  Here you can see how my leg looks after 5 months.  This is as good as it gets.  I usually have a fair amount of swelling around my achilles.  The colors of my scars are constantly changing as well.  One thing I do want to mention is that when I was uploading the below pics, I did look at my old pics from before.  It was a definitely a good reminder of the progress I've made!

First pic is the lateral side of my foot.  You can see the scar from the modified brostrom repair on top and the scar from where he went in to do the osteotomy on the bottom.  The second pic shows the scar from where he put in the screws.  The last pic shows the dent in the back of my calf muscle and the scar from the gastroc recession on the front.

  

4 Months+ (August 14)

Some positive news to report.  I went to the beach over the weekend and was able to walk around without any major issues.  The last time I tried, my foot was too sensitive and it was painful to step on anything.  I even had to walk across a 10 foot path of rocks & shells to get fully into the water.  It didn't feel great on my foot and far from normal but I was able to do it.  Every now and then I'm able to do something that reminds me of how far I've come.  Just have to keep that in mind.

4 Months+ (August 8)

My recovery has really seemed to have stalled.  The pain in my achilles area seems to be getting worse and the ankle joint is very sore when walking.  The fascia on the bottom of my foot is hurting quite a bit.  My big toe is incredibly weak and the whole bottom of my foot plus my ankle hurts when I try to flex it with any resistance.  Getting very frustrated again.

I did go boating over the weekend and suffered from the usual daytime swelling but it went down over night.  I did step onto a boat cushion that must have had a latch or screw underneath and it really hurt my heel.  It wouldn't have felt great on my good foot either but my repaired heel is still extra sensitive.  Had that horrible burning feeling....

4 Months+ (August 4)

Did a lot of walking while in California and am still paying for it.  Walks would range from 1 to 2 hours and be up to 5 miles long.  My achilles has been very sore as well as the plantar fascia.  In fact, the whole ankle is sore.  It got to the point that I would have to take a pain pill in order to do the long walk.  I must still be limping a bit as I have developed a pretty bad pain in my lower back.  I will be seeing my therapist today and will ask her.  I also noticed that on long walks, I can feel the screws in my foot and it's pretty irritating.  Thinking that they may need to come out.  Very frustrating.

I did fly back yesterday with the compression sock and my foot swelled this time.  Must have to do with how upset the ankle is on the day of flying.  Had swelling on the medial side as well as lateral.  Most of the swelling on the lateral side went away overnight but the medial side is still pretty bad.

4 Months+ (July 28)

Another travel update.  Had a much longer flight (1 hour + 1.5 hour layover + 4 hours) last weekend.  Wore my compression sock and took aspirin.  Ankle and foot didn't swell at all.  Was very impressed.  However, I did have another interview on Tuesday.  1+ hour drive, 6 hour interview, and 1+ hour drive home.  By the end of the day, it was sausage foot again.  Very frustrating.  I didn't wear my compression sock as it would have looked odd.  On a positive note, swelling was down the following morning.  I am still pretty sore though.

Through experimenting, I have been able to narrow down what upsets the ankle a bit.  The biggest culprit is the lack of support.  If I wear my tennis shoes, I can walk for hours without swelling issues.  If I wear sandals though, my foot balloons within a few hours.  I am trying something new today and wrapped my foot/ankle with an ace bandage and wearing flip-flops.  Will see how it goes.  Really hope it helps as wearing shoes during the summer is torture.

I still have a dent in my calf muscle from the gastroc recession.  The scar is on the front but the dent is in the back.  I am slowly rebuilding the muscle in my lower calf and can almost go up on my toes using just that leg.  Almost.  My pain is mostly on the lateral side of my foot underneath that ankle bone.  Therapist said it's the tendons getting irritated.  Burns pretty bad after I work my leg.  Other than that, I get pain at the very base of my achilles.

Will try to upload pic of calf later.

4 Months (June 18)

Almost 4 months out from surgery.

Had my first trip since going under the knife.  Wasn't sure how my ankle/foot would handle it.  I wore a compression sock on the flight and took aspirin just in case.  I was very careful to keep my foot moving every 20 minutes or so while in the air and rested it on my bag while waiting at the gate.  My flights were 45 minutes and then 2 hours (~6 hours total travel time).  Was very pleased when I took off the compression sock and my foot was not really swollen at all!  Just a bit around the toes.

The bad news is that I had an interview the following day and was sitting for 8+ hours with my leg down.  My foot exploded.  Was huge.  I didn't wear the compression sock but was still shocked that it swelled so much.  I attribute some of it to having a few beers after the interview as the swelling always seems worse after having a few.  Anyway, I elevated it that night and most of the swelling was gone by the morning.

I did go on a walking tour and was cruising around the city for about 6 hours.  I wore tennis shoes but no compression sock.  Strangely, my foot didn't swell very much.  Very odd.  Once again, I'm beginning to see some correlation between alcohol and the swelling.

Flying back today and will report anything interesting.  Still very upset that I had this surgery.  Not worth the ramifications (in my case).

Day 101 (June 30)

Worked my leg too hard on Tuesday night and am paying for it.  I've irritated my plantar fascia and need to take a few days off of working out.  Started getting a shooting pain in the bottom of my foot yesterday morning.  It got worse as the day went on.  Seems to be settling a bit now and hope it's gone tomorrow so I can resume my workout.  I was really pleased with how far I was able to walk Tuesday night and went up an down a steep part of the golf course a few too many times.  My therapist says it should calm down on its own and has taped my foot to provide additional support.  She also told me to make sure I keep stretching my toes, especially the big one.  Also had quite  bit of pain on the medial side of my heel.  That was new.  Has calmed down as well.

Day 99 (June 28)

Almost 100 days post-surgery.  Still having swelling issues and mild pain.  I drove in the car for 2.5 hours and my foot did swell.  Not too bad though.  Spent the next few days on it quite a bit and had "sausage foot" by the end of the third.  I'm walking 30-40 minutes a day on the golf course.  Trying to take as many hills as possible.  I get pain on the lateral side of my foot where the incision was made for the osteotomy.  I understand there are a number of tendons that go through there and it is common as my calf muscle develops.  Speaking of which, I can not go up on my toes with just my one leg yet.  I still need to support it with the other.  The bottom of my foot is finally becoming less sensitive.  It's still far from normal but it is progress.  I have started wearing flip-flops but I don't think my foot likes it.  It swells much more quickly than when I'm in shoes.  Overall, my therapist is still very pleased with the progress.  Sessions typically include the following:

8 minutes on eliptical to warm up
2 minutes on each of the balance boards (side to side, front to back)
3 sets of 10 squats holding onto a rope for support
3 sets of 10 pushing down on elastic with arms (for support) while attempting to go up one toes
Standing on one leg and pulling elastic band towards, away, and across both sides
Standing on one leg and tossing a weighted ball against a trampoline
Standing on soft cushion with legs staggered and tossing ball to the side
2 minutes on total gym focusing on engaging calf muscle only
Calf and foot massage
ROM manipulation of ankle

Day 88 (June 17)

I had my follow-up appointment with my surgeon yesterday.  He took new x-rays and had me walk.  Said everything looks great.  I read the report from my physical therapist and she noted that I was making excellent progress and ahead of schedule.  My surgeon said I was about average as far as progress.  A bit confusing.

