Successful Foot Surgery (21 Month Update)

April 22, 2012 by  
Filed under Our Recovery Journal

There is a big difference between acting tough and being tough.  Acting tough can be accomplished by narrowing your face into a scowl and staring down everyone who walks by.  Acting tough is a characteristic that is noticeable at all times.  It is a look that requires conscious effort to keep up.

On the other hand, being tough is a much more natural state.  Toughness doesn’t reveal itself until you are confronted with adversity.  Being tough means being able to deal with disappointment.  It means being able to handle pain and accept heartache.  A tough person is able to shrug off life’s setbacks and continue onward.

Toughness presents itself in the steadying hand of a true friend.  It manifests as the will to continue on a chosen path when that path winds through rugged terrain.  Toughness is smiling before you are to go in for surgery in order to make those around you feel more comfortable.  Toughness is a patient who shines with positivity during a frustrating hospital day.  Toughness is accepting that having your foot cut open and rebuilt is the best chance at permanent improvement.  Toughness is my wife Jessica.

Foot surgery doesn’t fully describe what Jessica dealt with during the past two months.  A better explanation would detail the number of surgical incisions (seven) and exactly what is meant by “lengthening the achilles.”  Her operation actually consisted of two separate and distinct surgeries.


Goal #1: Lengthen the Achilles Tendon

Our muscles and tendons are made up of thousands of tiny fibers.  These fibers keep the muscle tight enough and strong enough to allow it to operate the joint it is connected to.  Tendon lengthening is a matter of trimming down some of these fibers.

In Jess’ case, lengthening the Achilles was accomplished by making three tiny incisions on the back of the ankle.  Each of these incisions was used as an access point to trim down fibers in each of the three locations.  The goal was to lessen tightness in the tendon by reducing the amount of pull of all the fibers.  In a practical sense, three little trims of the tendon were a safe way to relax the tendon and give the foot more flexibility.


Goal #2: Tendon Transfer

A tendon transfer is one of the most creative medical procedures ever devised.  In simplest terms, it detaches a tendon from one place and reattaches it somewhere else.  In our case, the tendons of the ankle joint have tightened up.  Her foot is inverted so much that it has affected her walking.  Stroke victims frequently experience this condition, and it is called “dropped foot.”

A dropped foot is twisted in and down.  Instead of the toes pointing straight out, they point toward the ground in front of her opposite foot.  This condition fights against the normal walking motion.  In Jessica’s case, a heavy plastic brace was needed to keep the foot pointed forward.  She was not able to take a single step without wearing the brace.

A tendon transfer is performed on a patient who been unable to regain movement, control, and flexibility in the foot.  In an ideal world, therapy and stretching be enough to allow the body to return back to its natural state.  Once these avenues are exhausted, it is time to consider more invasive options.  Tendon transfer is an invasive but effective way to alter the structure of the foot.  It is an opportunity to reset the foot into its natural position.

The procedure involved tendons that attached to the top of her foot.  The tendon connected to the inside bone was severed and then reconnected to an outside bone of the foot.  Since the leg is filled with bones and muscles, accomplishing this task requires threading this muscle and tendon through the existing parts of the leg.  The biggest consideration is the anatomy of the tibia and fibula, and the tendon must actually be pulled back up the shin and threaded between these two bones.  This is the only way to reattach it to the outside of the ankle at the correct angle.

This surgery is a high tech sewing project.  It is not something to undertake without feeling completely comfortable about the procedure.  The most nerve-wracking part of it all is the uncertainty that comes with a major decision.  After our first consult and some follow up research, it became obvious that there was one clear choice for this surgery.  Only one doctor in town that had the pedigree to put us in our comfort zone.


Researching the Surgery

It’s pretty scary to contemplate surgery… especially when the results are so permanent.  If the surgery went badly, then the experience would be a disaster.  A poor outcome would result in an avalanche of guilt and regret. Although there is no way to be 100% sure when faced with a difficult choice, researching the operation and the surgeon is one way to feel just a little better about it.

