Return of the boot !

Ello, ello, ello,

Yes it's been a while hasn't it ?
I was so astonished to see that I'd had over 4000 hits when I logged on last night !
Thanks to all of you that have read my woeful tale :-) I have been quite miserable in some of the posts I've made ,I noticed, but then It's been a crap year for me ! A Lisfranc fracture is not funny & I'm not superstitious but I do find myself being careful around mirrors & ladders these days !
It has been probably the most difficult & challenging year of my life, not just because of the foot....
Where shall I start to bring you all up to date?
I think where I last left you will probably make the most sense....

Sadly I haven't been away pirouetting on the foredeck, or trekking up Mount Kilimanjaro :-(

When I returned from my road trip to the US last October, I learnt that my dear Grandfather Pete was seriously ill, so ill in fact he died just three weeks later. This event was devastating to me, more so than the consultation with Mr Ritchie last April when I learnt the full extent of the damage to my right foot.

We were best friends you see, really true best friends.
When together we were always in cahoots, giggling together about the silly daft things that our mutual sense of humours connected on, often hiding away together when I was a young child in his woodworking shed from my quite strict Gran when she was on the war path !
In fact I think my Grandfather gave me my love of the sea & all things salty ! As soon as I was old enough to walk he got me a life jacket & took me sea fishing with him off of the coast of Hastings in East Sussex. This was the way I would spend most of my summer holidays with him right up until the age of 13 or 14. My grandfather taught me all of the essential things that a young lady should know, like how to thread lugworm onto a fishing hook, how to cast a decent line, how to tell the difference between a Flatty & a Plaice (fish!) & of course how to tell a decent pint of beer from a wrong 'un', although not this lesson until I was of the legal age to consume alcohol of course :-)
I experienced my first man overboard with him on Emma 1 (of course it was me) & my first rescue by the RNLI when the new radio he'd installed on Emma 2 failed when we were out at sea. My grandfather found this event most exciting & whilst I was being uplifted from the boat by the RNLI, he got his camera out to photograph the entire proceedings- LOL

So it all came as a huge shock to me, to lose him so quickly & unexpectedly, the foot actually became second priority to my grief for the best part of six months. He'd appointed me as his executor in his will as my Gran had died 14 years previously. I carried out all of his wishes as best as I could & then after much soul searching I decided to leave my birth place- Tunbridge Wells for a fresh start. I found a house in Addlestone, Surrey, closer to my work, my son, the rest of my family & my man. Yes, my man did hang around (see earlier posts about my worry & self doubt) & he has proven himself to be my rock during this difficult period. I often wonder at his unwavering support & faith in me as he'd only known me for a few months before my life was turned upside down.
I moved to Addlestone on April the 4th, the house is lovely but a project. It needs extensive redecoration & repair as well as having a garden that needs designing from scratch. So I spent the first three weeks in April decorating & cleaning the house with my man in earnest & we travelled to London on April 22nd to watch a great friend of mine compete in the London marathon. The foot was behaving well, a little tender at the end of the day but that was about it. I discussed climbing Mt Snowdon with my friends that evening, I planned to join the local gym the following week & my man had just booked me a trip to Hawaii in October this year to celebrate my 40th birthday.

Then on April 27th after a few days of feeling a little more tender than usual I got out of bed & upon standing I experienced acute pain through my 2nd & 3rd toes. I presumed that I'd just overdone it, I took some Ibuprofen (Aadvil to all you Americans ) & continued with my day hoping for the best.  On the Monday evening (30th) I caved in & drove myself to the local hospital casualty department, by now walking was extremely difficult, I couldn't bend my big toe at all & the pain wasn't responding to the Ibuprofen. I had a standard X-Ray & it didn't show any fractures (neither did the one I had last September) but the doctor decided to refer me to the fracture clinic the following Friday as a precaution in view of my history. I declined the offer of Tramadol & decided to persevere with the Co Codamol & Ibuprofen that I had stocked up at home.
After driving some 700 miles for work over the next three days I arrived at the Fracture clinic sore & feeling slightly unwell. I met Mr Monk- an Orthopaedic & Trauma consultant who browsed my X-Rays with considerable interest & read the letters I'd taken with me that detailed the details of my original injuries, previous surgery & then the second fracture in September. He informed me that he was very experienced in Lisfranc injuries & expressed sympathy at my latest predicament. He recommended an MRI examination & a referral to his private clinic as the current waiting list for the NHS service was around six weeks. Luckily my health insurance provider approved this & it was arranged for the following Tuesday (8th May). Mr Monk also strapped my foot back into an Aircast boot & presented me with another pair of crutches, precautionary but essential as was the ban on driving he explained :-)
Oh the irony wasn't lost on my either, the date ? Well it was the 4th May, exactly 13 mths since my original injury..........
So I had the MRI & met with Mr Monk this evening for the results, the good news, no fractures detected, the not so good news was that the radiologist omitted my toes from the scan ! Mr Monk puzzled over my symptoms, he commented that I was a mystery as both he & the expert radiologist he'd asked to interpret & report on the MRI were convinced as was I that I'd developed a stress fracture in either my 2nd, 3rd or 4th metatarsal. A second MRI of the front of my foot has now been booked for next Monday (14th May) with a further follow up consultation booked for the 15th with Mr Monk.  Morton's Neuroma was also mentioned by Mr Monk as a possible diagnosis;

Morton's neuroma is a condition that affects the nerve between the toes. The nerve becomes irritated and compressed, which results in severe pain on the ball of the foot and at the base of the toes.
Morton's neuroma usually affects the nerve between the third and fourth toes. It is rare for more than one nerve or foot to be affected apparently.