I am able to walk with a very slight limp.  I went for a 25 minute walk on the golf course the other day and my quads were pretty sore the following day.  Had to negotiate a fair number of hills.  It's going to take a while for the muscle to come back.  I did try to go up on my toes using my repaired leg only.  No luck.  Need to keep strengthening that calf.  I still experience very slight swelling after physical therapy but it goes down over night.  Most of the swelling occurs where the ligaments were fixed as well as on the medial side of my ankle.

I asked my surgeon about travel and he said I should be fine to fly.  Recommended compression socks as well as aspirin to minimize risk of clotting.  He's not worried about it though.  Just said I'm at a slightly higher risk due to the fact that the vascular system in my leg is still recovering.  I also asked him when the heel pad will start to feel normal.  He said probably another six months.  Great.

One thing to note is that I started taking Tramadol as my pain lessened and didn't need the strength of the Norco.  Be very very careful with Tramadol.  It's marketed as non-addictive but the withdrawals from that were/are 100 times worse than the Norco.  I had 3-4 days of withdrawals when I stopped the Norco and it was mostly malaise, anxiety, and upset stomach.  The Tramadol withdrawals are anxiety, horrible ache in the legs, upset stomach, short temper, inability to sleep, and are lasting much longer.  I strongly recommend having valium (Diazepam) available for when you stop taking the meds.  Need it to sleep and does make the days more tolerable.  I took the Norco for 60+ days and only took the Tramadol for a week.  Crazy.

Day 82 (June 11)

Have made a tremendous amount of progress since my last post.  I am no longer using the boot or crutches.  The swelling is down enough in the morning so that I can see my achilles.  If I'm on my leg for more than a few hours, it does swell up.  Pain comes and goes, sometimes worse than others.  My range of motion is about 70%.  I can't walk down stairs yet but can pretty much do everything else.  My leg is incredibly weak.  Therapy consists of exercises in a therapeutic pool, strengthening, range of motion, and massage.  My calf is very sore and I can feel the knots of muscle.  The bottom of my foot is still very sensitive and stepping on anything (including a grain of sand) feels like a needle.  My heel still feels very awkward.  I bumped the back of it during therapy and it was incredibly painful.  The fat pad is still quite sensitive.  I could definitely work now if I were able to elevate at the office.  Anything that requires an extended amount of time on my feet would not be possible though.  Standing still for more than a few minutes is painful.

Day 49 on..

Got the cast off and doctor asked me to bear weight.  Very scary but he wanted to check the alignment.  Said everything is surgically correct.  Here are pics of my ankle that day:

The scabbing on my ankle fell off a few days later.  Have some pretty nasty scars that change all sorts of color.

I started PT the next day which consisted of stretching and trying to loosen up the joint.  The first week wasn't bad but the second week is when the pain came back pretty bad.  I was back on round-the-clock meds for about 7 days.  When I put weight on my foot, it felt like there was a bump on the bottom lateral side of my heel.  After a few days of partial weight bearing, it finally went away.  I'm 66 days out now and walked for the first time without crutches or the boot.  Pain was really bad earlier this week and decreased by about 50% over night.  Can't explain.  Barely need the meds now.  It still aches really bad in the mornings or when I have it in the boot and not elevated.  Swells up if I have it down for a few hours.  I think I could probably work as long as I have it elevated.  My therapist applies kiniseo tape when after each session and I believe it helps with the swelling.  I also elevate at night.  The lateral side of my foot is still numb but I think it's getting better.  I can feel the screws in the back of my heel with my fingers but other than that, they don't bother me.

Day 48 (May 7)

Went to class and made it for 5 hours.  I brought my leg elevating wedge which really helped.  Wasn't able to get it above my heart but probably half way between waist level and heart level.  My foot has swollen a bit but not nearly as bad as yesterday.  I did end up taking norco around 11 this morning. 3 more days in cast....  

Day 47 (May 6)

Went to class tonight for 2 hours.  Toes were very swollen afterwards.  I had my leg propped up on a chair.  Not comfortable.

Day 43 - 46 (May 2 - 5)

No major changes to report.  Made it through the day on Tuesday without any pain meds until 1030 pm and my leg went crazy.  Ended up taking oxy.  Wednesday was pretty miserable as well and today wasn't much better. Oxy doesn't seem to be as helpful with the pain as Norco.  Kind of strange.

4 days until I get my cast off.

Day 40 - 42 (April 29 - May 1)

Nothing significant to report.  Let has been hurting a bit more.  I did go to the grocery store and walked around for about 15 minutes with my crutches.  Foot blew up right away.  Pain changes from burning in ankle to shooting nerve pain to an overall ache.  I'm now 9 days until I get my cast of though.

Day 38 & 39 (April 27 & 28)

Back to needing a pain killer in the afternoon.  Pain moves from one spot to the next.  Today my foot feels way to big for the cast.  Hope for an improvement tomorrow.

Day 37 (April 26)

Made it through the day without pain killers!  My leg was the best it has been.  Had occasional discomfort but nothing like it has been.  I did take valium today which I think helped.  Just really pleased that I didn't have to take pain meds.  Hope the trend continues!

Two weeks until I get the cast off.  Can't wait.

Day 36 (April 25)

Had a pretty good day.  Took my mother to lunch and propped my leg up while at restaurant.  I took a valium before I left and it seemed to help.  By the time I got home, I did have to take a Norco.

Day 35 (April 24)

Same story as before.  Leg uncomfortable when I first wake up but gets a bit better.  This morning it was burning heel pain.  Was uncomfortable for most of the day though.  By 330 pm, I had to take a norco.  It didn't do much so I took another half a pill at 430.  It helped for a few hours but pretty uncomfortable again.  Left side of foot is really tingling and I'm getting shooting nerve pain.  Heel is still burning a bit.  Feels like my foot is really hot.  Going to try not to take anything.  I feel like I'm moving backwards as far as pain.

Day 34 (April 23)

Leg was a bit sore when I woke up but that seems common.  It calmed down after about 15 minutes.  Was fine for most of the day until about 5:30 pm when I started getting a horrible burning where the modified brostrom procedure was done and shooting pains throughout the ankle.  I really wanted to make it through the day without any pain meds but gave up and took 1.5 Norco.  Hope it kicks in soon as I am really uncomfortable.

