[foot] Bunions and more bunions..
Warning: I’m writing this post to document more of my medical journey. But I suppose it’s a good read for those considering having a bunionectomy, maybe. Because even though I only have 2 bunions (one per foot), I’ve had multiple bunion surgeries so I know a thing or two about them.
I mentioned in an earlier post that I had a sort of “experimental” bunion surgery after I turned 18, in 1992. Fast forward to 2016. I had been running a long time and always chalked up my foot issues and injuries to lack of good training, lack of overall fitness (and focusing on the wrong things) and just sheer dumb luck. By 2016, I had run several 100 milers and had finished Badwater 135 the year before. While it’s not uncommon to have foot issues like blisters and lost toenails when running something as brutal as Badwater 135, I was having them all the time. I tried many different shoe models, eventually settling on Altras, which make really wide toe-boxes and zero-drop insoles. I won’t get into the whole “chi running form” thing but needless to say several years prior I hired a professional running coach to fix my form and he introduced me to this style of running and these shoes in an effort to move away from heel-striking, which does two terrible things: a) it slams your body weight into your knees, which, OUCH—and for those with flat feet, it allows the foot to roll inwards leading to b) excessive stress on the inside of the ankle and posterior-tibial tendon. Two things I struggled to move beyond once I started getting more serious about distance running. And this worked relatively well for a while.
But after Badwater in 2015, my foot had really spread out into what looked like a weird flesh-shaped Dorito. My foot was suuuuuper wide in the toe box and my heel was super narrow. I was in a size 10.5 wide shoe to accommodate the bunion but this caused other issues, namely a lot of friction and movement bc the only part of the shoe that fit was the top area between bunion and bunionette (yes, the mini one on the outside of one’s foot below the pinkie toe also has a cute little name.) And not surprisingly, the 10.5 was far too big for my right foot, which had a bunion as well, but wasn’t nearly as bad. In short, I got a lot of blisters, lost a lot of toenails and started having all sorts of pains in various places on the foot due to the inability to find shoes that actually fit my foot correctly.
After getting some recommendations, I went with Dr. Amir Assili at Shady Grove Podiatry. We talked at length and ended up deciding on a lapidus bunionectomy. Because the big toe had years of arthritis in it from having surgery at 18 w/ little to no PT, he didn’t want to do too much in the bunion area itself. This approach of putting a support system in away from the bunion and more towards the middle of the 1st met would also help correct the flatfoot which had really been doing a number on my posterior tibial tendon over the years.
That December I had surgery using this method. Prior to surgery I called the hospital that had done my original “bunionectomy” in 1992 and had the surgical records sent to Dr. Assili so he could see what I couldn’t seem to accurately describe. I mean, how do you describe a procedure that a) never became mainstream because b) it was a really dumb way to fix a teenager’s growing foot that c) was done so long ago that I honestly couldn’t remember much about? Anyway, fast forward to post-op when I came out Dr. Assili said to me “By the way, I read your surgical notes from your original surgery and what that guy said he did to your foot, and what he actually did are not the same thing.” Oh dear. That’s never a good thing to hear post-op.
This 2016 surgery turned out to be more complicated than we expected. Not only did he have to put in the standard 1st met hardware, but he put in a set of lag screws that extended across the 2nd and 3rd metatarsals. He also put in a long screw up the 1st met to stabilize the bone along with several pieces of hardware. All of that metal for a bunion repair.
The initial pain wasn’t terrible because I had some decent narcotics but once I was back to weight-bearing in the boot, I had some debilitating—and I mean not able to walk at all—pain. I remember having to go on the road for work and trying to walk about half a mile in my boot to a client site from the parking garage. I nearly passed out from the hardware grinding into my bones. I was in tears by the time I arrived and had to clean myself up in the bathroom. Additionally, at around 10 weeks, I had a post-op issue called RSD or “reflex sympathetic distrophy” that required me to go on steroids because my mid-foot suddenly went red and purple with swelling and severe pain that wasn’t near the surgical site. It was on fire and the burning sensation was brutal. I feared we had done something really terrible to the foot. It was scary.
Anyway, the first 3 months post-op were the darkest, both physically and mentally. It was middle of winter, my pain was getting worse, not better, and I had run out of real pain meds, choosing to self-medicate with alcohol. After a couple of consults, we decided to go back under the knife and remove the lag screws and hardware stretching across the metatarsals. This wasn’t really a surprise — Dr Assili said some people are able to retain such hardware, others not so much, but because I had a “floppy foot” or a lot of flexibility, the foot’s natural movements just needed to be free of any additional constrictive hardware. So in early March 2017, almost 3 months to the day of the initial lapidus surgery, I went back in and had the lag screws removed. We left the long screw going through the 1st met in place (where most of it has stayed ever since.)
After that surgery, most of the pain went away relatively quickly. I began to ramp up my exercise and even squeezed in an 81 mile race in April, albeit a very slow one. But things didn’t end here and while training for Badwater 135 that summer of 2017, I managed to injure my opposite (right) hip, not surprisingly due to over-compensating. My training came to a rapid halt as I was back on crutches, with non-weight bearing on this new side. Thank goodness the left foot tolerated being the one now in charge of taking on the burden of crutch-ed movement in order to keep pressure off my right hip. And believe it or not, because I’m a real glutton for punishment, I decided to have a bunionectomy on the right foot that summer. As you can see in the photo up top, my right foot also had a bunion and was flat-footed. The prior surgery on the left foot not only gave me a bit of a much-needed arch, it also moved the bones into a place where the overall foot was shorter and better structured (at least that was what it felt like for a while.) The right foot was still lacking an arch with a painful bunion. Not surprisingly, having two very different feet was contributing to my compensation issues and causing some weirdness in my walk/run form. And I figured that if I’m already on crutches, keeping weight off of that side anyway, why not just go ahead and do the other foot so both feet are more in alignment with each other…? Right?! RIGHT?!?
Back: Escape.
Next: Two years ago today.
