Soft bones and a fusion

Four months ago I was feeling good. Both of my feet were, for the most part, fine and I was getting back to a normal life. Then my body decided to give out on me again. It first started as a nagging soreness and dull pain that emanated from the inside of my right ankle. The soreness and pain emerged when I walked or stood but dissipated with rest. I initially thought the pain was from posterior tibial tendonitis. The symptoms correlated well - but a correlation does not mean causation. Over the course of a week, the pain only continued to worsen until eventually it lingered even with rest. The pain grew to a point where I could not even walk on my right ankle. I brought back out my boot and crutches. My ankle and lower leg were throbbing, and I knew the root cause of my pain had to be more than just tendonitis.

I saw my orthopedic doctor two weeks after the initial pain began. I gave him the details of my pain and he took some X-rays as the standard procedure. The X-rays came back negative, and the doctor told me I most likely had posterior tibial tendonitis. I knew my body, and considering the amount of pain I was in, I was not sold on the idea that all I had was tendonitis. I explained my doubts to the doctor and to make sure we discovered the correct injury he ordered an MRI. A few days later I got the MRI and received the radiology report the day after. In short, the report explained that I had tendonitis but also a stress fracture in my medial malleolus (a.k.a the inside ankle bone). I returned to the doctor a week later and he reviewed my MRI with me. In short, I had a stress fracture in my ankle and would have to be in a boot for 6-8 weeks. The tendonitis was in response to edema in my ankle.

The root cause of my stress fracture woes? Ironically, bone requires weight bearing to increase its density and strength. Bone in the human body is considered a tissue and is not static. Your body is continuously remodeling bone (i.e. removing old bone and building new bone). Without weight-bearing, this process slows down. My bones were soft in my lower leg/foot from many months (even technically years) of accumulated time that I spent non-weight bearing. 

Fast forward two months. I was back on my two feet and doing some physical therapy to strengthen my ankle and foot. Physical therapy helped and I was back to my pre-stress fracture activity (e.g. walking and biking). However, there was one problem I was still unable to shake. I noticed my right mid-foot was sore when walking. I knew the cause of the pain/soreness. I still had remaining hardware from my ORIF surgery in my right food a year prior (September 2016). With each step, the hardware irritated my mid-foot joint. The pain wasn't too bad and I could still walk around fine for the most part. But walking more than 1/4 mile was uncomfortable, and I knew that if I ever wanted to graduate to a higher activity level this problem needed addressing. 

I was warned when I first got the ORIF surgery that there was a likelihood that I could develop arthritis or the hardware could cause pain in the future. This thought was always in the back of my mind. For a year, I dealt with the discomfort with hopes that it would go away. I gave myself to the end of 2017 to make a decision. If the pain hadn't vanquished, I would consider the fusion of my first TMT joint and cuneiform. I knew from experience - with my left foot - that fusion could prove to be a viable solution to my problem. At the end of 2017, I spoke with my doctor. He also agreed with my reasoning and said that eventually, I would most likely need to get a fusion anyway. It would be prudent to go ahead and get it done now. So with a heavy heart, I decided to go ahead with fusion surgery of my Lisfranc joint. The only thing that made my decision palatable was the knowledge that the fusion of my Lisfranc joint in my left foot has given me great results.

The surgery took place at the beginning of this year (2018). This being my fifth surgery on my feet, I was unfortunately very accustomed to the pre-op and surgical procedures. My nerves were surprisingly low. In fact, the alarm on the heart rate machine kept on going off because my heart rate was below 42 bpm. I nearly fell asleep in the hospital bed waiting to be taken back to the operating room. The surgery went smoothly, but my surgeon did notice that my bones in my foot were noticeably soft. This finding wasn't unexpected, considering my history. 

The first three days after surgery are always the worst in terms of pain and discomfort and this time was no exception. However, the pain was tolerable and the swelling minimal. I have experienced worse after surgery. Two days out I even ditched my pain meds. The worst part of the post-surgery experience is coming down off of all the pain medications and anesthesia. It took five days for me to emerge from fog and nausea caused by my body's attempt to detox itself. Ten days after surgery I went to the doctor and got X-rays and the post-surgical splint on my foot removed. My doctor said the X-rays looked good and my incision had healed nicely. We spoke about my recovery options. Considering my history and my soft bones in my foot, my doctor advised that I start weight bearing sooner rather than later. Instead of going into a hard cast, I would be placed in a walking boot non-weight-bearing for three weeks then start partial weight-bearing. The tentative plan being that by 6-8 weeks I would be full weight-bearing in a boot. This recovery approach will hopefully help decrease bone density loss and muscle atrophy. The only risk is that too much weight-bearing too soon could compromise the fusion of the bones. I will have to be very vigilant in my weight-bearing progression.

At the moment, I am recovering in my moon boot. It is great to be able to take my boot off to shower or sleep. This whole Lisfranc thing has been a 3 1/2 year deal. Hopefully, I am careful and my fusion heals well. I don't ever want to go through this ordeal again. Five times is five times too many...

My dog Ruby, keeping me comapny.