Goal for tomorrow is to not take any meds.

Day 33 (April 22)

Woke up in a lot of pain today.  Not sure what is going on.  Called docs office to ask whether I should take the oxy instead of the norco as it doesn't give me the euphoric effect that norco does.  They said they prefer that I take the norco as it is less addictive.  Oh well.  Figured the oxy would be better as it works on pain and that's it, doesn't even seem like a drug.

Did have a new sensation today.  I got up to use restroom and it felt like a spot on the bottom of my foot was wet and cold.  Lasted about 20 seconds and then moved to my toes.  Then back to the bottom of my foot off and on.  Went away for an hour and then came back after I went into my bedroom.  Strange.  I did take norco earlier today.  Not sure if it has anything to do with it.

Day 32 (April 21)

Slept pretty well but woke up pretty groggy from the pills.  Still getting shooting nerve/bone pain in my calf area and on top of my foot.  I've discovered that if I sit with my foot down for a bit, it's not quite as painful when I'm up on crutches afterwards.

Kept having pain today and ended up taking 2 norco at 330 pm.  It is helping so far.  It's been almost 72 hours since I last took a norco so I'm hoping that alternating in the oxy will help me avoid any dependence.

On a side note, I started posting on the healthboards forum and there are some great people on there with advice and feedback about their experience with similar procedures.  As with anything on the internet, have to take it with a grain of salt.  Just nice to know that my pain is actually ahead of schedule compared to others.

Day 31 (April 20)

Had the worst night since I can remember being home from the hospital.  That valium I took at 1030 pm didn't do anything so I took an oxy at 1220.  It kicked in pretty quick and I was asleep by 1.  Pill wore off after 3 hours and I woke up at 345 in a lot of pain.  Took an oxy and then tossed and turned for 3 hours.  Pain was coming back so I took an oxy 10 mg extended release at 630 and slept until 9.  Have been okay so far today.  Really hope tonight is better.  I don't want to take any meds as I've been on them more or less for a month (with the occasional day without).

Update: had to leave the house for a few hours and take my mother to the doc.  25 minutes in car each way and 40 minutes in office with leg elevated to waist level.  Tolerated it pretty well.  Leg really started hurting in the evening again.  I didn't mess around and took a 12 hour oxy and a valium.

Day 30 (April 19)

Took my usual dose of aspirin in the morning followed by a 600 mg ibuprofen at 2 pm.  Ibuprofen really didn't seem to do anything.  I wasn't as active as the previous few days and had leg elevated to waist level or higher most of the day.  Around 9 pm, leg really started hurting.  I took a valium at 1030 and it really didn't do anything.

Day 29 (April 18)

Had a pretty rough night again.  My foot stayed swollen so I tried to elevate it a bit higher.  Makes it more difficult for sleeping.  I did go into the office for a few hours this afternoon.  Foot tolerated it okay but it's just difficult to get comfortable.  I also didn't want to push it too much as I had a little trouble with swelling yesterday.

Here's a pic of my toes after being up for a few minutes.

They will stay slightly red when I elevate to waist level and are almost normal if I elevate above my heart.

Day 28 (April 17)

Foot was still a bit swollen when I woke up this morning.  It's odd how the swelling really seems to be in the foot and not as much in the ankle.  May just be perception though (although I can tell when my foot is being squeezed).

Having a hard time finding the right balance between keeping it down and elevating.  Swelling doesn't go down as quickly as I would like it to.  I had my foot down for about 40 minutes this morning and then elevated for a few hours.  Had it down while I bathed (20 minutes), then again while I was in the car for about 15 minutes, then at waist level on couch for 3 hours before 15 minute drive home.  It's swollen and aching this evening.  I can even see the swelling in my toes.  Was planning to attempt a few hours in the office tomorrow but will have to wait and see if the swelling is down in the morning.

Today is 4 weeks since the surgery.  Tomorrow is 3 weeks until I get the cast off, get boot, and can start partial weight bearing.  Can't wait to put this whole experience behind me.  

Day 27 (April 16)

Foot still felt a bit swollen today.  Seems to swell in the actual foot, not sure if it's happening in the ankle as well.  The bottom of my foot feels like it's on fire.  I took 1.5 norco at 12:30 pm as it was getting a bit uncomfortable.  Then left house and went to niece's birthday party.  Was able to spend most of the time on couch with my foot at waist level.  Could tell after a few hours that my foot was swelling a bit and I was also having a hard time getting comfortable.  Got home about 4:00 and put leg up immediately.  6:45 now and had to take an oxy.  Going to keep it elevated in hope that the swelling and pain go back down.  On a positive note, my toes didn't seem to be as purple today when I was standing and moving around.  

Day 26 (April 15)

Continue sleeping with leg elevated.  Figured that it's a good way to keep swelling down as I'm going to continue increasing amount of time my leg is down during the day.  It also ensures that I move around a lot at night as it's not very comfortable. 

Toes continue to turn pretty purple but not as bad as yesterday.  Have family coming in from out of town so I will be on my feet more today.  I consider it another good test.  Will update later. 

Day 25 (April 14)

Woke up today with my leg really aching.  This cast just feels too tight.  When I get up, my toes still turn dark purple and my leg above me knee even hurts like it isn't getting enough blood.  I also can't move my toes nearly as much.  I decided to call the doc's office and let them know.  I spoke with the surgical nurse and she said it may be too tight.  I was little worried about calling in again but she said to always call if there's a concern.  Makes sense.  So, I went in and had a new cast put on.  The med assistant even spoke with my doc before applying the new cast.  He said to go ahead and make it a bit more loose and put in some extra padding.  Wow, what a huge difference.  My toes are still turning purple but my leg feels a million times better.  One thing to mention, my calf muscle just hangs off my leg except for the area where the doc made the incision. That spot is still pretty hard and not sagging at all.  Very sore to the touch. 

I asked the nurse about alternating ibuprofen and aspirin to make sure I understood the benefits.  Said it would be fine to switch completely to ibuprofen or I can continue taking aspirin in the morning and evening and add ibuprofen in the middle of the day.  Any combination is fine as long as they are not within 6 hours of each other.  I also asked about the meds preventing clots and she said there are studies that have shown aspirin doesn't even help prevent clots.  I guess it's not clear.  She even said that they used to give patients a blood thinning shot but it didn't reduce the occurance of blood clots in those patients.  Guess there isn't an answer.  Most important is to balance moving around as much as possible while keeping the swelling under control. 

Throughout the whole process, my leg was down for over 2 hours.  Very pleased as it didn't even swell (very much). 

Here are some pics of the ankle, old, and new cast.

