One year Post-Op and Vist back to HK!

I cannot believe it is now over one year since my surgery! Time does fly by and I am fortunate that everything seems to be progressing well. I apologize for the delay in writing this blog. I just came back from Hong Kong and China and now have time to settle in to provide an update.

For my one-year post-op, I decided to fly back to Hong Kong and have my check-up in person. I do not believe it is required to fly back to Hong Kong for the check-up, but I was able to find a very inexpensive airfare and I wanted to tour Guilin, China, so I said why not?

I had my follow-up appointment with Dr. Wu on November 5th, 2016. This was a little past my one-year anniversary, which occurred around Oct 21st. During this check-up, Rachel took another set of X-Rays and she also took follow-up pictures for their records. They also performed the foot function test again, which normally is done at 6-months post-op. The foot function test requires me to wear special shoes that contain a sensor strip. I then walk on the following treadmill for a certain period of time, to determine how I am placing pressure on my feet. They extract various readings as I walk my normal gait, and also as I place specific pressure on my big toes, as I walk.

Overall, Dr. Wu explained that the scan showed my weight is now more in the middle of my feet instead of towards the outside. When I had my bunions, I would compensate by putting more pressure away from my bunions so that they did not hurt as much. This resulted in various callouses throughout my feet. I am happy to say that most all my callouses are gone with the exception of one, behind my fourth toe on my right foot. This eventually can go away too as I re-structure my gait over time. Below are pictures of the foot scan (F-scan results) and how my callouses looked before my surgery and 1 year later.

BEFORE surgery:

Per Dr. Wu, Pre-surgery result showed the most weight-bearing part of your forefoot for pushing off in walking was in red under your 2nd and 3rd metatarsal heads, ie: behind their 2nd and 3rd toes of your feet. Callouses are seen in those areas on my feet.

One-Year post surgery:

Per Dr. Wu, One-year post-surgery result showed the most weight-bearing area has shifted to under mostly your 1st metatarsal head where it should be of normal feet. This was the reason why your metatarsal calluses have disappeared.
 

Dr. Wu stated that I must continue to perform strength exercises on my big toes and eventually use my big toes more to walk. This should be the proper way to use my feet, but the progress will of course, depend on how diligent I am with my exercises and where I emphasize my gait.

My X-Rays look good, with no significant changes since the last time. That is great news! My scars have also diminished quite a bit and are less noticeable.

Overall, I am still very pleased with the outcome of the operation. My feet are definitely not perfect, but they are much better than before. When I walk a lot in certain shoes, my feet do feel tired. I am hoping this will change over time as I continue to build my strength. The pain in the bunion areas have almost all disappeared, except for some minor irritation from time to time. It does not happen often, but I figure its to be expected since I had bunion pain for so long. That I also hope, will go away with time. The flexibility of my big toe can still be improved with my right foot, but so far, it has not limited me in any way. 

I hope many people are finding this blog helpful. I now plan to only update this blog once a year or unless I have some significant reason to provide an update. I will also do my best to respond to any comments or queries people have. Some people have been emailing me through google+. I leave you with some beautiful pictures from Guilin, China. I definitely recommend a visit there if people have a chance. Happy Holidays and wishing everyone peace and happiness!

Update - Roughly 8-9 months post-op

It's been almost 9 months post-op and I wanted to provide a quick update on my status. I would say that I am about 95% back to normal. I felt a noticeable difference mid-June and felt more confident in my step around that time. I started exercising a few days a week, doing a 25 min cardio and strength training program. I modified any exercises that required a lot of pressure on my toes. I was glad that my feet were able to tolerate the exercise and its frequency. I also went on vacation for a week on a Disney cruise. Overall the trip went well and I had no major setbacks with my feet. I wore flip-flops and also heels on this trip. I couldn't wear them for a long time, but was glad to transition out of just sneakers. I did have to switch back to my sneakers, from time to time, as my feet felt tired from wearing the other shoes. That is where I am at currently, where my feet get tired if I wear shoes that have less cushion, for multiple days straight. Hopefully, I can build my tolerance by slowly introducing those shoes over various periods of time. My walking speed is back to normal. My flexibility is still not 100%, so I need to work on stretching everyday. Overall, everything seems to be going well. At times, I still worry about over-taxing my feet, but this may be more of a mental than physical concern. My guess is that my feet are sturdier than I think. I will continue to be careful and hope that I'll be 100% comfortable with my "new" feet soon. I have not gotten any X-Rays since the last time, so I cannot tell if my toes have shifted or not. They still look pretty similar to before, so I'm hoping everything has stabilized by now. Below are some current pictures of my feet (weight-bearing and non-weight bearing), and also some pictures from my cruise. I hope everyone enjoys their summer!