So A further week of minimum weight bearing, in the Aircast & no driving awaits me now. I have limited Internet access at home due to no WiFi as yet so I re subscribed to SKY TV today just to relieve some of the boredom. I will have to sit on my hands to stop myself from getting up & grabbing a paintbrush or doing any more of the various DIY jobs that are outstanding in the house. I must admit I'm now doubting myself, I pondered on the way home if the pain really was that bad or was it just me being nervous about the foot ? When I got home I removed the boot & tried to walk around the house, yes the pain is still there, between my 1st & 2nd metatarsal, maybe not as acute as it was but enough to prevent me from walking normally. So I will just have to await the verdict on Tuesday.

I also received the results from my bone densitometry scan (DEXA) that my GP referred me for a month ago this week. It appears that I do have signs of Osteopaenia in my lower spine so it's a lifestyle change for me, from now on a careful diet & a lifetime's supply of Acal D3 (Prescription Strength Calcium & Vit D)! When my time comes to enter the Menopause then I will need a rescan & possibly more of the Alendronic Acid that I had following the fracture last September (Oh the joy !).

The positives; Well it's an Olympic year here in Blighty, Oh & we have the Queens Diamond Jubilee to look forward to ! Yay !!!!!!!!!!!!!

Day 80 Weight bearing- Woohoo !!

I had a really good appointment at the hospital today, for the first time in this recovery process, I finally received some real positive news !
My AP & Lateral X rays looked as good as the consultant would expect at this stage, his words were "You're making a good process in line with what I would expect at this stage".  The fusion (with bone graft) of the 3rd TMT joint is healing well & the plate & screws that are also holding it & the 4th metatarsal will remain permanently in my foot. The 2nd metatarsal which was treated with an open reduction & fixation look like it's healing well, the screw that was put in in place will hopefully be removed along with the fixation plates & screws in the 1st metatarsal. If I continue to make progress at the same rate, I can expect this to happen in about 17 days (July 15th).
After examination of the foot, he was encouraged with the low level of swelling that it presented with.  He wasn't concerned by the swelling I described & the purple appearance "the foot" sometimes adopts he said it was quite normal to experience this after exertion at this stage & I should take it as a sign that I need to rest it whenever it happens. The swelling should always subside after resting, which mostly it does.
I explained to him the problems that I was having with the boot, it was loose & hung awkwardly on my foot rather than supporting or cushioning it. This was causing the bridge of my mid foot to become sore, pins & needles in my toes & irritation of the operation scar.  He explained that he was hoping to get me to start weight bearing using the boot, so we needed to resolve this other wise it would mean transferring back to a cast, which would be a slight regression. So we hopped along to the physiotherapists office to see what her verdict was. After having a look, she explained that the boot was far to loose, following the reduction in swelling over the past 3 weeks. I also still cannot get my ankle & heel to bend into the normal 90 degree position due to stiffness & swelling within the ankle joint. This is also affecting the positioning of my foot within the boot. The physio suggested that we try to inflate the air cushions more to hold my foot in a better position, although it would mean discomfort short term, the long term benefits would be important. After doing this, the boot was a lot tighter, all around my foot & calf, apparently this is how it should have been all along :( I also need to continue with the ankle exercises at home.
Then came the "moment"................. after another nurse was called in for support, I was asked to stand up slowly.............. on both feet ! After much coaching from the physio & lots of instructions I then began to walk, just putting 50% of my weight into my heel. Crikey it felt alien, completely abnormal ! I painstakingly slowly put my crutches out in front of me, then brought my bad foot through, parallel with my crutches, put my weight down into it's heel & then brought my good foot through to meet it. The smile on my face after the first couple of steps was immense ! I even felt emotional, my bottom lip wobbled a bit, I don't mind admitting. The relief was over whelming, at last a real tangible step forward in my recovery process. I also had a lesson in staircase techniques, so hopefully after a bit more practice, I may be able to leave the days of bum shuffling behind me- Yay !
I asked my consultant if I had actually displaced the Lisfranc alignment when I fractured all of the bones that I did, he confirmed that in deed I had & it was by a serious measurement. However If I continue to make the recovery that I currently am, he felt confident that the ligament & tarsometatarsals should heal well. I asked about my prognosis, he confirmed that subject to the good recovery continuing I stand a relatively low chance of developing a debilitating level of arthritis. The good news is that I stand no chance of developing arthritis in my 3rd TMT as I've already had the treatment by having it fused. If I were to present with painful arthritis in the future then he would treat it my fusing the rest of my TMT joints. I feel reassured that it would be treatable & actually if it came to this, well at least I'd still be able to stay relatively active. I have lost some feeling on the inside of my 3rd & 4th toes, my consultant said he couldn't say for sure if this would be permanent, but it shouldn't affect me too much. I also asked if I would be left with a permanent limp, he said that I would have a slightly displaced gait, but after 6 months or so I shouldn't have an obvious limp & should be able to walk relatively normally. It will take a full 12 months or so, before I will reach my full recovery. I should be able to sail again next year, OK so no pirouetting on the foredeck but I WILL be able to balance well enough on both feet to be able to sail.