Old cast:

Ankle

New cast

Day 24 (April 13)

Slept pretty well but moved around a lot.  Not a deep sleep.  I ended up taking a valium last night so I think it helped.  Didn't have too much pain today.  The purple toe/pain/pressure when standing seems to have gone backwards about a week+.  Can only assume it has to do with the new cast and how tight it is.  I did have my leg down for 45 minutes without much swelling or pain.  I did put it up immediately after for about 30 minutes.  Good sign overall.  Think I have a bit of a pill hangover today.  Been absolutely exhausted.  Must be the 12 hour oxy extended release that does it.  Going to avoid those as much as possible going forward.  

Day 23 (April 12)

Slept okay last night considering I had to keep the CAM walker on.  Took another oxy extended release before heading to docs office to get new cast.  New cast feels very tight, not very comfortable at all.  Once cast was on, I asked if I could speak with a nurse about expectations going forward.  Was advised that I should keep my foot down more and more each day and should be able to keep it down for 4+ hours at a time in a few weeks.  The nurse said it's good to get the leg used to being down again and I should only need to elevate it for 20 minutes 3 or 4 times a day.  Said I no longer need to elevate at night.  What's interesting/concerning is that these instructions are different from the ones I received last week (from a different nurse).  She also said I can take ibuprofen as long as its not within 6 hours of the aspirin as both thin the blood.  I did not know that ibuprofen thinned the blood.  Oh well.  Leg has been really sore all day and I'm going to take another oxy extended before bed.  Plan to not take meds tomorrow unless it's absolutely necessary.

Day 22 (April 11)

Had a terrible nights sleep and woke up pretty sore.  Noticed an ache in my calf muscle around 10 am that just kept increasing.  I tried to move around or shift to see if it would subside.  The most it would go away would be for 30 seconds after moving into certain positions.  I decided to call the doctors office and left a message for nurse at 11:50 am.  My pain kept escalating and at 1 pm I took a couple oxycontin.  Called doctors office again at 2 pm and they said I should get checked for a blood clot.  Went to docs office where they cut off my cast and put me in CAM walker.  Went to the hospital where they did an ultra-sound.  Fortunately, it was negative.  Have fluid and bruise where the incision is in my calf.  Was very painful when tech pushed on there with machine.

Leg is very sore after being manipulated and I ended up taking an Oxy extended release for the first time since coming back from hospital a few weeks ago.  Painful but it's tolerable.  I head back to docs office tomorrow morning to get a new cast.  Going to stay medicated.

Day 21 (April 10)

Slept through the night but couldn't get comfortable.  Still having problems now but it's nearly noon and I haven't had to take a pk.  Will really try to avoid them today as I had to take so many yesterday.  On a positive note, the swelling is down to where it was before I went to class on Friday.  Will update again later.

Update: Had an amazing day until 4 pm.  Very little pain or swelling.  Unfortunately, out of no where, pain got really bad at 3:30 and ended up taking 1.5 norco at 4:30.  They seemed to help but pain started coming back at 9.  Took a valium and really hope it helps.  Aspirin now and then bed, hopefully.

Day 20 (April 9)

Only 30 more days in cast!

Had a horrible night.  Couldn't get comfortable and leg was aching pretty bad.  Woke up and it's still pretty swollen.  My toes feel numb like they did last week (they aren't, except for pinkie toe).  Glad I went last night as it was a good test.  Definitely shows improvement and hope to be able to do 4 hours by next weekend.  Quite a bit of pain today and will probably end up taking pk's.  Took my aspirin and hoping it helps.  Going to give it another 30 minutes.

Update:  Today was the worst day since I got back from the hospital.  Can't understand the way the pain works with this surgery.  About 10 am I had to take an oxycodone.  At 11, I was still miserable and took another.  Pain was just a horrible ache throughout my ankle and foot with the random shooting nerve pain.  The pills seemed to help a bit but the pain came right back at 3:30 pm and had to take 2 more oxy. These numbed it but I still felt a horrible pressure on the bottom of my foot, almost like something was boring into my arch.  That was new.  Pain didn't come back as bad in the evening and I was able to get by with a diazepam (valium) before bed.

Day 19 (April 8)

Had a horrible night.  Couldn't get pain under control.  Can't believe how up and down it is - tolerable one day and then miserable the next.  Feel like I've gone back to the 2nd week.  I did sleep with leg elevated and woke up with it still swollen, feeling very hot, and painful.  Keeping it up as much as possible.  Going to try going to class tonight.  If I can get in and get my leg propped up, I may be okay.  This will be a good test.  Driving will take me 10-15 minutes to get there and then 10 minutes to get up to room.  Really going to be pushing the limits.

Update: ended up taking a Norco around noon.  At 2, I decided I couldn't go to class but changed my mind and went.  Made it from 6 to 8 and then started getting worried about swelling.  Had leg down/partially elevated for about 3 hours total.  Elevated as soon as I got home but by 11, the bottom of my foot had swollen out of the cast and was pushing on my toes.

Day 18 (April 7)

Best nights sleep so far.  Didn't even take any meds.  I was so exhausted after leaving the house for an hour that I fell asleep at 10:30 and didn't wake up until 8 am.

I started off the day pretty well.  Went out to living room, sat on couch, and had leg down for 30 minutes.  Put it up afterwards and didn't have any major swelling or pain.  Great.  Then, 3 hours later while sitting with leg up on couch, my foot, ankle, and leg light up something terrible.  My heel is feels really hot, not the searing poker pain like immediately after surgery but just really hot.  Getting the random crippling shooting pains and foot is aching.  Ended up putting ice behind knee and taking an Oxy IR.  Going to give it a half hour and see what happens.  It's actually bad enough where I"m contemplating taking another.  Would be first time since day 8.

Ended up having to take another Oxy at 8 pm.  Didn't do anything for me.  Took my aspirin, didn't help.  Had one of those crazy shooting nerve spams that made my whole foot flex.  Can't explain the pain. Finally took a valium at 11.

Day 17 (April 6)

Slept great last night.  Didn't wake up covered in sweat.  Really beginning to think it's bc of the pain killers.  Not good.

Calf was a bit more swollen this morning than last night.  I must not have my leg up high enough when I'm sleeping.

I went out to living room and spent about 20 minutes sitting on couch with my leg on the floor.  Darn thing blew right up again and feels like it's way too big for cast.  Hurts like crazy.  This is really frustrating.

Update: After elevating leg above heart for 40 minutes, the swelling has reduced to a tolerable level.

I spoke with nurse at doctor's office and asked about timeline for recovery.  She advised at least one more week with leg raised above heart as much as possible.  She said the more we control the swelling now, the faster it will heal.  She recommends continuing pain killers as necessary and continuing to test the leg.  Wants me to try 20 minutes again tomorrow and then elevate.  Try 25 the next day and so on.  I did ask about the risk of DVT and she said as long as I am wiggling my toes for 5 minutes at a time a few times a day and getting up every few hours during day, it shouldn't be an issue.

