This surgery had been a long time in the making. I developed a pretty good sized bone spur on my heel over the last ten years. A bone spur in this location are referred to as a Haglund’s Deformity or a “Pump bump” because they are often the result of wearing high heels. Mine, however, can be attributed to jamming my feet into climbing shoes that were too small, ski boots that didn’t quite fit, and being incessantly pounded in mountaineering boots. As I understand it, some people are genetically predisposed to the condition because of their foot anatomy. Mix in some tight shoes that irritate the heel and over time a bursa develops to protect the area. If you continue to irritate it this bursa calcifies and a bone spur develops. The bone spur, in turn, causes more irritation and now you are on a train to pain town.
I thought I’d write up my experience, because there isn’t much on the web about this injury (especially for men) and the information that is out there verges on the ‘yer gonna die’ tone that is omnipresent in any medically related Internet debate. I found this blog to have a pretty well balanced and realistic tone, however.
If your heel is bothering you, I’d highly recommend going to an orthopedic surgeon who specializes in foot issues early on. They will be able to tell you the extent that your Achilles tendon is involved, which I think is the main driver of the decision process of when to get surgery. Most of the posts online are from people who had significant Achilles involvement, which causes the recovery to be much longer. I was “lucky”. The location of the bone spur was toward the outside of the foot. This meant that they didn’t need to detach the Achilles tendon and my recover is pretty easy (so far). However, if the bone spur is located under the Achilles then they may have to detach more of the tendon. This video shows a more involved surgery (don’t watch it if you are at all squeamish), but it’s still amazing how quick the process is.
I’ll do my best to keep this updated until I’m back to 100%
Well my surgery is tomorrow and I’m a bit nervous about it. Rationally, I know that it isn’t a very big procedure, but I had a really big surgery when I was 10 so I think my conception of what this will be like is colored by that. We shall see…
Surgery Day. I opted to just do spinal anesthesia so I was awake during the whole procedure.
Couple things about the anesthesia. First, it didn’t hurt at all for the anesthesiologist to insert the needle into my spine to inject the anesthetic, so don’t worry about that. And if you don’t want to be awake they can give you twilight drugs like Versed so you don’t really know what’s going on. Second, I didn’t realize that the anesthesia would paralyze me from the waist down (as well make me unable to feel my legs). This is actually really good because I was worried about flinching during the procedure. Also, it gave me a whole new perspective on what it is like to be a paraplegic. This experience was especially interesting to me since I help the disabled ski every winter.
The whole operation took about 35 mins from walking into the OR to being wheeled out. It took another 1.5 hours for the feeling to return to my legs. At the end of the surgery irrigated the site with an anesthetic so even when the feeling returned I had no pain. In fact, that day I kept asking myself, “Did they even do anything.” I took a couple doses of oxycodone to stay ahead of the pain in any case.
At 7 pm things took a turn for the worse when I realized that my ACE bandage was soaked in blood. Since the orthopedic office had closed an hour earlier, I opted to go to the ER. It was amateur hour when I arrived. Although, my stitches were intact, they couldn’t stop the bleeding, despite applying pressure directly on the wound. After a couple fruitless hours of dropping bandages on the floor (not even kidding) and dressing the wound, they sent me home.
The pain overnight was pretty real. I’d rate it at around a 6 or 7 (enough to make you pay attention and want it to be over, but tolerable). Thankfully, this morning it’s not too bad. I continued to take oxycodone today, but added tylenol. The combined effect is keeping the pain in check. Keeping my foot elevated and icing it religiously also helps with the pain.
I went to the orthopedist’s office to get the incision re-dressed, since I didn’t trust that it was all that clean after the circus at the ER the night before. They cleaned up the blood, threw some more Xeroform on it (which is an bacteriostatic dressing) and wrapped it back up.
The doctor says I don’t need crutches, but I borrowed a pair just so that I can get up and move around without having to strap my walking boot up. They also make hopping in the shower much easier. So while they probably aren’t really necessary, they are making life a little easier right now.
The pain is way better now. I only took a single oxycodone today and am just taking tylenol now. I honestly don’t know how much the narcotic pain killers helped. Elevation and and tylenol seemed to be the biggest help.
I’m able to hobble around pretty well with just my walking boot, which is amazing considering the just carved off a chunk of bone.
