14 Weeks Post-Op

Yay, so I'm not really good at keeping up with this blog thing!  But I thought I should at least do an update the progress Matthew has made in the  7 weeks since I last wrote.  Here we are 14 weeks post-op and things are looking great!!  Everything has gone so much better and faster then we had expected.

Rewind to the end of December ... Matthew had taken his first steps but was dealing with a stitch abscess.  We did warm compresses and added some pressure around the spot (as much as he could handle) for a few days and it pussed and oozed and one morning there was a bit of a hole in the area  and the pressure was gone and from there on it slowly healed up nicely.

Our follow-up appointment in Calgary was on January 6th. We had spoken to the clinic a few times but never to our own doctor and everyone wanted to error on the side of caution and told us to leave him in his walking boots until his appointment.  After 10 days in his walking boots we decided that we were going to go with the doctors first instructions that said when he was comfortable he could move try without the walking boots. 

Walking in the walking boots seemed like more work then walking in shoes as his feet had to drag around heavy items that seemed unnecessary and since he had two walking boots it did make it awkward to walk and seemed to be putting some strain on his knees.  He had quickly gotten comfortable in the boots and was having no pain, which made him want to get out and do "normal' things, so he would be biking around town and played goalie at the outdoor skating rink in his two boots.  We decided he was definitely comfortable and we wanted to give the shoes a try before we arrived at the clinic so we knew what kind of questions to ask if there were issues.

First time walking in shoes.  He found the biggest challenge was learning how to balance, as he had been leaning forward more when balancing in his walking boots.

For the first few days he just did a little bit of walking in his shoes with his orthotics and slowly he tried more. He found he could not stand or walk in bare feet.  That immediately gave a lot of pain, but as long as he wore his orthotics the pain was minimal if he didn't overdo it.  I made him continue to wear his walking boots when he went outside the house as often he would get more active and be less cautious then. By time we went to the clinic a week later the wheelchair was staying in the van and he was walking to his appointment.

Sunday morning he came out of his room and declared "I look normal again!"

On January 6th we seen the orthopedic surgeon.  He didn't even bat an eye that Matthew was in shoes and not his walking boots.  We reviewed what pain he was having, which was none in the actual surgery area, some in the heel and upper foot area if he walked for too long and some in his knees.  Upon finding out Matthew had been biking in his walking boots he got him in trouble and said this was likely where his knee pain was coming from.  He watched Matthew walk and then gave us a referral to physiotherapy telling Matthew he was to do no biking, to WALK ONLY and to follow physios instructions on how to SLOWLY return to activities.  For his entire life he has been walking incorrectly on his feet since the bones have messed up his structure, so he needs to be properly trained and have all muscles/tendons/ligaments working well before he returns to full activities.  Our biggest question was how to determine when he's done too much, as in, when is it okay-pain and when is it too-much pain. The doctor said that his feet should wake up refreshed each morning.  He should not start his day in pain, if he has pain then he did too much the day before.  It's a bit of hindsight, but he felt that was the best way to determine how much to do.   With that information Matthew was discharged from the clinic and only needs to go back if there are problems.

Before leaving the clinic I got pictures of his last x-rays before his surgery.  They never took x-rays after his surgery, but it would be interesting to see the difference.

X-ray of the left foot before surgery.  The Accessory Navicular is where the cursor is on the picture.  

Zoom in of the left foot.  The left AN came out in one piece.  You need to look closely at the x-ray to see the smaller, more faded piece where the cursor is pointing.

X-ray of the right foot before surgery.  This foot caused more pain then the left foot

Zoom in of the right foot.  The AN on this foot came out in two pieces.
On this foot the AN had completely attached/calcified to the Navicular bone. 
The part that is circled is the part that was extra and came out.

On January 12th Alberta returned to in-school learning and Matthew soon discovered that the school hallways are a lot longer and require a lot more walking then being at home.  His feet were sore by the end of the day but usually by morning were doing good again.  It would take his feet a bit to "wake up" in the morning as they would be stiff and he would walk awkwardly for the first little bit, but by time he headed out the door for school he was usually walking pretty normal.  

Matthew went for Physiotherapy for only three weeks, each week would start off painful but by the end of the week he was doing the exercises without much issue.  Most of the pain he was getting was on the top of his feet (especially the left) and sometimes in his heels, but nothing in the area of his surgery.  Because of his AN he also has Posterior Tibial Tendon Dysfunction (PTTD).   The posterior tibial tendon runs through the heel and attaches to the navicular, hence the reason his heel continues to give him pain.  An MRI of his feet last year showed that he has bursitis  (inflammation of the bursa - a fluid filled fibrous sac) in his heels.  It is our hope that as his feet strengthen this condition will also be alleviate as the AN was interfering with the Posterior Tibial Tendon and it needs time to recover.  Once it recovers it will hopefully function without pain.  After three weeks Matthew was doing so well that physiotherapy discharged him with some exercise to continue to do for a couple more weeks and told him he could slowly keep building up and doing more things as his feet tolerated.  He was extremely excited (to put it mildly) to be able to bike and play sports again, but for the next couple weeks these last physio exercises (involved jumping) seemed to cause a lot of pain on the top of his feet and caused him to have to back off on some of the activities he had been doing.  Eventually we checked back in with physiotherapy and they wanted him to have it checked out by a doctor and have some imaging done.  I didn't get around to booking anything right away and now these last few days this pain has gone away and he has been out skating and running and jumping and overall doing really well.  He still gets some heel pain if he does too much, but he's been making huge progress on what he's able to do!!

It's hard to believe that the original timeline for this surgery had him in Walking Boots until February 1st and instead here he was walking in shoes and discharged from physiotherapy by February 1st.  In recent weeks he has also been taking his shoes off in the house and going in socks at home without having extra pain, something he could not do during those first weeks of walking.  

A  mug shot of his "war wounds" 

Not only are his feet doing better but Matthew is also super excited that upon returning to walking he is now 5' 7 1/4" inches tall, which makes him not only taller then Marietta (who he surpassed during the summer) but also taller then Rebecca and his mom!  His next goal is to surpass his dad ... he has another 5 inches to go before he accomplishes that.

Time will tell whether surgery will alleviate ALL of Matthew's feet pain, but for now we are so very thankful for how the Lord has blessed this process in so many ways - with the timing of the surgery (COVID means he's not missing out on any sports), the straight forward procedure of the surgery with no surprises, the low pain levels he had after the surgery, his determination to be independent and do things on his own during recovery, the speed at which he recovered, that the infection he got did not become anything serious, that he had so little pain when he started walking again, how quickly he was able to build up his muscles and strengthen his feet once he began walking and how well he is currently doing.  Indeed, lots to be thankful for!  

I will give thanks to the Lord with my whole heart;

I will recount all of your wonderful deeds.

I will be glad and exult in you;

I will sing praise to your name, O Most High.

Psalm 9:1,2