Boot, Insert, Plate, Repeat...

Boot, Insert, Plate, Repeat...

 

 

On September 19th, 2017 I had my first orthopedic appointment at Brooke Army Medical Center (BAMC).  Between the orthopedist and the podiatrist, they agreed that I had two choices.  First was surgery now and minimal pain later.  Or chronic and worsening pain for the next few years resulting in surgery later. 

 

Hmm...didn't seem like there is much to dwell on in this scenario!  The reasoning was that the fracture was in the joint and since there are bone fragments not healing, any wrong step could dislodge these fragments and cause even more damage to the surrounding tissue.  Not Good!

 

Also, and just as important, these types of fractures (in the joint), will speed up the arthritic breakdown of the joint based on activity level.  And based on my activity level, running, trailing-running more specifically, would further speed up this process. 

 

However, the joint was still swollen and sore when the doctor worked the joint through a series of range of motion exercises.  This did hurt!  So we began down the road of reducing the swelling and giving the joint some rest. 

 

 

The Boot

So, we began with the Boot.  For four weeks.  Wear it all the time except for bathing and sleeping.  No running.  So I began my gym workouts.  I do not like the gym.  I would prefer to be outside running, even if it is 110 or 10 degrees!  I would need to ice/heat my foot four times a day.  This was a pain as when you wear one, you have to put an insert into your other shoe so your feet/knees/hips/back remain even.

 



The Boot

 

 

 The Insert

October 24th, I returned to BAMC for a checkup and to see how the joint was doing.  It was stiffer, but less swelling.  That was a good thing, but also I had more pain in the joint, which kind of made sense.  However, it meant that probably the fragments were not healing and continued to move causing the pain.  The next 'step' was to keep the ankle from stiffening and the Doc moved me to a stiff shoe insert.  At least I could wear normal shoes and boots again.  Its purpose was to keep my foot and toes from flexing and aggravating the joint.  We would try this for another three weeks then come back for a follow up appointment.

The Carbon-Fiber Plate Insert

The final attempt to reduce swelling and stabilize the joint was this little beauty.  An insert that would not allow any motion at the great toe joint.  I certainly did its job, but the side-effects were worse than the pain at the joint.  I could not tolerate this it caused a significant amount of pain across the metatarsal heads of all toes and inflamed the arch of the foot.  I could not wear this as prescribed. 

 

 

Final Follow Up

 

The week after Thanksgiving on the 28th of November, the Podiatrist saw me for our final follow up and basically said, it is time to take it to the next level of treatment- Surgery.  The follow up X-Rays showed the same as before, no changes in the location and healing rate of the fragments.  So, we scheduled a visit with the Orthopedic Surgeon for pre-op evaluation. 

 

 

My podiatrist gave me an overview that didn't sound too appealing!  He told me he has done hundreds of them over his career, but his surgical days are behind him and that the 'younger whipper-snapper surgeons' have a much steadier hand than he does.  The process would be to fuse the joint.  Permanently.  He recommended surgery because it would be inevitable based on my activity level, age and the fracture at the joint. 



 

Go for the surgery now while I am young and can adjust biomechanically now rather than wait and have a more difficult time at a later age. As an added bonus, I will have this surgery done at a world-class facility by a health care team that is second-to-none in helping Soldiers-Sailors-Airmen-Marines recover from injury and illness.