Sooner or later, either you or your clients may require major foot surgery. That’s why it is important to know what foot surgery can involve and what post-operative exercises can be used.
I have been “in” the gym for the past thirty plus years at a high level of intensity. I’ve gone on crutches, in leg braces and with stitches in my forehead, nose and knee. As a certified personal trainer, over the past 25 years, I’ve been a Fitness Manager in California and The Men’s Fitness Trainer at The Betty Ford Center. I’m now 61 and have trained, and/or, counseled more than 4,300 people towards improving their fitness and endurance.
On April 26, 2012 I underwent a major, left foot reconstruction-type surgery that has permanently changed my life in several ways.
I’d like to offer as an informal case study my own personal experience involving a major bunionectomy, great toe reconstruction and four claw toe corrections. I might mention that all these were performed in the same procedure and resulted in the installation of permanent hardware. It sounds extreme, right? It was just that. But my pain level gave me no other choice but to get wheeled into the O.R.
The Anatomy of the Foot
First, let’s take a brief look at some of the functions and structures of the human foot.
The foot combines mechanical complexity and structural strength to provide the body with support, balance, and, of course, mobility. The ankle at various times performs the functions of foundation, shock absorber and propulsion engine, while the foot itself can withstand enormous pressure (several tons over the course of a one-mile run).
By the numbers, the foot and ankle contain 26 bones (accounting for a quarter of all the bones in the human body), 33 joints, and more than 100 muscles, tendons and ligaments. That is in addition to complex network of blood vessels, nerves, skin, and soft tissue. Wow! Our feet sure have a lot going on, right?
With such complexity, it’s no wonder that things can go wrong.
Let’s use bunions as an example of something gone so wrong it can require surgical correction. Although hallux valgus (bunions) is a common condition and accounts for a significant number of office visits to foot and ankle specialists, experts believe its incidence has not been documented accurately. Literature on the subject states that there have been relatively few studies done, and much of the information that has been gathered comes from empirical data based on patient observations.
According to the National Health Interview survey conducted by the National Center for Health Statistics, bunions affect 1 percent of adults in the United States.
One study found that the incidence increased with age, with rates of 3 percent in people 15-30 years of age, 9 percent from people age 31-60 years, and 16 percent in those over 60.
Now that I’ve “set the table,” so to speak, let’s move on. My pre-op chart note stated: “Severely deformed left foot, symptomatic Left Hallux Valgus deformity and 2 – 4 claw toes/joint dislocation. Plan for McBride Bunionectomy with 1st TMTJ Arthrodesis (modified Lapidus). 2 – 4 MTRJ capsuloctomy, Extensor tendon lengthening, BDB to HDL tendon transfer, (All American Toe Reconstruction).”
What this medical terminology basically said is that my left foot was severely deformed for far too many years. It finally got a total remodel by a great orthopedic foot specialist in Houston, TX. He did three separate procedures over a four-hour period. Lucky me, right?
My bunion and claw toes condition had worsened over the years; several surgeons wanted to operate but they make no guarantees for improvement. Over previous two years, all my symptoms increased to the point of extreme pain, swelling of the foot and less time with my clients.
Changes in Attitude
Attitudes change when you have no choice but to seek medical relief under the lash of unrelenting pain and daily swelling!
Fortunately, my surgeon was smart enough to order pre-op x-rays of my spine as I’d had pretty nasty back and left hip pain related to my body canting to the left side for years. The x-rays found I have degenerative disk disease with “significant” Grade 2 Spondylolisthesis involving L-1 through S-1 disks. (Trainers, know what this disease is!)
Now enters the orthopedic back specialist for more x-rays and an MRI. My life will change now to avoid back surgery at all cost! That means that permanent lifting restrictions, recently imposed, will not only change how I train myself in the future but will also affect my client base. See what a bad foot, and spinal tilting, can produce?
Remember also that there is a good reason we carry personal trainer insurance. Don’t be as smart as a doctor if you aren’t one. Operate within your “scope of knowledge” and you probably won’t need an attorney to defend you for hurting someone. You may actually need to study a lot more and get some advanced certifications. I’m just saying…
Recovery time for bunion surgery can take between six weeks and six months, and in some cases, it can take up to a full year to make a complete recovery. The time depends largely on the extent of bone and soft tissue affected by the surgery.2 It is typical for stitches in the foot to be removed between one to four weeks following surgery.
If pins were installed to keep the toe in place, they are usually removed between three and six weeks after surgery. In most cases, specially designed surgical shoes are worn for about a month, but in some case, this can extend to up to two and half months.
Most patients can resume everyday activities within six to eight weeks after surgery. However, in most cases the foot cannot bear any weight during that time. For several more weeks thereafter, the may only be able to support partial weight. During this time, a cane, walker, and/or special shoes are often recommended to help with mobility.
The above almost exactly describes my own post-op regimen. In my case, all 200+ stitches came out at three weeks! It hurt so badly I can’t adequately convey it to you. Let’s just say that “cross-stitches”, used to close long incisions, hurt like crazy when removed! Oh yes, there was no topical pain reliever given beforehand. Yes, I cried, cursed and sweated through the process.
I’ve been in a wheelchair at home, in public and on crutches since the surgery. If you’ve never used a wheelchair borrow one sometime and spend an hour in it. If that doesn’t make you grateful for two strong legs, I give up. The world operates a lot differently from a wheelchair! (As a side note, as a trainer, if you have never worked with a client in a wheelchair, I implore you to accept the challenge if ever it is presented to you. When I’ve accepted difficult clients, it has invariably increased both my knowledge and my confidence.)
At seven weeks post-op, I was into a walking boot to begin partial weight bearing on the crutches. This was to continue for another eight weeks. I have no idea how long the healing process will take… I’m guessing it will be a year at least given the amount of work done and my age. Yes, our bodies do heal more slowly as we age. At least I went into the surgery physically strong with great lab results.
Please remember that a foot surgery client has endured a lot of pain, and fear, to get back into the gym with you! His or her foot is going to swell after each session, so please be aware what the surgeon and physical therapist have recommended! See the exercise plan in writing and do no more, no less than prescribed!
Our feet are the furthest extremities from the heart. You do know what that implies, right? Just on the slim suspicion that you may not, let me say, “That from my experience, there is a balancing act between weight bearing and elevating above the heart with an ice bag applied several times per day.”
So, remember take very good care of your feet and the feet belonging to those people writing you monthly checks. My personal hope is that this article has helped just one person, if not many!
About the Author
Bill McGinnis is an NFPT-certified Master Fitness Trainer, and trains exclusively at the University of Texas Medical Branch Alumni Field House on Galveston Island, TX. He has over 25 years in the Fitness Industry, including work as the Men’s Fitness Trainer at the Betty Ford Center and as a Fitness Manager in Southern California. He currently specializes in training older clients for balance, strength, endurance, golf, tennis and an improved quality of life. He can be contacted at [email protected].
View the Author’s Profile and other articles published in Personal Trainer Today.