I did go out to a local restaurant for 1.5 hours.  I brought a pillow and put leg on chair.  My foot and ankle are swollen but within tolerance.  I did take 1.5 norco before leaving.

Day 16 (April 5)

Had a terrible nights sleep, just can't seem to get comfortable.  Woke up at 4 am and my bed was soaked with sweat.  Really annoying.

Made it until about 2 and then took Oxy IR.  Helped a bit.  Getting very frustrated about not being able to keep leg down for more than 20 minutes.  Also nervous about circulation.

Took Oxy SR (extended release) at 10 pm.  Have noticed I can get three fingers into top of cast now so that's a good sign of decreased swelling.

Day 15 (April 4)

Finally fell asleep around 1 am.  Woke up at 1:30 with pillow soaked with sweat.  Was told this is body expunging all the synthetics left over from meds.  Not fun.  Slept until 8 and woke up less groggy than the last few days.  That's progress.  I called doctors office to tell nurse about cast getting wet.  She said that if it doesn't feel wet anymore or like there are blisters forming, it isn't a problem.  No idea if it's wet (where I can't get my fingers) or if blisters are forming as the whole thing hurts.  Oh well, guess I'll wait it out.  One thing to note, when I saw the horrible b-grade doctor on Friday, she told me I no longer needed to take aspirin.  I reconfirmed with nurse today who checked with another doctor and said that is 100% wrong and I need to stay on aspirin regimen the entire time I have the cast on to reduce a risk of clot.

Took a bath today and leg really lit up afterwards.  That feeling of the cast being too tight is back with a tremendous ache throughout foot and ankle.  Tried a diazepam instead of a Norco and it seems to have helped a bit.

Day 14 (April 3)

Didn't wake up as groggy today.  Definitely getting over some of the meds.  Trying to move around a bit and take care of myself more.  Still trying to get the brain more engaged.  Need to get back to where I was.

As with the last few days, the foot really starts to hurt around 1 pm.  Held off on pk until 3:30.

Appetite is finally back and I was able to eat a whole steak again.  Thank God.  I need steak at least twice a week to survive.

Update:  had to take Norco at 10 pm.

Day 13 (April 2)

Still really groggy when first waking up and can't seem to get warm.  Very strange for me as I don't usually like too many covers.  Took my temp and I'm fine.

Slept decently.  I stack 2 sets of pillows, one for my bad leg and one for my other leg so I can sleep on my side.  

Used cast protector from docs office and took shower.  Water went down back of leg so had to call docs office.  As it's a Saturday, the on call doc just said to either go to ER/Urgent care or deal until Monday.  Wow, very helpful.  I used a blow dryer on cool for about a 1/2 hour and it seems to have helped a bit.

Toes are back to tingling and pinkie toe partially numb.  Feels like cast is too tight on foot.

Took a norco at 2 pm and another at 10 pm.  Not getting the searing hot pain as much anymore.  Mostly shooting electric pain that causes whole body to cringe.  Been using ice behind knee and it helps a little.    

Day 12 (April 1)

Had my stitches out today, x-rays taken, and fiberglass cast set.  Overall, not a bad experience.  I had read on a number of posts that it can be rather painful, especially when they set your foot at 90 degrees.  I took a daizepam (valium) at 7:30 this morning as well as a Norco.  Just in case, I put a few Oxycodone IR's in my pocket.  I arrived at doctors office and was back in the room within 10 minutes.  Unfortunately, my doctor is on holiday so I was seeing all his partner's team members.

The medical assistant removed my surgical dressing and splint.  She was very gentle.  She then called in the doc to take a look at stitches and make sure everything was okay.  Temp doc was horrible.  Zero personality, one word answers to questions, just very unhelpful overall.  Anyway, I got the all-clear and was taken to get x-rays.  I asked the tech about pain and told her what I'd read online.  She asked what meds I was on and suggested I take the Oxy IR.  I complied.  X-rays weren't very painful, just difficult when maneuvering foot and placing it on hard surface.  X-rays looked good so I was sent back to room for stitches removal.  One thing that is different from all the other times I've had stitches taken out is that they now spray the stitches with some crazy cold solution that kind of numbs the area.  Very nice perk.  Not that it hurts to get them out usually (and I've had stitches and staples removed many times), just stings sometimes so it was nice to not have that happen.

Next step was going to casting room.  Tech was very friendly and walked me through the process.  They used a crazy upside down L shaped contraption that you rest your foot on to ensure a 90 degree angle.  It wasn't easy to get my foot in position and I could really feel the achilles stretching.  Overall, not very painful.  Not sure if that was due to pain killers or my foot being set pretty well in the original surgical cast.

I was then instructed to come back in 6 weeks.  Absolutely no weight bearing.  If I get the cast wet at all, I need to come in for a new one.  She suggested I keep my leg elevated one more week if possible but that I can go to work if I can tolerate pain.  The real kicker was when she said my ankle will be swollen for a year.  That's going to make work difficult considering I'm in international sales and flying with swelling is not recommended due to increased chance of thrombosis.

They recommended one of those knee scooter things that you see old people on.  I did ask if many younger guys get them and they said almost all of them do.  It's being delivered tonight.  Also purchased one of those specially designed bags for my cast so I can take a shower with much less risk of water getting through.

So, got home and rested leg.  Took a 2 hour nap.  Leg aches a bit but overall I just feel relieved to know everything is okay down there.  I'm still getting random shooting pains anywhere from the calf muscle to the bottom or side of my feet.  Guess that will happen for a while.  Pain is darn-near intolerable when I first get up after laying down.  Also, if I need to stand in one place, my leg begins to spasm.  I did ask doc for some more diazepam as that helps to settle the muscles.

Update:  My foot really ached in the evening and I took a Norco at 11 which seemed to help.  Feels like cast is too small around end of foot and my toes are tingling/partially numb.  I know they said to call if they go numb but I'm not sure if it's due to cast or just the procedure.  I'll call on Monday.

So, here's the good stuff.  Pics of the foot.

Top set of stitches is where doc went into for the ligament repair (modified brostrom procedure), removal of bone fragments, and overall inspection of tendons, etc.).  Middle set is from the calcaneal osteotomy.  Where he went in to cut the bone.  The third set that you can barely see on the back of heel is where the screws went in.

Here's another view where you can see back of heel.

Here is where the doc went in for the gastrocnemius slide.  Assistant was a bit surprised there weren't any stitches.

And here are x-rays showing the screws.

(Had to remove pic of xray as it showed personal information.  You can search for a similar pic online)

Not sure how often I will update blog going forward.  Will do so occasionally when reaching milestones.  Main purpose of this blog was so people can know how bad it can be (and I'm sure it could be even worse than what I experienced).

