I am now 15 days postop. I did go to work this past Thursday but only made it through with a pain pill and my husband giving me a block in the knee so the nerve pain would go away. I went to see the surgeon yesterday and all is looking well. He removed about 50 staples in the incision lines but left about 30 since there were areas the skin had not totally healed together yet. As you can tell in the picture above, there was a small inch incision on the inside of the foot, a 2 inch incision on the extreme outside of the foot, and a 6 inch incision just to the outside of the mid part of the foot (the 2 small ones were in the same spot as 2 of my prior surgeries).
Each surgery has been a bit different in my response to it. This one was no different. The first week I had mainly bone pain mixed with the nerve pain from the decompression of 2 of the main nerves to the feet. They both had been caught in scar tissue and the surgeon released them. Normally after a decompression, the nerve pain gets better after. Mine didn't. It got a whole lot worse, actually to the point that I wanted a knife to just cut off the leg. I couldn't sleep without being fully medicated and I hated using the pain pills. (Also the reason I haven't posted much).
But the nerve pain has been bad - really bad. Ever get the pins and needles after your foot or leg go to sleep and they start waking up? Now imagine that feeling all the time only 100 times worse with increasing intensity at times but it never ever goes away. My foot was getting to the point that I didn't want to move it as the pain would worsen. It didn't like anything touching it and it was swelling in weird spots and ways. My husband gave me a nerve block in the side of the knee which knocked out all the pain. I could think again. It was amazing. One doesn't realize how much pain they are really in until the pain disappears.
But it came back within 24 hours. So I had to get another shot. The reason? I have a complication of the repeated surgeries and trauma to the foot and ankle - it is called CRPS or Complex Regional Pain Syndrome and it is pretty serious. Thankfully my husband diagnosed it early as there is a better chance then to get it settled back down.
CRPS is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. There are 2 types: Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND) or algoneurodystrophy, does not have nerve lesions. Type II, formerly known as causalgia, has evidence of obvious nerve damage. I am considered Type II by virtue of the injury and amount of surgery I have had to be put back together.
There are also 3 types of symptoms: Type one is characterized by severe, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur. Type two is characterized by more intense pain. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy. Type three is characterized by irreversible changes in the skin and bones, while the pain becomes unyielding and may involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and flexor tendon contractions (contractions of the muscles and tendons that flex the joints). Occasionally the limb is displaced from its normal position, and marked bone softening and thinning is more dispersed. Right now I am Type one. The pain and all symptoms involve just the foot and ankle.
So instead of being casted, I have a light compressive bandage on to control the swelling and to protect the incision lines and remaining staples. Every hour I have to move my ankle and wiggle my toes to break the cycle.
CRPS is actually an interesting disease complex. One's perception of pain is actually a response to a painful stimulus. The cycle is pictured perfectly below:
In a normal pain cycle, the cycle breaks when a medication is taken or you rest the part that hurts - that is what I always did before. Just enough good times to really let the body heal itself and feel right again.
But in CRPS, one does not break the pain cycle with a simple pill or rest. It involves different treatment patterns. Right now we are using the nerve blocks to the whole leg on a daily basis along with passive range of motion and different sensation things like touching my foot with a soft rag, touching the foot with a scratchy rag, hot rags, cold rags, etc.
