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Rehabbing after Foot Surgery
By Dawn Lewis
I have osteoarthritis in the MP joints of my big toes. I have had 3 foot surgeries. Each time, the surgeon (there have been 2) says to me, “you rehab better than any patient I have ever had.” The first surgeon did not go further. He did not ask me what I was doing or why that was, and I did not tell him. The second surgeon did ask. I told him that I had begun doing massage on my foot as soon as I could touch it and that I was doing yoga. Now, I was only 7 weeks out from having my left big toe joint fused, but his response was, “what, yoga? You’re not doing the down dog are you?” I told him that yes, I was, as a matter of fact, that down dog was easy, and I could do up dog, it was the transition between the two that was difficult. He told me that he couldn’t hear this and changed the subject.
To clarify, I am in no way being derogatory to either surgeon. I think it is simple lack of knowledge about how massage or yoga would affect the foot after the surgery that each of them performed fantastically well. They know what they know, and I am grateful for that. But, when it comes to what happens after they do their job to perfection, each of them was kind of lost. The second surgeon said, “well, I’m not going to send you to physical therapy because that is about movement and we just fused the toe.” But then as I was leaving that final appointment he said, “make sure you get movement in the joint beyond the fusion and the joint before the fusion.” No movement, movement? He did not expound.
My first foot surgery was on the right. The metatarsophalangeal joint (the joint at the base of the toe) of my right big toe had no cartilage left in it. The proximal phalanx and the first metatarsal had rubbed together and formed fairly large, pointed bone spurs. I could have simply had the bone spurs removed, but with no cartilage and no space in the joint, they would have returned. I chose one surgery, a basic bunion surgery in which the surgeon removed the bone spurs and resected the first metatarsal, which basically means he removed a section of the bone and screwed the two sections left together.
There were times in that first year post surgery that I did not know if I would ever walk comfortably again or be able to do my job. But I kept working with it. The biggest issue was that in trying not to put pressure on my big toe, I rolled to the outside of my foot with each step I took. This created two problems: 1) my foot was in chronic oversupination, which left me with pain in the top of my foot and moved my foot toward the top of my shoe, which led to my shoes causing me even more pain; and 2) my lower leg muscles (specifically peroneus brevis and tertius, extensor hallicis longus, tibialis anterior, and extensor digitorum longus) were inflamed and adhered. My lower leg felt like a block of wood.
I used basic hatha yoga to flatten my feet. During the postures you are supposed to feel all 4 corners of your feet. I worked with my balance and forced the joints and muscles in my foot to figure out their new reality. And I combined this yoga with massage treatments. I worked on my foot myself and I had other massage therapists work on my foot. The massage was amazing for the muscles in my lower leg (which would need forever maintenance) and for correcting the alignment in my foot. I knew that after 8 weeks I could not damage the work that had been done. The metatarsal was fused back together. Now it was just about moving through the pain without fear.
My second surgery was a partial joint replacement on the left big toe for the same reasons – no cartilage, giant pointed bone spurs. The same surgeon replaced the proximal half of my proximal phalanx. I did similar things to rehab, but this time I also went back to work 7 weeks after surgery. Now, I do almost exclusively therapeutic massage. No full bodies. But, it still requires that my body work, and that I can move around the table fluidly. It was interesting to me that I had to literally retrain myself to walk correctly, but when faced with a massage table, instinct took over and I just began to move. Doing what came so naturally for me helped my body understand how to move.
Seven years later, the prosthetic in the partial joint replacement failed. There was no other option but to fuse my left big toe. I will admit to you that it was devastating for me. But this time there was little fear about the rehabilitation portion. I knew what I needed to do. What I was not expecting was the difficultly I had with shoes after surgery. I had always opted for athletic shoes with good support, namely Brooks. This was my way of providing my feet with the support I believed that they needed.
But, after the fusion surgery, I could not walk even a block in those shoes. For years, I had been reading the articles about barefoot running. I was skeptical. My husband began to have foot pain a few years before. He decided to wear his shoes even when he was home at night, for support. It did not help. He finally went to a doctor, and the doctor told him that the muscles in his feet were unable to operate correctly inside the shoes and he needed to spend a lot more time barefoot. Several clients told me similar stories.
Preferring to massage barefoot, I was never a big fan of shoes, but after the surgery, shoes became impossible. I saw a web ad for Vibram toe shoes and decided this was the way to go. The position the surgeon fused my toe into was slightly adducted and extended, so my big toe and second toe were rubbing together, and my second toe was going under my big toe each time I took a step. I thought toe shoes would at least help the rubbing. These shoes have no support. The idea is to allow the feet to work naturally. Wearing these shoes after all of my feet issues was a little like being thrown into the deep end of the swimming pool and not knowing if you could swim.
Because I had always opted for large soled shoes with high levels of support, I was afraid of trashing my feet, which for me could happen very quickly and take a long time to recover from. However, almost immediately I noticed that I had quite a bit less pain. When I purchased the toe shoes I also bought a pair of Merrill Road Glove Dash shoes. These have become my everyday shoes. They do not have much support, but I have considerably less pain in my feet and lower legs than I did with athletic shoes.
Although my biomechanics are chronically dysfunctional from having osteoarthritis and from the foot surgeries, adding these shoes to my rehab protocol has moved me back to a place of comfortable function. I see quite a few clients struggling with foot and lower leg pain. Some from surgeries that they did not rehab well from, and others from day to day stresses. I have recommended yoga, massage, and barefoot shoes more than a few times with great results.
