9 weeks and counting

Today marks 9 weeks from toe surgery. This is just a quick update. I've increased my activity and am able to run without significant pain. I remain optimistic but skeptical that the surgery was successful. I do have some inflammation and the clicking is still present as it was prior to the surgery. There does seem to be some improvement on the antero-lateral movement. I've been doing mostly heart rate training and aerobic running as not to stress the toe and to build my base. Longer update next time! Keep on keeping on!

Today marks 8-weeks since surgery on my foot. I didn't have much to report last week so I skipped it. A lot has changed since then. When I saw the doctor about 6.5 weeks post-sx I has a few questions/concerns. I  was concerned mostly about the swelling and clicking. He wasn't too concerned about either and said swelling on the feet can last several months post-surgery due the distance from the heart and the fact that we walk on our feet all day. The doctor thought some of the clicking could be from scar tissue. He said I could start to run again - slowly increasing the amount of activity. I was concerned with some pain on flexion so he suggested that I leave the carbon fiber plate, which limits flexion, inside my shoe while I started jogging. I began very slowly at first. My first mile after almost 7 weeks of zero running was an 11:15 min/mile on the treadmill. It felt great. I was alternating days of jogging to allow some swelling to subside from the increased activity. What I have noticed over the last week is the reduced pressure when walking on the medial portion of the great toe joint. Prior to surgery I felt that the toe was deviating laterally due to the inability to properly move through its' proper motion. Occasionally clicking is still present - usually when walking barefooted. On Wednesday I removed the carbon fiber plate and ran a couple miles. I've decided to alternate days of running to allow for continued healing. I will weight-lift or cross-train on the non-running days. Also, I have decided to train mainly in my aerobic heart rate zone (around 150) to build my endurance and engine before adding speed. I've noticed over the last week I've been starving since adding some running. I hope to get this in check to avoid too much weight gain. Things are progressing! Until next update!

I've come this far! 6 weeks post surgery

It has been 6 weeks (42 days) since surgery. Not a whole lot to report this week. Things seem to be improving very slowly. Still some medial pain and occasional popping of the toe joint which is concerning. Maintaining decent fitness at the gym - on the bike and walking at elevation the treadmill. Next Monday is the next recheck and I hope it will provide some good news. Possibly removing the carbon fiber plate. See you in one week!

Keep on, Keepin' on - 5 weeks today

That's my motto each day - keep on keepin' on. Suprisingly it has gotten easier for me over the last several weeks of not running. I know most runners won't believe that but it is true. I believe running is similar to an addictive drug. Studies have proven that running releases endorphins in the brain. This is the something many runners and even non-runners have experienced at some point. For frequent runners they are used to this constant flow of euphoria and a day without it can be hard. This is why athletes, runners in particular, are difficult patients. However, separate someone from their drug for an extended period of time and the craving is diminished.
Fortunately, I have been maintaining some basic fitness at the gym. This includes riding the stationary bikes, occasional elliptical and arc trainer workouts. I still plan to start cycling on the weekends and look forward to some longer endurance rides to increase my stamina.
The last week I have noticed more improvement and reduced swelling. There is still the occasional click or pop on dorsiflexion. The carbon fiber toe plate is still limiting the motion of the joint and allowing it to heal. I continue to ice and manually flex the joint to ensure proper healing. Next recheck will be just after the six week mark since surgery.

28 days later.....

Well, today, 13 June 2013, marks twenty-eight days or 4 weeks since surgery on my foot was performed. Things have definitely improved gradually. The swelling is significantly reduced, mobility, flexion, and walking is easier than those first few weeks post-procedure. My surgery, an arthrotomy or opening of the joint, is a significantly more invasive procedure than arthroscopy and requires a longer incision and longer recovery time. Apparently, it does provide better access to the joint for evaluation, especially a smaller region like the MTP joint.

I've continued the flexion exercises daily and have noticed that joint still has some popping or clicking usually during dorsiflexion. This was present prior to surgery. It may be slightly descreased now but still evident. I wonder if this is due a laxity in the joint from original injury or the surgical procedure. The best description I can give regarding this clicking is that it feels like the proximal and distal phlanges are slightly laterally deviated from the 1st metatarsal - and when flexing the toe upwards, it catches the proper position making the noise. Some medial pain is present and very occasionally severe radiating pain if I flex the toe too much when walking.

I've really been able to increase my exercise. Especially stationary cycling. This week I've increased my cardio from about 15 minutes a session to a lower intensity 30 minutes. Just over the past two days I was able to use the elliptical and Precor-type elliptical for 10 minutes each. I've also continued with strength training, stretching, and have incorporated more leg work including squats into my routine. I remain cautiously optimistic that I will continue to improve, until then, farewell.