Day 11 (March 31)

Slept for about 8.5 hours last night.  Woke up very groggy and almost confused.  Was just a major fog. It's 8:30 pm and the only thing I've taken so far is the Aspirin (for circulation).  Although I'm not in miserable pain like before, my body is very uncomfortable with keeping leg up all the time.  I'm shifting every 10 minutes probably.

I did go out to the living room today and watch some tv.  Also ate out there. First time since back from hospital.

I can definitely feel the effects of all the drugs I've been on.  My brain is very slow and my vocabulary is a bit limited.  I'll probably take a diazepam tonight before bed so I can sleep.  I go to the doctor tomorrow at 9am to get the surgical cast removed, stitches out, and new cast put on.  I'm a bit nervous as I've read in a few posts that it's pretty painful.  I may just take a valium in the morning and keep an Oxy IR in my pocket in case I'm really hurting.

Day 10 (March 30)

Still making progress.  Have cut out the Oxycodone SR and almost all of the Oxycodone IR (only took 1 dose late at night).  Only taking 1 Norco per 4 hours.  Ankle and foot hurt when elevated but it's tolerable.  Absolutely miserable when lowered and using crutches.  Trying to wiggle toes every hour or more.

Day 9 (March 29)

Today the pain is beginning to subside and I cut back on the Norco.  I also cut out a dose of the Oxycodone IR in the evening.  Still taking other meds though.  I'm also getting up to use the bathroom.  Don't want to risk a blood clot.

Day 8 (March 28)

Still in a lot of pain.  Taking all meds as scheduled.  Spent day in bed.  Once again, keep a log of when and which medicines you take.  Also, I kept 3 liters of water by my bed in the evenings as I wanted to stay hydrated and everyone else was asleep.

Day 7 (March 27)

Doc stopped by again to check on ankle and said I should be fine to go home.  They want me to stay on same pain meds as in hospital (not the dilaudid though).

Checking out this afternoon.  Here's a list of a few things I took home from hospital that were a big help.
Disposable sanitizing/moisturizing clothes
Extra hospital gown
2 urinals
Little pink plastic pan for using after brushing teeth
4 of the paper ice bag things
Couple of the body washes and lotions

On very strict pain med schedule as leg kills if I don't stay on top of it.  Here's an example of 24 hours:

21.5 pain pills total.  I could have taken the Oxycodone IR every 3 hours (instead of 4) but I didn't need to.  Here's a pic of the sheet I kept next to my bed.  It has the instructions for each medication and the anticipated schedule.  I would just circle the time I took the pill or write in the time.  Worked very well, even in my drugged state.

12 am

2 5 mg Oxycodone IR (instant release) 

2 am

2 10/325 Norco 

3 am

1 5 mg Diazepam (valium) 

4 am

2 5 mg Oxycodone IR

6 am

1 10/325 Norco 

8 am

2 5 mg Oxycodone IR

9 am

1 5 mg Diazepam (valium)

10 am

1 10 mg Oxycodone SR (extended release)

2 10/325 Norco

11 am

325 mg aspirin

12 pm

2 5 mg Oxycodone IR

2 pm

1 10/325 Norco

3 pm

1 5 mg Diazepam

4 pm

2 5 mg Oxycodone IR

6 pm

2 10/325 Norco

8 pm

2 5 mg Oxycodone IR

9 pm

1 5 mg Diazepam

10 pm

1 10 mg Oxycodone SR

1 10/325 Norco

11 pm

325 mg aspirin

Day 6 (March 26)

Cutting back on some of the pills but still taking dilaudid shots.  Pain still goes from a 5 to 8/9.  My surgeon stopped in and said I should be able to leave the next morning.  I asked him if I was just a total sally for having so much pain and he said absolutely not.  It really varies for each person.  Some people have moderate to severe pain and others have severe.  Every person reacts differently.  I emphasized that I felt like such a baby and he started to get mad.  He said that he should have explained the procedure in more detail before the surgery and what to possibly expect afterwards.  He said the procedure should have been in-patient.

Day 4 - 5 (March 24 - 25)

Mostly a blur.  I remember the pain coming and going.  It would go from a 5 after injections to a 8 or 9.  I can't really remember too much.  In reflection (even now), I think I was very social and went to other peoples rooms but that is all a dream.  I guess an effect of dilaudid.

The nurse did tell me that she really doesn't understand how they can do these surgeries outpatient.  She said they are always much more painful for men then women (calcaneal osteotomy) and she gets people in all the time.  That made me feel a little better.

Going to the restroom was miserable.  The nurse would escort me and then leave once I was settled.  Unfortunately, the pain in my ankle/foot would come out of nowhere and the first few times I actually screamed which would cause the nurse to come in running.

While in the hospital, they were giving me:
Dilauded shot every 3 - 4 hours
Oxycodone SR (10mg), 1 pill twice a day
Oxycodone IR (5 mg), 2 pills every 3 hours
Lortab (10/500), alternating 1 pill then 2 pills in between the Oxycodone (not replacing, but 2 hours after each does of Oxycodone IR)
Diazepam (5mg), 1 pill every 6 hours

This leads to a bit of a funny/scary note.  Be careful if you have your phone or computer.  I reread some of my correspondence and it was humorous and embarrassing.

Day 3 (March 23)

Take norco at 1240 am, really drowsy.  Sleep (or drug induced haze) until 215 am.  Take an oxy and sleep/haze until 345.  Ankle is not responding to pain medication and I am in complete agony.  Take norco at 4am.  Due to take another norco at 5 but am nervous about getting too close to 4 grams of acetaminophen in 24 hours.  Please see the importance of keeping a log of your drug intake as this is critical.  Acetaminophen poisoning is not a fun way to die (or so I've read)!  Decide to take an oxy at 5 am instead.  Ankle is burning and whole foot feels like it is going to burst.  At 530 am, I am very drowsy but do not have relief from pain.  Plan to call doctors office in the morning to see if alternate pain management program is available.  Not sure how much my previous use of Norco is impacting the effectiveness of pain killers.

I think I slept from 630 to 730am.  Woke up in even more pain than before.  I call the doctors office at 8:05 and leave a message for surgical nurse.  She calls back 5 minutes later and says she will write another script for Oxycodone SR (extended release).  She also says that we may want to consider going to ER to get pain under control.  My mother, who is taking care of me but can not drive, is getting very worried.  At 8:30, a sibling agrees to pick up script.  At 9 am, I call sibling again and leave a voicemail that I just need to go to ER.  This is horribly embarrassing but there were tears flowing.  I'll mention it again, I'm 34, have had multiple surgeries in the past, have even walked around on a broken leg for a week before going to doctor, have had my finger tips (flesh and bone) crushed off in a steel door, and nothing compares to what I'm going through.  At 10:30 am, I'm going to call an ambulance to take me to ER.  My mother says she can drive and loads me in car.

