Make mine a double (bunionectomy)!
A little less than a year ago I went to see a foot specialist about my ankle, which was still sore months after I’d rolled it. At his request I took off my orthotic-lined clogs and sporty anklet socks and walked across the floor. Well, hobbled. My feet had changed in just a few years from normal-looking to having a large lump on the inside edge of each foot, right near where the big toe joins the foot.
Bunions. A silly-sounding word. An old-folks word. I’d been to podiatrists and used orthotics but the bunions were getting worse. Even before I got out of bed in the morning, I could feel a dull ache in both feet. I needed to wear shoes to walk at all, but still, walking hurt. Running had become too painful, so I’d quit. Of course, I’d looked for solutions first, but after seeing every podiatrist in Marin I’d got the impression that there was nothing to be done about it. So I tried not to wince as I walked across the cold floor in my awkward feet, with bones that didn’t seem to be in the right place any more.
The doctor — who happens to be a rare combo of podiatrist, doctor, and orthopedic surgeon specializing in foot and ankle issues — immediately lost interest in my ankle. “Right now, you’re the perfect candidate for something we call a minimally invasive bunionectomy,” he told me. “Your bunions are bad enough to benefit from surgery, but not yet so extreme that we’d have to do the more traditional surgery. I’d strongly recommend you do that. Let me show you some before-and-after x-rays.” He pulled up some images on his computer screen.
I saw bent feet made straight again. I felt tears prickling behind my eyes. I hadn’t known that this was a possibility. But I now knew what I wanted.
“Let’s do both at once,” I said. “Make mine a double.”
“Oh, no, that won’t work,” he said, looking alarmed at the idea. “If we did both at once, the pain could be unbearable. You’d be incapacitated. You’d have to be in a wheelchair for a few weeks and would probably need someone you could call on around the clock, because all the activities of daily living would be very hard if not impossible.”
I wasn’t prepared to give up so easily. “Have you ever done a double?” I asked.
“Nobody does both at once.” Here he paused. “I do have one patient who has insisted on a double bunionectomy. Her surgery is next week. But she assured me she has round-the-clock care.”
I didn’t have round-the-clock care because we’re a two-person household and my husband works full time. What I did have going for me was persistence. So, four weeks later, back for my final pre-surgery assessment, I asked again.
This time, I saw a flicker of hesitation. “Do you remember that woman I told you about, Taylor, who insisted on a double bunionectomy?” he asked. “I saw her for her two-week post-op appointment and she told me that I’d exaggerated how hard it is. She said that if I met anyone else who wants a double, I should tell them to talk to her.”
“Give me her number,” I said, and added, “I can already tell you, I want to make mine a double. Let’s book it.”
At the time I had no idea what it would entail. But I’m a logical person. It seemed clear to me that doing one foot at a time would mean:
· Going into surgery twice, which is more expensive, stressful, and harder on the body
· Doubling the amount of time I’d need to spend recovering and rehabilitating, because once I’d recover from one surgery I’d have to start all over again
· I might not come back to do it again after the first time!
In fact, my doctor told me that almost all people who get bunion surgery on one foot don’t come back for the second. Believe me, I can understand why. But getting a bunionectomy on just one foot, when the other still needs repair, means missing out on the full benefits of bunion repair. With one foot still problematic, you’ll still have pain that interferes with your activities and will still be stuck wearing only those shoes that work for your uncorrected foot. People with painful bunions on both feet need to repair both in order to resume their physical activities and wear “normal” shoes.
The problem is that most patients are intimidated by the idea of double (also called bilateral) bunionectomy, and most doctors don’t have experience of it. To try to set the record — and people’s feet! — straight, I decided to share the story of how bilateral bunionectomy worked for me and Taylor.
It helps to go in strong
Let’s start with a little background. Taylor is in her mid-40s and I’m 57. We are both in excellent overall health and normal weight. We are fit and enjoy sports including yoga, hiking, and cycling. We were candidates for minimally invasive bunionectomies on both feet, and since physical activity is important to us, neither one of us could bear the thought of dealing with the disruption to our exercise routine twice over. We opted for bilateral bunionectomy.