21 days later

Three weeks ago today I was struggling to hop around the house and was popping pills to dull the pain. What a difference a few weeks can make. This past Monday I had my second appointment with the orthopedist. I had previously removed the stitches around the fourteenth day. The incision was healed and they were causing some tension during my range of motion exercises. On Monday, 6/3/13, I was instructed

to remove the stiff orthopedic shoe I had been wearing since the surgery. The doctor prescribed a carbon fiber plate for my regular shoe. He also mentioned to continue my range of motion exercises and ice. Interestingly, on my post-op form it said "No Ice." However, things change and we must adapt.

I had to make a quick visit to the orthotic department to get the plate. This sturdy and stiff plate is very lightweight and fits directly under my shoe inserts. It was great getting back into my regular shoe. The device allows a reduced amount of metatarsophalangeal dorsiflexion but more-so than the stiff post-op shoe would allow. The idea behind rehab is to slowly increase the motion of the joint while weight-bearing but manually move the joint throughout the day to allow proper cartilage formation and healing. Fortunately being back in a regular show it allows more of a normal gait cycle, though still not normal. Swelling is significantly reduced since surgery. Some swelling is still present on the medial aspect of the MTP joint especially after manual flexion and extension exercises. I mentioned in my previous post about clicking or popping. That is sometimes present during flexion but seems to be somewhat reduced over the last week. Another positive I have noted is the feeling of a more medial motion of the great toe. Prior to the surgery there seemed to be increased resistance when raising the toe upward. Currently that motion is difficult- primarily due to inflammation, scarring, and swelling around the extensor hallucis longus muscle, which allows flexion of the great toe.

I've been continuing to maintain some type of aerobic fitness by using the stationary bike. I plan to increase

the duration on the bike by lowering the intensity. It is difficult to replicate a similar running heart rate while cycling so a lot of the training is designed to keep a high cadence of pedaling which is somewhat similar to running turnover. I am also able create an ankle motion while on the stationary bike that activates the calf muscle. Free weights, machines, leg exercises, and stretching are also part of my current fitness plan. I hope to introduce a "long ride" on the road bike each weekend to further benefit my cardiovascular fitness. It is difficult to maintain ideal weight with zero running but theses exercises will minimize the degradation of my fitness since the surgery. I remain skeptically optimistic that my foot will continue to heal and I will again be able to run without pain. Until then, I'll keep on keeping on.

MTP Toe - 2 weeks later

It is the evening of May 30, 2013. It has been fourteen days since the procedure on my right metatarsophalangeal joint which had been affecting my walking and running for several months. Symptoms included slight loss of range of motion, catching or clicking on dorsiflexion, and redness imflammation on the anteriolateral region of the first MTP joint. I had to removed the stitches as they were becoming embedded and were extremely tight. Other than some typical inflammation, the incision healed well. Due to the location on the dorsal aspect of the first metatarsal, the stiches were strained somewhat during the plantar and

2 weeks later

dorsiflexion of the joint. The orthopedist had prescribed those manual flexion exercises to allow a smooth cartilage layer to form in the area of the distal metatarsal where the osteochondral defect was removed.

My mobility has definitely improved since surgery but clearly not to a normal level. I can place more weight on the medial side of my foot without much discomfort. However, I am still wearing the stiff sole medical shoe prescribed, until my second follow-up with the surgeon. Range of motion has improved during my
manual flexion exercises but is still not equivalent to my unaffected toe. That will take time. I am on my feet quite a lot for work but take breaks, place most weight on the lateral region of my foot, and elevate my foot whenever possible.

I have seen a lot of improvement as far as the wound physically healing. However, there is still some medial MTP discomfort and an occasional catching or clicking on dorsiflexion which was one of the major complaints and reasons for the operation. This catching or clicking sensation is usually associated with an osteochondral defect or loose body within the joint itself. The surgeon removed that defect and remarked that joint itself looked fine. There was no evidence of a osteophyte or bone spur on his examination.

5K Planning at Phipps Park

I am continuing to remain optimistic and continue to follow the surgeons orders to the word. Next up will be a carbon fiber insert for my regular shoes. This fiber plate will limit flexion of the joint while healing continues. I'm excited to finally get back into my regular shoe and look forward to more progess. I am maintaing my fitness through accelerated weightlifting sets and some stationary cycling- using my heal to pedal. Stretching is also critical while I recover due to my gait being affected by the different shoes. It is also important to stay connected to running while I recover. Currently I'm assisting a local organization by directing a 5K trail event on July 4th. In addition, I plan to volunteer at other running events this summer. I look forward to seeing the other side of sport but am anxious to return, if and when I'm able.