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Past 6 months Post-Op!

It is now past 6 months post-op! I can't believe how time flies. I apologize for the delay in posting. I was waiting to hear back from Dr. Wu about my last X-Ray and I've also been busy watching the exciting NBA basketball this season. :-)

I took my last X-Ray on April 14th and it looks like some more spacing has appeared since the last X-Ray. I cannot say how accurate Dr. Wu's measurements are as in my opinion, the quality of the X-Ray image can slightly skew the measurements. When I compared the other X-Rays, I noticed that when some are more "zoomed in", it can make the spacing look larger than it is. I have not noticed any major change in how my feet look, so I'm hoping the change in spacing is really very minor. Dr. Wu's main focus is that I am still within the normal range and has not commented much on the variations in the measurements. Below is my X-Ray from April 14th:

As far as how my feet feel overall - my walking speed is practically back to normal, but the amount of pressure I can put on my feet can be sensitive at times. The sensitivity is not so much pain, but feels like the joints or tendons feel a little strained or tired. This could be associated with the type of shoe I'm wearing and how much cushion is present. At this point, I can wear any type of shoe as long as the shoes can accommodate my inserts. So, I wear sneakers and casual work shoes/flats. No heels yet, as I want my feet to be 100% before I attempt to wear heels. But I noticed that when I wear shoes with a harder base, my feet feel more tired and/or strained at the end of the day. I then transition to wearing sneakers the next day and that seems to help lessen the strain/tiredness.

I haven't done any strenuous exercise that involves high impact on my feet (ex. running, jumping jacks, etc) and will slowly build my tolerance before I attempt anything. At the moment, I am trying yoga and more low impact exercises. I feel improvement every week and hope that in the coming months, my feet will soon feel 100% normal. They are at about 90% now, which is quite good and does not limit my activities much. I believe I'm also a bit hesitant to challenge my feet further, since I've spent so many months trying to stay off them. In terms of skin appearance, I've continued to use scar-reducing strips, and can say that my scars have greatly diminished. My feet have not felt any swelling for quite some time, so that is definitely a plus. Here is a picture of how my feet look today:

Below is a summary of my Pre and Post X-Rays over time (with the exception of the December X-Ray as that X-Ray did not show both feet together).

Now that my 6 months have passed, people may be wondering how I feel, overall, about going through this surgery. I believe I made the right choice in undergoing this non-bone breaking surgery over the bone-breaking one. The overall experience was not difficult and definitely not very painful. I had not needed to take any pain killers for my feet since the day of my surgery. The recovery process can be tedious, but as long as you know what to expect and have lots of patience, the time flies by quickly. The only minor disappointment was that the toes cannot be completely straight. It is important to note that Dr. Wu never guaranteed the feet would be completely straight, but when I first saw how straight my feet were right after my surgery, I became hopeful. But as this recovery involves soft tissue being re-built, there will be a natural shift of the bone over time, as we saw during my recovery. Still, my feet definitely look better than before my surgery and hopefully will stabilize very soon. 

My next X-Ray is scheduled around my 1 year anniversary, which I hope to go back to Hong Kong to see Dr. Wu. I will continue my blog (hopefully posting once every 1-2 months), updating everyone on my progress. Thank you for following my experience so far and I hope you have found it helpful. Enjoy the springtime and upcoming summer!