ER:
I would like to note that I'm fortunate to live in a town that is known for its hospitals.  I arrive at 11am and security guard wheels me into admitting area.  I provide my date of birth and name.  One minute later, I am moved into triage where nurse takes vitals.  2 minutes later, I am wheeled into an ER room.  I can't even look at people at this point.  1 minute later, the ER doc comes in, does an exam and asks questions.  I hate to admit it again, but the tears are rolling.  Fortunately, I brought my medication log which greatly helped his ability to prescribe additional pain medication. He said he would put a call in to the orthopedic resident and order me a shot of dilaudid (hydromorphone).  For those not familiar with meds, look it up, strong stuff (I believe it is second to fetanyl).  20 minutes later, a nurse came in and injected me in hip.  Could only give me half the normal dose due to the amount of meds already in my system.  Shot didn't do anything for pain.  At this point, things are getting a bit fuzzy.  Ortho resident then came in, cut open the top of my surgical cast to make sure it wasn't too tight and to inspect leg.  ER doc came back in and ordered more pain shots.  I don't remember this but I guess I was still writhing in pain so they kept pumping me up with shots.  After a few hours, they called in the head of pharmacology who put together a super cocktail of pain killers.  I was told it finally worked.

Ortho resident wanted to get an x-ray of ankle to make sure nothing had shifted.  I remember being nervous but they were very gentle and used a machine that moved around me and provided immediate digital images.  Everything looked fine.

ER doc then came in and said they need to admit me in order to keep pain under control.  They put in IV and wheeled me up to room.  I remember telling the nurse that they had a hard time getting my pain under control and she laughed at me saying that doesn't even being to explain it.  She was amazed by the amount of meds they had to give me.

Day 2 (March 22)

Please note that I wrote this while on a pretty heavy dose of pain killers.  

Took a norco at 1:30 am and another 1/2 at 2 am.  Finally fell asleep around 3 am, was not really having much pain yet but I could begin to feel nerve block wear off (slight tingling in calf).  Woke up at 530 am and took 1 norco and another 1/2 at 6:30.  Still no major pain but continue to feel nerve block wear off.  Guessing when the nerve block will wear off is the most frustrating part so far.  Most of the reports I read online (so take it with a grain of salt) say the nerve block doesn't typically fade, it will begin to wear off and then be gone in an hour.  

Toes are still numb and continue to feel block wear off (tingling on inside of ankle).  Still no major pain.  Took a norco at 10 am, 1/2 at 1030 am.

Throughout the course of the day, the block was fading but only on inside of ankle (not the surgical side) and calf muscle.  Definitely tolerable.    

227 pm, I take a oxycodone 5 mg.

4 pm, block fades completely and my heel and ankle are on fire. I have never experienced pain like this in my life.  Almost to tears.  Bear in mind what I mentioned about my history and familiarity with surgeries and pretty intense pain.  I am very used to pain but nothing like this.  It feels like someone is inserting a molten hot wedge into my heel.  I take a norco at 417 pm.  I call pharmacist to see if I can take more drugs.  Pharmacist says I can either take 2 of the oxycodones and then a norco to break through pain or 2 of the norcos and an oxy to break through pain.  As I'm familiar with the norcos, I decide my approach will be 2 norco and 1 oxy.

Take an oxy at 6 pm, still in tremendous amount of pain.  Take norco at 7 pm, another at 830 pm, still miserable.  Take oxy at 1015 pm and starting to get a little relief.  Getting very drowsy from all of the drugs.  Sleep for 1.5 hours, take oxy at 1015 pm, norco at 1140 pm.  Still awake and not getting much relief.  

Day 1 (March 21)

Also posted on Health Board forum which is an excellent resource:  http://www.healthboards.com/

General:
I've decided to create a blog to help others understand what they may be able to expect post-surgery.  From what I understand, this procedure was more painful for me immediately following the procedure than for most people.  On the flip side, I've also been able to switch from taking pain killers all day to taking them on an as needed basis 10 days after surgery (most report 14 days at bare minimum).  I attribute it to a reduced effectiveness of pain killers due to other conditions (more about that below).  I've also been told it's typically more painful for men than women, don't know why.  This just gives you a worst case scenario (from a pain perspective) and hopefully some ideas to make your experience less traumatic.

I had a calcaneal osteotomy, lateral ligament repair (modified brostrom procedure), removal of bone fragments, and calf lengthening (gastrocnemius slide) on my left ankle.  If you're reading this and don't know what all of those are, here you go:

Calcaneal osteotomy:  http://www.footeducation.com/calcaneal-osteotomy
Ligament repair:  http://en.wikipedia.org/wiki/Brostr%C3%B6m_procedure
Calf lengthening: http://www.footeducation.com/gastrocnemius-slide-strayer-procedure

My surgery was Monday March 21, 2011 at 9 am.  I'll recap what happened Monday but first some background.  I will continue to update pages as I recall information.

Background:
I'm a 34 year old male and rolled my left ankle July 2010.  I'm 240 lbs and 6'5" tall.  Went to ER and x-ray was negative for fracture.  Gave me air splint and crutches.  Saw an orthopedic surgeon a week later who took new x-rays without significant result.  Tried conservative treatment (immobilization in cam walker) for 2 months followed by therapy.  At the beginning of October, the doctor said that we should revisit the problem in a year if there is continued pain and instability.

I saw a different orthopedic surgeon (a specialist focused on cartilage grafting, regeneration, etc.) for an ongoing problem with my knees (see below).  Asked him about ankle and had an MRI done that showed torn ligaments and fracture.  He recommended trying the boot again for one month.  He said he could continue treatment but recommended a foot & ankle specialist.

*I have a history knee problems including patella alta which has resulted in the wearing away of the cartilage within both knees.  There are grooves worn into the bone under the knee cap.  It is tolerable 95% of the time and I mostly have issues when kneeling, using stairs, or sitting for long periods of time.  I have had 2 arthroscopic surgeries on the left knee, one included patellar drilling to cause blood to fill in the hole on underside of kneecap (to serve as pseudo-cartilage).  I tolerated the procedure well and had limited post surgical pain.  I have an ongoing script for Norco (10/325) and typically take 1.5 and then the other half 1 hour later.  I don't usually take more than 2 per week.  I mention this as it may have impacted the effectiveness of the post-surgical pain killers.

I have also had 2 surgeries on my right ankle to repair ligaments damaged in a car accident.  I tolerated both procedures very well and had little pain.

The Surgeon:
The surgeon is a highly respected foot & ankle specialist.  He has been the president of the state board of foot & ankle specialists a number of times.  He is published and highly recommended.  He performed the two surgeries on my other ankle in 2002.

