As some of you may already be aware, in mid-March I had some surgery done on my legs, ankles and feet. Since I was young I have had a condition called equinus contracture. My calves have been unnaturally tight causing my various kinds of discomfort and pain, as well as difficulty in walking with my heel striking the ground. It also made it impossible for me to stand with my feet flat, or to touch my toes. As Crooklyn so delicately put it, I was ‘Like a fairy walking on tulips.’
Usually this kind of issue is resolved at age 7 or 8 through physiotherapy or surgery, but for whatever reason it was overlooked in my case. I finally decided to have something done about it this year at age 24, mostly because it was having a significant negative impact on my working out and martial arts training. It’s hard to do a 100kg squat when your heels don’t touch the ground, and harder still to open your hips on a roundhouse kick. If i’m ever going to fulfill my life-long dream of kicking a bamboo tree down while a tiny, wizened asian man watches on approvingly, I have to have this surgery. Thank you, Jean-Claude Van Damme for the inspiration, you crazy Belgian bastard, you.
When I went for my orthopedic consultation I was made aware that I was something of an oddity – the surgeon, Mr Carter (not Dr for some reason), told me that in his entire time in orthopedics he had never heard of anyone my age with this issue – and had never seen anyone at all with the degree of equinus contracture I had. Equinus contracture refers to the position of the foot, it doesn’t mean i’m contractually a horse. I kind of wish it did. Stephie, can you contractually oblige me to be a horse?
A normal persons foot has 3 possible positions. Dorsi-flexed, where the leg is straight and the foot points towards the ceiling. Neutral, where the foot is at a 90 degree angle to the leg, and plantar-flexed, where the foot points down towards the floor. In equinus contracture the foot is unable to reach neutral and is permanently plantar-flexed. As a result whenever I walked before, it would be on the balls of my feet.
He had his entire staff come in to look at me. That was super fun, over half a dozen people studying me while I walked around on the balls of my feet like some sort of spy caricature from a cartoon. One of them was in her early 20s, and pretty cute. But if you can be suave when you’re on your back and have a grunting man trying to make your foot move in a direction your entire body has conditioned it not to move in, you’re a significantly better player than me.
So, my feet were permanently in equinus contracture. Where 90 degrees is neutral, the most my foot could reach was 45 degrees pre physiotherapy. After 3 months of physiotherapy this had improved to 60 degrees on my right foot and 65 degrees on my left foot, with most of the improvement coming in the first 4 weeks. I hear of people who have issues with sticking to physiotherapy. For me it was easy for two reasons. The first, and least important reason, was I really wanted to get my legs fixed. The second reason, was the med student in charge of my physio, was a tall, lithe blonde called Caroline who was happy to demonstrate the stretches I should be doing, no matter how much bending over they involved. I miss that.
Beyond that, progress more or less stalled, and it was decided after a number of consultations, x-rays and various physical tests, that if I had any chance of reaching neutral, surgery was my only option. Usually, with this kind of surgery there are two options. The first is called Gastrocnemius Recession, or the strayer procedure. This procedure is designed to lengthen the calf muscle by making an incision behind the knee, cutting the outer (Gastrocnemius) calf muscle, stretching it, then re-attaching it. The other option is releasing the Achilles tendon, where an incision is made at the back of the foot/ankle, the tendon is cut, stretched, then re-attached.
That was pretty cool, finding out that one of the things they might do to me was the thing that literally killed the greatest greek warrior to ever live. His Achilles tendon got cut on one of his legs and he died. I might be getting it done on BOTH of mine. Try not to be too impressed by this, ladies.
Mr Carter informed me that until I was under anaesthesia and my legs were in a completely relaxed position he was unsure exactly what work would need to be done. I gave my permission for him to perform any procedures he felt necessary to get my feet to neutral. I was given a choice at this point between having one leg done at a time, or both done at once. Various interns and orthopedic doctors gave me their opinions on this. The most common opinion was that these surgeries were usually done one leg at a time because the recovery could be long and difficult, and two legs would make it even more so. On the other hand Mr Carter told me that having both done at the same time had the greatest chance of long-term success as I would be able to recuperate both legs at once, have physiotherapy for both legs at once, and essentially re-learn to walk with both legs at once.
This was a tricky dilemma, so I asked myself the question I always ask myself in these situations; ‘What Would Batman Do?’ Truth is The Batman would only make one decision here, and that was the bilateral surgery. Me and Batman are on the same page, so I told the doctors I would have the surgery on both legs at once. Mr Carter informed me that someone would be in touch to book the surgery slot with me, but that I should expect to be waiting 2 – 3 months. The next week I got a phone call informing me there had been a cancellation, and would I be able to make my way to the hospital to have my surgery the next day. I took 30 seconds to consider it (What Would Batman Do?) and decided to go ahead and get it out the way with. It made a mess of some of my plans but hey, that’s life. Batman can’t even make plans, so I wouldn’t complain.
(Credit Neal Adams/DC Comics)
The surgery itself I obviously have no recollection of, but the pre-surgery I do. I was able to watch via an ultrasound monitor as the anaesthesiologist carefully navigated between the nerves at the back of my knee to numb my calf muscles. This was a little painful, buy the fentanyl I received beforehand, 100 times more potent than morphine, definitely took the edge off. I remember asking lots of questions about the names of the nerves, the type of anaesthesia being used and more besides, which my nurse and anaesthesiologist were kind enough to answer. Sadly my memory of the time is hazy enough that I don’t recall those answers.
I woke up about 3 hours later in a considerable amount of pain and discomfort, thankfully morphine was made available to me to help with this. Even so, a comfortable position to lie in was something that would evade me throughout my stay in hospital and for weeks at home. I wanted to get gravity boots and sleep hanging upside down, like Batman would. Apparently though, that’s “ridiculous” and “literally the dumbest thing i’ve ever heard”. Thanks, Mom.
As it turned out the surgery had been more extensive than anyone had anticipated – the medial head of my calf muscle was cut, stretched and reattached, as was the Achilles tendon (Suck it, Achilles). In addition to this, several tendons across the top of each foot were also cut, stretched and re-attached. At this point I’m making an educated guess as I don’t have my surgery notes, but I believe it was the tibialis anterior tendon, extensor digitorum longus tendon and the extensor hallucis longus tendon. Say that sentence five times fast, I dare you.
Next week i’ll discuss the early stages of my recovery and the trials and tribulations therein.