Post-Op 21 weeks - The End is Near!

I'm happy to say that it has been a little over 5 months since my surgery and I'm so happy my 6 months is almost over! Granted, it probably will take some more months to re-gain FULL strength in my feet (so no intense workouts just yet!). I will judge how I feel month by month, but for now, I am just happy to be getting back to my normal routine, pre-surgery.

I sent Dr. Wu another X-Ray on March 9th. He said there was indeed a slight increase in spacing again, but I am still less than the upper normal limit of 9 degrees. You can see the comparison Dr. Wu made, of my last two X-Rays. 

Since I am progressing well, Dr. Wu now says it is safe to get back to normal walking, as tolerated by my feet. It is very interesting how as each week passes, I can feel my feet getting stronger and walking comes back easier as well. My pace has increased and I have gone back to driving and taking the train. The one caution I have about taking public transportation is to make sure you give yourself enough time and to not rush. People cannot see that I had surgery and have pushed me around if I walked too slow. You have those few who are not considerate of others and are so focused on getting to where they need to, they don't see who they affect. 

I am still instructed to continue my big toe ground-pressing exercises. I feel how important these exercises are to rebuild my strength. I am also continuing to place emphasis on my big toes as I walk. This will take months to fully adjust so that I learn to walk correctly. I haven't tried any running or intense exercise yet, and will probably wait until after 6 months to explore those options. I want to be able to walk my normal pace without any feeling of discomfort. Some of the discomfort I currently feel is a slight pulling sensation (periodic) and also inadequate strength at the bottom of the big toe area. My feet will also "tell me" if I've walked too much and need to rest, which now doesn't happen as often.

My next X-Ray will be mid-April which will be a little past 6-months! I cannot wait to see what other progress I've made and also, see my scars diminish over time. The end is near and looking forward to a vacation in the summer :-)

 

About 18 weeks Post-Op - Getting Stronger Day by Day

Hello everyone, I took off my casts two weeks ago and things seem to be progressing well. I've taped my feet very tightly for the past two weeks and I feel the strength coming back slowly each day. Below is another image of my feet taped. I've also started to put on scar-reducing strips to help decrease the redness of the scars and I've had to put bandages on the side edge of my feet (underneath my pinky toe) to add a little more cushion. Wrapping my feet so tightly has caused the edges to bruise a little and be sensitive. It is quite funny all the things I have to do in the morning. I do not wear the tape when I sleep so I wrap my feet up early in the morning before I get out of bed.

I've now almost fully resorted to walking without my crutches. I bring them with me to work, but I barely use them. Wearing my sneakers with the inserts have made my feet feel very secure. I've also stopped using the wheelchair as I need to walk more steps to rebuild my tolerance of walking. I've noticed that when I walk quite a number of steps, my feet get tired and swell up a tiny bit. I still walk slow, but Dr. Wu says I can increase my pace gradually each week. I am tempted to walk my normal speed, but my feet tell me they're not ready yet. Below is a video I recorded of Dr. Wu explaining to me how I should be walking. He is teaching me to over-emphasize walking with my big toe, to build strength and also to learn how to walk correctly. 
 

 
Besides walking as described above, I'm also supposed to continue my toe pressing exercises. The toe bending exercises, I do periodically when my toes are not as flexibile. A little bit of stretching every day helps the feet get back to normal. I am still concerned how much the bones may have shifted over this time. I will not know until my next X-Ray, which will be in about 2 weeks. Dr. Wu says they will still shift slightly and I hope it is not too much. This surgery does not guarantee that your bunion area will be completely straight after your recovery and I warn people not to expect that. I even have to remind myself and I have to remember that the ultimate goal of this surgery is not aesthetics, but better functionality and less to no pain. What I believe this surgery will do is to help restore better overall foot function and also get your feet back to within normal degree angles. Let us hope this proves true.

I have tried out driving once, but not yet on a regular basis. I feel that I can drive short distances around town, but again need to build up my tolerance. This is especially so for me since I drive a manual transmission. I use both feet quite often when driving and shifting, so I don't want to over tire them. 