Pre-surgery appointment:
Doctor examined ankle and felt the ligaments were torn and stretched.  He had me perform a number of exercises and asked if I feel like I walk on the outside of my foot.  He also questioned how stable I feel.  He then said that he strongly recommends a calcaneal osteotomy.  He said it is not to the point that he would insist upon it but that it will greatly help my ligaments and overall joint health in the long run.  He said it is a realignment of the ankle.  Unfortunately, I did not ask very many questions as I was pretty sure I just wanted to get the ligaments fixed.  I told him I would like to do some research and would get back to him.  He also recommended the calf lengthening (gastrocnemius slide).  He mentioned it was not a common procedure when he performed my previous surgeries (on my other ankle in 2002) but highly recommended it.  I agreed to the surgery to fix ligaments and calf lengthening with the understanding that I would confirm the calcaneal osteotomy in a few days.  We scheduled the surgery for March 21st at an outpatient surgical center.  Recovery time was explained to be 2 weeks no weight bearing, 3 weeks walking cast, 3 weeks cam walker (boot).

I later discussed calcaneal osteotomy with a family friend that is a retired orthopedic surgeon.  He recommended the procedure.  At this point, I really should have done more research on the topic but I did not.  If I had known what it entailed, I probably would have decided to pass.  The recovery period (which I did not know until post surgery) is expected to be 8 weeks no weight bearing, 4 weeks in cam walker, and months of therapy.  I contacted the surgeons office and confirmed that I would like to proceed with the calcaneal osteotomy as well.

Surgery:
Arrived at surgical center at 8 am with procedure scheduled for 9:15.  Was told it would take just over an hour and then would be in recovery for a few hours before being sent home.  I completed paperwork and was led to pre-op area where a nurse put in IV.  Anesthesiologist visited and explained what would happen.  He said the doctor has recommended a nerve block to help with the pain.  He then gave me something to relax.  Next I rolled onto my stomach and he injected the back of my leg to numb the area.  He then inserted a larger needle and injected the area round the nerve with a solution to numb it.  All I really felt was some pressure, not bad at all.  The doctor then arrived and explained the procedures and what to expect.  He explained the calcaneal osteotomy and that really freaked me out.  Unfortunately, at this point I figured I would just go through with it.  I went to surgery, anesthesiologist gave me some more meds to calm me down, then knocked me out.  Woke up a few hours later, leg completely numb and with a head ache.  At that point, I could move none of my toes.

Post Surgery:
Left surgical center at 2 pm, stopped at pharmacy to fill prescriptions.  Doctor forgot to write dosage on script for percocet (oxycodone and acetaminophen) so the pharmacist could not fill.  As it's a class II drug, they can not fax or call it in.  Fortunately, the doc had written a proper script for Norco (10/325) so I was able to fill that.  I requested the new script to be oxycodone only as a way to avoid too much acetaminophen.  This may be the smartest thing I did.

Medication plan:
Either take 2 norco (10/325) and 1 oxycodone (5 mg) for breakthrough pain or 2 oxycodone and 1 norco for breakthrough pain.  Every 4 - 6 hours.  The biggest variable is the nerve block and when it will wear off.  Everyone metabolizes differently.  For some it lasts 8 hours and others 36.  They recommend starting pain medicine the evening after surgery in case the nerve block wears off in middle of the night.  They also want to make sure the pain does not get ahead of you because it can be difficult to gain control.

Home:
Home around 3 pm.  No pain all day.  Began to feel a few tingles in foot in the evening.  Once again, no idea if nerve block is wearing off or not.  I took 1.5 norco at 9:30 pm.

Biggest recommendation I can make is to keep a log of when you take your medications.  It is the smartest thing to do to avoid taking too much or too little.

Suggestions for Pre & Post Surgery

This will be updated as necessary....

1.  Do not get a calcaneal osteotomy unless it is absolutely necessary.  Best case scenario (highly unlikely), you will able to return to work after 3 weeks.  It takes most people 10 - 12 weeks.

2.  Get a nerve block.  I can't imagine the pain without one.

3.  Request to stay at least one night in the hospital (until the nerve block wears off).  For some people, the pain after the nerve block wears off can not be controlled with pills.  You absolutely must stay ahead of the pain.

4.  Keep a medication list where you track when you take your meds.  You do not want to risk over dose and probably will not be able to remember when you took each dose.

5.  For guys, get a urinal to pee in for the first week or two after surgery.  The pain when standing is miserable.

6.  Have multiple water bottles by your bed side.  The drugs dehydrate you pretty bad.  Also keep some bread or something so you don't have to take pills on an empty stomach.

7.  Baby your foot/ankle.  If you can keep it elevated, it will be much less painful and will heal faster. You absolutely do not want to risk putting weight on it until cast is off (6-8 weeks).      

8.  Everyone that has the procedure goes through a different experience.  The Healthboards forum is good to get others perspective but keep in mind that most of the people that post have had bad experiences. So take what they say with a grain of salt.  My experience was horrible but yours may be much better.

Medical Groups, Facilities, Links, Blogs

As a reference, here are the medical groups and facilities involved in this experience.  I have also listed some other blogs about similar surgeries that may help.

Orthopaedic/Orthopedic Associates of Michigan (Grand Rapids, MI)
http://www.oamichigan.com/

Battle Creek Orthopaedic and Sports Medicine Clinic (now Southern Michigan Orthopaedics) (Battle Creek, MI)
http://www.bcortho.com/
http://w.mawebcenters.com/somiorthocom/

Deniel PLC (Grand Rapids, MI)
http://www.denielplc.com/

Lake Regional Health System (Lake Ozark, MO)
http://www.lakeregional.com/Locations/PrimaryCare/LakeOzark

Midtowne Surgery Center (operated by Metro Health in the Women's Health Center building) (Grand Rapids, MI)
http://www.metrohealth.net/
http://www.womenshealthcenterofwestmichigan.com/

Spectrum Health Blodgett Hospital (Grand Rapids, MI)
http://www.spectrumhealth.org/landing_custom.cfm?id=2814

The Center for Physical Rehabilitation (Grand Rapids, MI)
http://pt-cpr.com/

Great forum to share experiences and get answers from others:
http://www.healthboards.com/boards/foot-problems/

Blogs:
Calcaneal Osteotomy:
http://purplejetx.blogspot.com/
Calcaneal Osteotomy:
http://cokar-calcanealosteotomysurgery.blogspot.com/
Calcaneal Osteotomy:
http://annacmorrison.blogspot.com/2009/06/calcaneal-osteotomy-et-al.html
Calcaneal Osteotomy:
http://calcanealosteotomy2008.blogspot.com/
Calcaneal Osteotomy plus Bunionectomy:
http://kristysfootsurgery.blogspot.com/
Calcaneal Osteotomy plus other procedures:
http://kristysfootsurgery.blogspot.com/2012/02/day-43-doctors-updatetears.html
PTTD (similar):
http://pttdfootsurgery.wordpress.com/pttd-links/researching-socializing/