Has My Luck Run Out?
Written on January 28, 2013 by Daniel P. Malito
“Ugh, my ankle still hurts. This is crazy. I thought that this replacement was going to be easy-peasy like the rest.”
I can’t tell you how many times in the last month-and-a-half I have uttered the phrase above. This procedure has been the most painful thing I have ever experienced. Just to be clear, by most painful I mean in terms of total time that I have been in pain. In terms of the most pain I have ever felt at once there have been a few instances where I have literally seen my life flash before my eyes, but that’s another column. I digress, though. Bottom line — my surgeon really went to town on my ankle, and I can feel it.
Don’t get me wrong though, it’s partly my fault for having unrealistic expectations. Everyone and their long lost uncle told me to expect a very long and painful healing period. Normally, I’d tell you “they always say that,” but if I really think about it, this time all the doctors, nurses, and therapists really did do their best to impress upon me the fact that ankle replacement is the most painful joint replacement procedure by far. Being the Man of Steel (quite literally) that I usually am, I laughed off all of them with a stoic “Ha! Pain? Bring it on! I eat pain sandwiches for lunch along with a side of agony and an extra order of torment!” Looks like they got the last laugh, though.
Before the surgery everyone who cared about me urged me to get the procedure scheduled and on the calendar as soon as possible, before I ended up damaging my other joints permanently. Since I was walking on the outside of my right foot at that point (supinating for you medical jargon buffs), my lopsided gait was affecting almost everything from my knee on up. Before long, my back was hurting after standing for just five minutes. My ankle was constantly aching, and my shoes had to be specially padded for me to wear them comfortably.
All of that was horrible, yes, but to be honest the most unbearable part of my ankle being that way was the muscle fatigue pain that it caused. You see, select muscles in and around the ankle would fatigue very fast because they were trying to support the weight of my entire body. The problem is, those particular muscles weren’t designed to carry the body’s weight. If you look at a skeletal diagram, the ankle joint is designed to transfer the weight of the human body down through the bones of the joint onto the heel bone on the bottom of the foot – a classic weight transfer scenario. Since my ankle was curled so far underneath, the muscles of my foot and lower leg were supporting a significant portion of my body’s weight, trying to keep my fibula from exploding out of the top of my ankle. As you have probably pictured just now in your head, that would not be a very pleasant experience for me.
Since those muscles were always hanging on for dear life, they would get fatigued very quickly, and as anyone who has gone to the gym can tell you, the burning sensation of a muscle with too much lactic acid buildup (the result of fatigue) isn’t very pleasant at all. When you add that to the actual joint pain in my ankle, the combination made it so that I couldn’t walk or stand for more than a few minutes at a time. So, I finally decided to let the old ankle go.
As I have detailed in columns previous to this one, the surgery itself was painful and so was the recovery period. In fact, three times the pain subsided to a bearable point only to return a few days later in full force. It was enough to drive a man crazy, and it almost did. The only thing that kept me going was looking forward to the time when I would be rid of that damn itchy annoying cast and could walk normally for the first time in years. That day was going to taste so sweet, it was worth the suffering.
So, last Thursday, I went to get my cast removed. The removal itself was routine, and the x-rays showed a perfect replacement surgery. I’d expected nothing less from my doctor – he is the best and knows my body well. So when I finally did get the ok from him to ditch the wheelchair and walk on my own, I was thrilled. Right there in his office I stood up, put a big smile on my face, took a step forward, and almost collapsed from the pain.
When I took that first step, I almost broke down into tears right there in the surgeon’s exam room. The ankle that did not hurt at all just a few hours before when surrounded by a hard cast was now aching tremendously. Apparently no one told me that without the support and stability of the hard plaster shell, the ankle would move around much more and that was going to hurt “for a while,” according to the doctor who saw the pain in my face after that first horrible step.
After coming to terms with the fact that my ankle still wasn’t ready to go, and I was in store for even more pain, I grabbed my cane, got a script for physical therapy, thanked my surgeon for a great job and left. As I began to walk, albeit painfully, I began to realize that my foot was still curled under to some degree, and it still hurt in the same way as before the procedure. I told myself I was being crazy and took a nap on the ride home.
So, here I am now a week later, and my ankle is definitely still curled under, and the pain is still bad enough to make me, the guy who could have his fingernails ripped out and laugh with glee, wince and tear up in despair when I think about it. I am literally terrified that this entire ordeal was done in vain, and I am not going to get any extra movement from the replacement performed. In addition, I am scared out of my wits that the pain I feel now is going to be the new normal for my right ankle, and that’s the worst part of all. If I have to live with this level of discomfort from now on I am going to be a lot less fun to be around, I can tell you that.
So now my only hope is physical therapy. I have had several people in the know tell me that I have to break up the scar tissue and re-learn how to walk properly. “After all,” they told me, “you have been walking on the side of your foot for years. Your bones and muscles have re-shaped and re-grown to accommodate your lopsided gait.” So next week I will talk to my long-time therapist and he will give it to me straight, like he always does. If there’s nothing to be done, then I gambled and lost. Even if it can be fixed, though, it is going to mean shedding tears and shovelfuls of narcotics for the foreseeable future. While that might be a normal weekend for any teenager, for me it’s much less cool. I’m absolutely petrified that I’ve finally encountered something that can’t be fixed, and while I knew it would happen sooner or later, I never thought it would be this. I should have known, though, as everyone was all “thumbs-up” about it, and that’s when failure always sneaks up on you – when you are absolutely sure it won’t.