My Lapiplasty® Big Toe Joint Fusion™ Journey:3-week PO

3-week post-op picture prior to suture removal

By: Dr. Mindi Dayton

Today was my 3-week post-op visit with Dr. Kaldenberg.  I had my first set of post-op X-rays, and it was suture removal day! I must admit, I was a little nervous about the stitches, even though I have probably taken out tens of thousands. I have never had stitches before, and I knew I would be videotaping so I didn’t want to be a wimp! Thankfully, Dr. Kaldenberg did a stellar job, (I should have had no doubts), and I honestly didn’t feel a thing. I had little to no scab along the incision which did help keep discomfort at bay because the stitches were easy to get to. A small amount of scabbing is perfectly normal along the incision, but we typically don’t expect too much. Part of the reason I have very little scab was because of the full thickness dissection and great soft tissue handling at the time of surgery, and other reasons include: controlling swelling with elevation, my Incrediwear ankle/boot sleeve, range of motion and walking, and showering.

I should note that when I say “elevation” I don’t mean “above the level of the heart”; I never did this and only had it parallel with my heart when I was sleeping. What I mean by elevation is not keeping the leg in a dependent position for an extended period of time. This is most important in the first 3-4 days after surgery, and I had the foot elevated on an ottoman or just on the couch more often than not during that time. Once I went back to work one week post-surgery I did elevate the first day on Monday (I used a chair under my desk) but after that, I just put it up on the ottoman for a while in the evening when I got home from work. My x-rays looked excellent- just like they should look at 3 weeks.  Bone takes several months to heal, so at the 3-week visit we are just looking to make sure the surgery site is tight, and the hardware is still in the right position. We won’t see “healing”, but we are confirming no complications or concerns we need to address.

I don’t recall the last time I have taken any pain medication for my foot; I think it has been well over a week.  I am moving around very well with a combination of my boot, post op shoe, and barefoot. For the most part, I am not up for more than 10-15 minutes per hour and am not walking through my forefoot at any time.  I did do my first shopping trip to Costco Sunday, but we didn’t rush, and I did a lot of standing with the cart while Paul grabbed the things we needed.   It has been interesting- many people seem to find it hard to believe I am doing as well as I am and that I am actually being “active” (in a protected prescribed manner) during this phase of my recovery. The truth is, I am, and I am not unique in how I am feeling. Most of our patients have a similar recovery experience.  We hear all the time from patients how great they feel in the early recovery stages, and they share their experience with a prior bunion surgery they had, or the experience of their friends and family which was so different.  

As surgeons, we pride ourselves on understanding the science behind bone and soft tissue healing, fixation, and surgical recovery and we use that information to do what we can to optimize the procedure outcomes and the recovery for our patients.  Just because the “old” procedures and “old” fixation required extensive immobilization does not mean that we need to continue that paradigm. In one of the Facebook groups I am in a group member made the connection between knee and hip replacements and how patients used to be non-weightbearing for an extended period of time and now they are walking the next day, and in some cases, the same day!  This is the beauty of science: we learn; we improve; we change…or at least we should.