Information found on the internet is merely a starting point.  A google search for specific medical information can help, but I’ve found that it sometimes leaves me with as many questions as answers.  The bare minimum amount of data is just enough to make somebody dangerous.  In this case, we found that the surgeon had a pretty long history

Although I despise taking notes, I managed to keep a good record of all the contacts we had made in all our previous hospital stays.  The internet is a great tool for researching the procedure and the surgeon, but it is only a first impression.  When contemplating something serious, there is no substitute for the opinion(s) of experienced medical personnel.  Asking the opinion of a medical professional is one thing… calling on them as a friend adds an even deeper level of security concerning their advice.  The stress of wondering about the best decision is completely melted away when several medical friends have all concurred that we have chosen a good path.

Jess was a trooper the morning of surgery.  She understood that surgery would be a big deal.  Several incisions in an ankle and cutting and working with tendons could be painful.  Despite the dangers, she approached the surgery with hope.  The pain of walking had become so great that ANY possible solution was worth a try.


Surgery is a Lifestyle

Those who have not experienced surgery think of it as a one-day event.  They see it as having some work done and then recovering for a few weeks.  As a quick fix to a problem.  Most people do not see all the work that goes into sustaining the improvement.  They do understand all the maintenance that is required to help maintain the gains brought by the original surgery.

Jessica made significant gains during surgery.  These gains include increased range of motion and a more fluid walking motion.  More stability and a significant reduction in foot pain.

These gains have come with more responsibility.  Her straightened foot now needs daily stretching and hourly walking to keep it in good working order.  Staying on top of this maintenance is a big job.  There sometimes isn’t time for an extra hour of stretching and exercise each day.  Sacrifices are made in other areas of life in order to promote the absolute best outcome for her leg and foot.

There is no guarantee that the surgery is permanent.  Muscles can strengthen or weaken depending on usage.  Tendons can remain as they are or they can tighten up.  Stretching and hourly walks are investments we must make to ensure that we keep all the benefits surgery has provided.


Was surgery worth it?

Before surgery, Jessica expected pain with every step.  Her subconscious argued against walking for pleasure or for purpose.  Even a 20-step trip to the bathroom… is it really worth it?

Jessica recently went to the grocery store.  On trips like these, she leaves the cane in the car and uses the shopping cart to help her balance.  Upon arriving home, the groceries are carried in for her.  It is her job to take them from the counter and put them away.

She plopped down on the couch and made a proclamation.  She was tired and needed a rest.  One look in her eye and it was obvious that she had committed to staying on the couch for a while.  The groceries would to wait until she was ready.

She had been on her feet for about an hour at the supermarket.  Although she had a cart to lean on, an hour of walking is quite a feat for a stroke and TBI survivor.  At the beginning of the recovery, I had no idea what to expect from the weeks and months ahead.  If I had known from early on that she would recover enough to walk behind a shopping cart for this long, I would have classified her recovery as “excellent.”  Early on, it wasn’t clear that she would ever get this much back.  Continued hard work helped her achieve balance and strength gains.  She has truly been a turtle in this race, a slow and steady ascent to where she is now.

Jessica is a hard worker, but she knows her limitations.  It was clear that an hour of walking had tired her out.  She made a decision to rest for a bit, and her face showed that her decision was non-negotiable.  She may have secretly hoped that someone would put all the groceries away for her.  Deep in her heart, though, she knew that her husband is equally stubborn.  She would rest a while, then get up and organize the food.  It’s not like her to let all those brand new items go bad.

Pain free walking has been one benefit of surgery.  Another has been overall improvement in balance and stability.  Since the surgery, she has been able to bend lower and control her movements better.  Items on the floor are often within her reach.  Even the washing machine is a doable chore for her now.  Bending down to the clothes basket and throwing items in the front loader a movement she can now handle.