So I can hopefully look towards the op in July, then around a month later walking in a normal shoe, a few weeks later discarding the crutches & being able to drive sometime in August.
Happy, happy, happy of Royal Tunbridge Wells !!!

One bloody metatarsal cannot hurt this much ???

As I held onto the sink in my kitchen, big hot tears formed in my eyes & 9 hours after breaking my foot, I cried. My shoulders shook as I gulped back the sobs, eventually letting out a hopeless wail, my injured foot now bound up in plaster of paris hung down from my knee, bent to prevent it touching the floor. I remembered I had a few cigarettes left in my sailing bag (I've enjoyed a love/hate relationship with cigarettes since I was 17 & although I'd given up last January a few social & post race cigarettes had crept back into my life recently, normally accompanied by a lovely glass of red wine). I inched my way around my kitchen, hopping & pulling my self from the sink to the cupboard, to the cooker until I reached the kitchen drawer that I kept a lighter in. After hopping & pulling myself back round to where the crutches were I made my way to the living room, sat down & lit the cigarette. Inhaling deeply, it didn't taste great, nor did it help with the pain but somehow it comforted me just to smoke it, whilst I tried to comprehend how much impact this injury might have on my life.
I work as a technical sales person for a connector company within the defence & aerospace industries, lots of blue chip customers & I normally drive on average 800-1000 miles per week. I reasoned with myself that one fractured metatarsal should only mean 6 weeks or so in plaster, perhaps a week off sick, then a few more working from home, I could get someone to drive me into the office for a week or so, yes this isn't too bad I concluded. Far from ideal but not a total disaster, Internet shopping for a while & maybe someone to help me walk my lovely cocker spaniel. I sent a text on my blackberry to my boss & emailed my dad & my gorgeous new boyfriend to let them know that I wasn't contactable on my Iphone as I realised that this had been left behind in Southampton. New boyfriend I guessed had probably been trying to contact me, to see how my day had gone with the new crew & might be worried that he hadn't received a reply.
I took a couple more co codamol & decided to try & get to bed, yep it was a struggle, the crutches felt alien & unco-operative as i tried to get upstairs, my foot dangled precariously in mid air as I limped, dragged & hopped my way up the stairs to bed.

I must have slept, but can't really remember going to sleep as such. It was 2.45 am when I looked at my bedside clock, the pain was excruciating. The bottom arch of my foot felt like it was on fire, with a hard knuckle or ball being driven into it. The top of my foot throbbed, pins & needles shot up & down my calf & shins. My toes were swollen unrecognisably & a sensation of hot stabbing pins intermittently affected the tips of them. I tried elevating my foot & lower leg on pillows, but this just seemed to increase the strength of the pain, nausea swept over me & I writhed around in bed just trying to somehow find a position that offered some relief. I can honestly say even after experiencing childbirth, a childhood kidney complaint that frequently caused renal infections, a horse riding accident that caused a badly broken arm & significant muscle damage I have never known pain like this !

Sweating profusely & absolutely at the point of despair with the pain, I pulled myself out of bed, grabbed the crutches & made my way down stairs. I stood at the top of the stairs pondering the safest & most painless way to get myself & the cumbersome crutches down them. Eventually I decided, sitting down & bum shuffling was the way to go. Once down, I again hobbled into the kitchen in search of a cigarette, I noticed the co codamol on the side & after reading the dosage instructions, took one more, hoping that this just might take the edge off of it. I held on to the sink, smoked the cigarette whilst tears again rolled down my face. All the while my mind was questioning the diagnosis at A & E, how on earth could just one fractured metatarsal cause me to be in this much pain ?

After I'd calmed down a bit, I made my way back into the living room, switched on the TV & aimlessly flicked through the channels to find something to distract me from the pain. I persevered for another hour or so but it was hopeless, back I went to the kitchen, another cigarette I lit, it tasted foul, it made my head spin, it did nothing for the pain but feeling as wretched as i did, I smoked it anyway. Again another  wave of nausea & cold nerve tingling pins & needles came, this is no good I thought to myself, ring the hospital, this can't be normal. Anxiety & fear was creeping in at this point, it was nearly 4 am & I was on my own.

After a short time I was put through to the A&E sister on duty, I tried to explain to her what the pain was like & where it was, I also shamefully admitted I'd taken 3 co codamol within the last 3 1/2 hours, tears again rolled down my face in desperation & just bloody agony. She sounded tired & rather annoyed, she proceeded to lecture me about only taking prescribed pain killers as directed & then stated that the fracture I had was notoriously painful & I just had to bear it. So I did.