Surgery was trouble-free for both of us. Our doctor warned us both that we would likely be in a lot of pain after the surgery, so prescribed pain medication including opiates and anti-nausea medication (to take with the morphine). He also cautioned us both that we needed to take stool softeners and eat prunes to counteract the constipating effects of the pain medications.
For both of us, the pain was greatest the day after surgery, when the last of the anesthetic wore off, but we both found it manageable, in our different ways. Taylor took all the medications on schedule but didn’t pay enough attention to the anti-constipation advice and ended up suffering from extreme constipation.
I have a fairly high tolerance for pain but couldn’t stand the feeling I got from opiates. I took all the medications for the first day only, then stopped all prescription medications and switched to alternating 600 mg of ibuprofen (Advil or Motrin), three times a day and 1000 mg of acetaminophen (extended release Tylenol for arthritis) three times a day. I have a sensitivity to ibuprofen so when my stomach started hurting, I stopped taking the Advil and just took the Tylenol, tapering down to two doses per day by my two-week checkup.
Taking the path to recovery
We were both independent within a day or so of surgery. Taylor’s house has stairs, and she was able to navigate them well by sitting and scooting up and down. We needed hands-on help to transfer from chairs to beds and off and on toilets for the first day or so only. Within a day or two, we were able to do all that on our own. If you don’t live with someone who is strong enough to help you we’d recommend you either ask a friend to stay or hire some help for the first day or so. You might need help for longer if you’re not strong enough to lift a good amount of your bodyweight using your arms.
With the minimally invasive bunionectomy, you can bear weight immediately, but on your heels only. We bought or borrowed wheelchairs/wheeled walkers and orthopedic boots before surgery and used the wheelchairs for the first day when walking was unbearable — like stepping on Lego with bare feet. But by the next day we both were able to clomp around in the boots leaning on wheeled walkers, and within another day or so were managing with boots and a cane. Within the first week, we stopped using the cane as well and were easily able to walk short distances — always with the boots.
We were able to take showers on our own, although in the first week or two it does help to have someone to assist. We both used shower chairs for confidence and stability in the shower and cast covers for the first two weeks because the original dressings must be kept dry.
Two weeks after surgery, the doctor removed the original dressings. Since we were both healing well, the guidance changed, and he said that instead of just putting weight on the heels, we could now put weight evenly across the foot and walk flat-footed. At this point I switched to orthopedic shoes but Taylor continued with the boots. I also returned to my Peloton stationary bike but didn’t clip in. I rested the orthopedic shoes on the pedals — and took it easy!
At four weeks, with healing still going well, we were allowed to start driving again. It was also time to start moving the feet more naturally, rolling them when walking. We were allowed to start wearing any of our normal shoes that we could fit into but not many pairs could accommodate our swollen feet. Taylor switched to Uggs, and I wore lace-up running shoes and Velcro-fastened cycling shoes. We resumed walking short distances and at this point, the doctor prescribed physical therapy.
Both of us found that PT facilities near us were booked up a few weeks in advance, so we’d recommend you consider asking your doctor for the PT prescription earlier, so that you can book in advance and start therapy at four weeks exactly.
In physical therapy, they show you how to work the incision sites to break up the adhesions that form as the skin recovers. PTs also work on helping you to resume rolling your foot as you walk, which feels strange and even scary after weeks of walking like a duck. Exercises include toe-scrunching, toe-stretching, and balancing. Even one session can be very useful, but more is better.
At eight weeks, we got our final sign-off and were considered fully recovered. At that point, we could fit into “dress” shoes, but couldn’t comfortably wear them for long. Have patience and continue with your PT exercises at home. It can take many months for your feet to fully recover their strength and range of motion, but it will happen — and sooner, if you keep working at it.
We are both very glad that we chose to have bilateral bunionectomies. For us, the pain and inconvenience was far preferable to having to do it all over again! Our advice is, deal with the surgery and recovery just once and get both feet done at the same time. We found it to be the better approach — by far. Make it a double!
Equipment:
- Two orthopedic boots
- Two orthopedic shoes
- Wheelchair or wheeled walker
- Cane or walker
- Two cast covers
- Shower chair
You don’t need to buy all this equipment. We got ours from friends and from the kindness of strangers who replied to our requests on NextDoor.