For six weeks, Jess was slowed down by a huge cast.  She was tormented by itches she couldn’t scratch and a shower she couldn’t use.  Cast removal was a liberating experience… her first shower went on and on until the calls for “dinner” were loud enough to make their way up the stairs and into the bathroom.  She is walking further, faster, and more efficiently than ever before.  When we decide to run errands, I now assume that she’ll be walking.  I only consider the wheelchair for the longest of trips.  She can do the mall or department store without it.

Surgery has definitely been worth it.  The stretching and exercises that supplement the surgery are a nuisance, but the gains have far outweighed the cost.  The hope of improvement in walking has improved her outlook on life and strengthened her self-esteem.  Surgery has served as a reset button on her frustration.  It has renewed her spirit and inspired her to strive hard toward even more physical gains.


21 Months and Counting

All of the information concerning brain injury recovery can basically be summed up in the following statement:

“Most gains in brain injury recovery are said to occur within the first 6-12 months.” 

This statement is a staple of neurology and is one that we learned very early on in our recovery.  While it may be true in general, I believe that Jessica has shown that this statement is not a definitive one.  Her recovery is a case study in possibility.

To this day I still remember the ICU doctor who insisted I accept things as they are:  Jessica would never wake up and it was time to begin looking at life in a different context.  I remember this confrontation like it was yesterday.  Every word that was spoken and all the nuance that was left unsaid between the doctor and myself.  I was so shocked that (she) kept plodding along with her prepackaged speech long after it was obvious that I understood.  I was so disappointed in (her) for being unable to see that I understood her but simply wasn’t ready to wave the white flag on my wife.

Life can be defined by what you are willing to do.  I simply was not willing to give up my hope.  I was ready to make many other changes.  Willing to invest my time and my energy. Willing to make sacrifices that involved the kids and myself.  What was not negotiable was hope.  It wasn’t negotiable then and it isn’t negotiable today.

No matter how unlikely an outcome, nobody has a right to steal your hope.  No matter what life is like today, there is always hope that it will get better.  Hope that your loved one might come back.  Hope that they will learn to swallow, eat, and talk again.  Hope that they will recover enough to enjoy life once more.

It is unlikely that our life will ever return to what it was before the trauma.  It would be completely naïve to think that Jess’ body could operate as if the trauma had never happened.  It would be unreasonable to expect her to be able to climb a tree, operate a four wheeler, or run a half-marathon.  Jessica’s progress has been awesome over the last 21 months, but every gain she makes is a higher hurdle than the one before it.  Her final destination can now be approximated by our current trajectory.

Jessica has exceeded every possible expectation in her recovery.  I don’t know of any other medical case where the patient has exceeded expectations to this degree.  As bad as things were when they began, they have continued to get better.  Every goal that is met is replaced by a new one.  The journey is so long that there is no final expectation… only our current goals.  We constantly pursue these goals in the hopes of accomplishment.

Right now, we are living at the absolute peak of our post-trauma life.  It hasn’t quite returned to “normal” but I would call it “somewhat normal.”  The recovery is still our #1 focus, but there is now room to focus on school, work, and socializing.

We have been fighting against a handicapped lifestyle for 21 months now.  This is a fight we are taking on and one we can ill afford to lose.  We have learned that we can and must make adjustments to facilitate our survival.  We have learned to search out any and all information that could potentially lead to a physical or emotional victory.

We continue to learn that many things are possible.  That life is precious and even the smallest bit of happiness can be a big deal.  We’ve learned that

  • hope is something worth holding onto
  • everyone in this world goes through tribulation
  • when things are at their worst, it is the best time to look at things in a new light
  • a new perspective can find positives in even the most awful event or situation
  • you may be capable of far more than you ever thought possible
  • toughness is an important attribute when facing life-changing circumstances
  • each day we are alive is a valuable day

Our life continues to improve, and our perspectives continue to adjust to our changing world.  A day of seeking to live well is a day worth living.  Each morning, we set out to live out this day as best we can.  It is our prayer that you can do the same.


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