So dawned the morning of Thursday Dec 7. I was dropped off at the local Spire Hospital by my wife who was off to Jury service, more about that bad timing later, settled into my room quickly, and seen by Mr Malik and my anaesthetist. After a couple of hours it was a short hop along the corridor to theatre and although I have seen this process hundreds of times in my own patients, going to sleep is still a little scary but a marvel of modern surgery.
That instant of the anaesthetic infusion taking rapid effect, I was concentrating on a mark on the ceiling above me and seeing it start to blur and move around – then waking up a couple of hours later in the recovery area. Unlike natural sleep when you wake up realising that, hopefully, a large period of time has elapsed since you fell asleep; with an anaesthetic you are essentially in a coma, unaware of any passage of time, it could be minutes, hours or for some patients seriously ill in an intensive care unit days or even weeks. You just wake up with no sense of the passage of time, and these days almost never in pain. Loaded up with class A drugs, local anaesthetic blocks numbing my lower leg and foot most effectively, I felt dreamily comfortable and content. This had to be better than doing my own operating list that would have been scheduled for that time in my normal week! Later it was really nice to see my family and I felt pretty good.
The first night was restless. Mainly I was kept awake by the noise and activity of the mechanical calf compression device I had on my other leg. I got used to its varying cycles of compression cycles some slow, some fast but all noisy. I don’t usually sleep on my back so it was unusual anyway, but fixed with one foot in a big boot and the other in the compression device was quite immobilising. I was glad to see the sunrise through my window, breakfast was great including scrambled eggs with smoked salmon more decadent than I ever get at home!
I was then introduced to my new best friend, a zimmer frame, with which I learned to hop about the room, really just between the bed and the bathroom. You soon realise after any surgery that previously minor everyday tasks are much more difficult. Going to the toilet is one, though in my job I was worried about having difficulty myself peeing but luckily it was all right, though the hopping to the toilet with a zimmer, then manouvering my left leg to kneel on a stool by the loo to keep my foot up took some practice to get the aim right. With all the anaesthetic drugs, painkillers, pre-operative starving and immobility constipation is inevitable but luckily sorted itself out in a couple of days at home.
The first day after surgery my surgeon went through the operation and I was pleased to hear that it had all gone as expected – a couple of pictures here and I am really sorry if you are squeamish, better not look!
The FDL tendon transfer being prepared
If you would like to see a detailed video of the type of surgery I had then the link is here. It is a full surgical teaching video from a commercial source, so be warned!
flat foot reconstruction (video) from Arthrex
I was to try and keep my foot above the level of my heart for at least a week for a minimum of 50 min every hour. That essentially meant confined to bed and just up for loo breaks. After that if I sat in an armchair my left foot should be above hip level to minimise swelling. I found out very soon that even if I let my foot hang down for just a few minutes then it started to ache and I was glad to get back to bed and put it up again.
Not everyone will recover at the same rate, there is quite a range and I am constantly reminded of this when I review my own patients after surgery. Some bounce back as if nothing had happened, others take much longer. Part of course is your pre-existing fitness level and also the extent of surgery required. Flat foot correction surgery is a big thing for your poor foot to go though and will take many weeks of steady graduated exercises and physio to improve. I was dismayed that it may likely be 6 months before I would get back to gently jogging again, and 9 months for ballroom dancing, by then I expect that my wife will have given up on me and found another partner; we will have to see.
Crutches. The hospital physiotherapist got me up on crutches, I had never done this before and was told off for trying to go too fast, the last thing you need is a slip and a fall. I stayed in hospital 2 nights, but managed to disconnect the pneumatic calf pump for the second night so slept much better. I was to give myself heparin injections to reduce the risk of blood clots every night for 6 weeks after surgery. Pushing the needle in didn’t hurt but the drug would sting for a short while after.
I had plenty of painkillers and the block that my excellent anaesthetist had put in to numb my foot took nearly 2 days before it had worn off. The second morning my physio was back to teach me how to go up and down stairs on crutches. That was not so easy and it was clear that a good bannister rail is a must to do this safely and I might well be better off just sliding up and down on my bum, at least to start with at home. Then it was goodbye to the staff and off home sitting sideways across the back seat of the car. Then straight upstairs which involved an ungainly one footed bum-shuffle and into bed with my leg up on pillows above heart level, but not obscuring the TV.
My Flatfoot Surgery Recovery 