That is all I have to report for now. Here is a picture of my feet sans tape, strips, and bandaid. I hope to post again in another couple weeks. 
 

Roughly 4 months Post-Op: Finally out of Casts but still cautious

Sorry for the delayed post, but with Chinese New Year this past week, Dr. Wu's office was closed for the holidays so I was not able to hear from him until very recently. I took another set of X-Rays on 2/9/2016 as requested by Dr. Wu. Below are the last two X-Rays.

Before I sent the X-Ray to Dr. Wu, I noticed another slight change in the gap, and I was disheartened to see that difference. One of the challenges about this surgery is that I need a tremendous amount of patience for the process, and also, not have my expectations be that everything will proceed perfectly as described. My sister helped me re-shift my perspective when she said "it is still much better than what is was." SO true!  

Dr. Wu reviewed my X-Ray and explained everything is still looking well despite seeing another slight change. He once again said this change was normal and to be expected. My feet are still slightly over-corrected and will probably shift again over time, until the ligaments gain their full strength. I've been very cautious about not walking too much on my feet, but this can also be a detriment if I don't walk enough. If I refrain from walking, I will not be able to build the muscles needed and can experience more bone loss. 

So how do I find the balance? I am not so sure, but will take it slowly and gradually to start. Dr. Wu gave me the option to stay in my casts for another week if I wanted to be extra careful, or I could take the casts off now. I decided to go with the latter option and completely removed my casts on a Friday night, so I could use the weekend to slowly adjust back to walking. Below is a picture of my feet without the casts and I cannot tell you how nice it felt to finally wet my feet! Obviously, it was not a pretty site when the casts came off and the skin was sensitive after thoroughly cleaning the feet to remove old skin (very gross!). But it definitely feels nice to not have that hard, protective cast anymore.

Right before I left Hong Kong, Dr. Wu explained that it would be beneficial to tape my feet with surgical tape, initially right after I removed my casts. This is to provide additional support for the foot to prevent stress fracture and also help prevent more loosening of the ligaments. The instruction sheet recommends to use this tape for at least 2 weeks, which will also help me slowly adjust back to normal walking. See below for a video that I took of Dr. Wu explaining how to apply the tape. I also included a picture of my first attempt at applying the athletic tape I had. I applied it in the evening and did so very tightly (as per instructions), but found I could not sleep well with them as they cut off my circulation and made it painful. Oops!! I probably should apply them in the morning and walk in them a little more to loosen them a bit before going to sleep. It may also be that athletic tape is too strong so I will try both surgical and athletic tape to see what works best.

For outdoor walking, I can transition back into sneakers but I have to use the inserts that Dr. Wu provided. The picture below shows my old black inserts (left) and the new tan-colored inserts (right) provided by Dr. Wu. Looks like Dr. Wu's inserts are more sturdy and hopefully more helpful for my feet. Dr. Wu had sized these inserts to my feet before I left Hong Kong. 

When I tried placing my feet in my sneakers, including these inserts, the fit felt tighter than normal. I imagine this is to be expected since my feet haven't been in normal shoes for quite some time. I also don't know if the surgery has caused my shoe size to change since the big toe is now straight. I will check to see if more loose fitting shoes is better to start with initially. I will gradually return to normal walking and definitely not speed up my pace, otherwise this can cause a stress fracture. I need to also continue my big toe-pressing exercises for the next few months if not more. Since I am now out of my casts, I won't need to use the book anymore for these toe exercises. 

When I asked Dr. Wu about driving, he said that the actual driving is not so much a problem now. It is just how comfortable my feet would feel if I needed to emergently slam on the brake. It's true in that right now, my feet feel weak to even pull my car in/out of my driveway. I drive a manual transmission, so besides the brake, I have to shift quite often. I rather not risk driving for now, and see how things progress over time. 

My next X-Ray is scheduled about 1 month from now and Dr. Wu said I should feel almost back to normal by then. Let's hope everything will continue to progress as expected. I will try to post another blog in a couple weeks.