From Zero to Excruciating Overnight: Post-Surgical Days 8-10

Old-timey cane and bed-boot: Not a normal part of post-craniotomy care

The morning of the eighth day after my craniotomy, I awoke (if that’s the right word when I had an obsessive and sleepless night, thanks to Decadron) and got out of bed. Then I immediately leaned over to brace myself against the wall as pain shot up from the arch of my left foot and my calf tightened. Not only was I unable to put much, if any, weight on the foot, but I was flummoxed (okay, that’s a pretty common state so soon after brain surgery … but still): Why had my foot gone from completely fine to excruciating pain overnight?

Now, I am a runner, and plantar fasciitis is something that plagues the running community, as exercise or overuse is a leading cause of the inflammation and micro-tears that develop in the plantar fascia ligament, which runs from the heel bone along the bottom of the foot. It is the main cause of heel pain.

Wait… heel pain? Hmm. And the timing … WTF?

I have been fortunate (there’s that word again) not to have suffered from PF in my two decades of running (and again, I’m knocking on all the wood in the house). My husband has had it, though, and it took a long time for his morning heel pain to subside. It doesn’t really go away, though; every morning Brian stretches out his calves and feet, and he has SuperFeet orthotics in all or most of his shoes. The only odd heel discomfort I ever felt occurred about three weeks before my surgery, and then it was on the bottom and very back of my heel, not in the usual PF area. I stopped running about two weeks before surgery because I was so busy, and that little heel discomfort completely disappeared.

For three days, I was hobbled. We had an old, wooden cane that my mother-in-law gave me a few years back when I injured my knee while applying lipstick (true story). In order to get around with my pained foot, that’s what I used. Doing so put extra pressure on my right hip/femoral neck area which, if you read the post “My Year in Health,” you’ll recall I injured in 2016, so … yay. Now my foot and hip hate me.

Folks, this foot pain made me miserable. My consumption of acetaminophen skyrocketed up to 3000-3500mg a day (until the care representative from UnitedHealth Group informed me that the daily maximum dosage had been reduced from 4000 to 3000mg due to risk of liver damage). I was taking more painkillers for my blasted foot than I had for my head! The craniotomy was nothing compared to this debilitating pain.

I emailed my GP, asking him if possibly the Percocet was causing it. My suspicion stemmed from the fact that the night before the foot pain, I had taken two Percs, the most I’d taken since leaving the hospital. My hope was that it would prevent the middle-of-the-night headache I’d had the night before (it did) while helping me sleep (it totally did not). Muscle pain is not a common side effect of Percocet, but it is listed. [Note: I was still in a rather hazy state at this point, so I didn’t realize that muscle pain is listed as possible for both Decadron and Keppra.] My GP dismissed the Percocet concern, but he told me that I should go to an ER to get an ultrasound to rule out deep vein thrombosis, which can be a serious problem after surgery—though he stressed that it didn’t sound like DVT; he just preferred we be safe rather than sorry.

So Saturday morning, Brian and I are watching NOVA, a weekend ritual, and my foot is in so much agony that I can barely concentrate. Emergency rooms are expensive and can have you waiting for several hours if your life is not in imminent danger, so we opted to go to Tria Orthopedic Urgent Care, where I got in a little snooze while waiting for the doctor.

I have been to Tria for various running-related injuries in the past. The running evaluation I had there was very valuable in understanding how my running form had devolved into a form that put my bones and ligaments at risk. The physical therapy I received was also good. But seeing an orthopedic specialist with the title “Dr.” in front of his/her name? Well… my results have been mixed, at best.

Here’s how a typical visit with an orthopedist has gone for me:
First, before talking to anyone, I’m given an X-ray of whatever body part is troubling me. The X-rays do not show soft tissues or any detail on ligaments/tendons or even stress reactions on bones, so I’m subjected to radiation for a test that most of the time will never provide any information beyond “bones not broken.” Then, once I see the doctor…

Me: “I have this pain between my knee cap and my femur.”

Orthopedist: “Let’s give you an expensive MRI.” [After images return:] “I diagnose you with patellofemoral pain!”

Me: “Isn’t that what I just said?”

Orthopedist: “Yes, but I said it with a medical degree!”

Me: “But what caused it? Why now?”

Orthopedist: ::shrugs:: “Maybe your running form sucks or maybe you’re just getting old. Next patient!”

So the orthopedic specialist—I shall call him Dr. Sturm-und-Drang—entered the exam room after about an hour, pushed on my foot a little, and declared it to be PF, for which there is NO CURE! (He actually wrote that on my information sheet.) He talked about how the treatments don’t always work, and some of them, like cortisone shots, can cause nasty problems of their own. 😒  

Me: “So why now? Why did I go from no foot pain to severe pain overnight?”

Dr. Sturm-und-Drang: ::shrugs:: “It just happens. You don’t have DVT but your overly anxious GP wants to rule that out, so here’s an order for an ultrasound lab in a different suburb. Bye, and remember: NO CURE!”

Notice what’s missing in that convo? Any discussion of how my surgery or, more probably, my medications, might have contributed to the problem.

DVT was ruled out by the ultrasound. After that, we bought me some SuperFeet orthotics and I started using Brian’s bed-boot. I didn’t need the cane the next day. In a few days, I stopped using the boot because the pain dropped down quickly to just a twinge. A week later (or possibly even less), it dropped off to nothing.

My GP was skeptical of the PF diagnosis and wanted me to come in for an exam, but I’d had enough of doctors for a while and my foot improved so quickly that I didn’t do it. I, too, am skeptical about PF, though I still only wear two pairs of supportive shoes to keep the foot happy. My suspicion now is that I had a muscle freak-out in my calf that led to a tightening in my arch. Once the calf stretched out and relaxed, so did the foot.

The only shoes I wore for more than a week

So don’t forget: Medicine can be as much an art as a science, and some branches are more artless than others.