Pretty much status quo. I’d rate my pain around a 2 or 3, just enough to be annoying. Still taking tylenol, but will probably phase that out today.
Went home today (I was at my parents). I think my dog is dying of boredom and I am starting to get cabin fever.
No more tylenol. Starting working at my desk with my foot up on an ottoman. Even so, after about 2 hours I have to hit the couch to elevate it more. At least they released the final season of The Good Wife on Amazon On-demand…
Fuck! I really want to get outside and be active! I’ve been doing some isometric ice tool hangs to do something, but I have to be careful not to push to failure so I don’t land on my gimpy foot.
Week 1 (Day 7):
Overall, this has been way better than expected. Pain (with the exception of the first night) has been minimal. Now my foot is just a bit achey and the incision feels like a cut that is healing. I’m really curious to see what it looks like, but the bandages stay on for another week.
Week 2 (Day 14):
Went to the Physical Therapist this morning. They took my stitches out and I got my first look at it since that night in the ER. Looks a bit swollen and bruised, but not too bad. My ankle is pretty stiff, which they attribute more to being immobilized in the boot that the actual surgery. They gave me some ankle exercises (pulling the toes toward the my knee, circles, etc) to help loosen it up. And they said I don’t need the boot anymore, but cautioned me not to overdo it (they know me too well)! Next week the rehab starts in earnest, but I think with just a bit of time I’ll be back to running/climbing and skiing shouldn’t be an issue this winter.
I finally, went back to the gym to start doing a real upper body workout – Scott’s killer Core routine + an easy hangboard workout. Since I really haven’t been do a strength workout for the last 6 weeks (travel plus this shit), it’ll take some time to ramp back up.
I’m really amazed at how quickly I’m healing. I’ve been walking around without a boot for about 5 days now. Aside from a tremendously tight Achilles, I’ve got nothing to complain of. The tight tendon has me limping still, but I’m hoping to be taking some actual walks soon!
Got my foot back in my running shoes and walked 0.5 miles! With my running shoes on I’m not even limping. It must be because they are slightly rockered compared to my Birkenstocks (which have been my footwear of choice during this whole ordeal).
Also got the next set of exercises from my PT. Mostly these are therapy band stabilization movements, calf stretches, and toe raises. Rehab continues…
Four weeks out and things are feeling pretty good. I went to the orthopedist today and was given the okay to do any activity as pain permits. My physical therapist is continuing to work on strengthening up my ankle and desensitizing the incision. Honestly, the incision itself is what is the most uncomfortable when I wear regular shoes. It basically feels like it is raw, but I’m sure this will go away as new skin comes into the sight. So far I’ve been able to wear my running shoes, chucks, and desert boots. In terms of activity, I’m biking all over town again. I walked my dog 2.5 miles tonight and it felt okay. I even tried to jog a bit, but this did not go so well. It just felt as if my ankle was super tight and couldn’t provide the necessary spring.
Six weeks out now and things are steadily improving. I have worked up to walking 4 miles now. I got out on my first run!!!! I only ran one mile and it honestly was pretty painful. Every heel strike caused sharp pain. Switching to a toe strike felt even worse. But the pain went away when I stopped running, which is the supposed litmus test.
The pain starts over the incision and wraps around the outside of the foot and onto the heel. It seems to happen when I keep tension through the achilles, which is why walking is fine, but running and jumping hurt. My PT thinks that it has to do with a loss of strength in the calf and ankle stabilizers. I think it will just resolve with time.
So 9 weeks out and things are still improving. I’m back to running 3 miles 2 times a week. My foot still aches a bit while running, but it actually less noticeable than being out of breath at this point. I’ve also got out into the mountains a few times in the last couple weeks – on my bike, hiking, and canoeing. The only remaining milestone is shoving my foot in climbing shoes and getting back out on some rock.
It’s been 5 months since my surgery and I’m still not 100%, but I can do most things. I’ve been out skiing, pulled on my ice climbing boots, gone for 10 mile hikes, and worn dress shoes. Running is still a bit painful – mainly through the arch of foot. All the little stabilizer muscles and tendons that take the impact from the foot strike (heel or toe) must have really weakened following the operation. I think I pushed back into running too early and decided to back off and focus of rebuilding strength through toe raises and resistance band training. I’m hoping to start building miles again in 2017.