29 Mar

Friday Day 5

Either my foot is getting smaller or the bandage is getting bigger as it is starting to slip down my foot and gaps are beginning to appear. I can see the inside of my ankle about where the Hyprocure is probably sitting and it looks pretty black and blue. I am afraid my wound is going to be exposed so I find some white bandage that I bought from Lidl six months ago when my daughter broke her hand and I wind it around my foot covering up the gaps. I suspect that the bandage slippage is related to me moving around more.

original position of bandage

original position of bandage

after slippage

after slippage

goodbye toes!

goodbye toes!

29 Mar

Thursday Day 4

I realised when I woke up in the morning that I had gone to the loo in the middle of the night without any crutches! (Or did I just dream it?) Actually it is only a few steps with my weight on my heel but I feel I that this is a great sign that things are healing. Of course I am still walking heavily supported by crutches with my weight mainly on my heel. I think what pain I feel is around my wound site and as I don’t want to tear anything open I am going easy with my weight supported by the crutches.

progressing with crutches ...

progressing with crutches …

slowly slowly ...

slowly slowly …

29 Mar

Wednesday Day 3

The anaesthetic had finally worn off but no real pain. I was now actively trying to move my foot around more and discovered that I could flex and point it quite successfully. There was some soreness where I perceived the entry wound would be. Late in the day I discovered what partial weight bearing is: taking most of the weight of my body on my arms on the crutches.

exercising ('walking') with boot and crutches

beginning to exercise (‘walking’) with boot and crutches

DSC0progressing with crutches ...8711

progressing with crutches …

I began to get better at moving around with my bad foot on the ground, sometimes using it as a pivot. I could balance my crutches with my elbows so I can do simple things in the kitchen.

However I still found the whole thing exhausting and had to keep lying down with my foot up.

29 Mar

Tuesday Day 2

I had slept well but no wonder – my foot was still completely numb. I had been told that I would also have a cortisone shot during the procedure so that may well have been contributing to the numbing effect.

We really just wanted to get home so I managed to hop on my crutches out to the car (harder than it sounds!) and into the back seat of the car. I rode stretched across the back seat down the the motorway. A few hours later we were home – bliss! We are so lucky to have built a house with a bedroom and en suite on the ground floor and I have to say I am so grateful that we did. I was finding out how difficult it is to be disabled. Just hopping on crutches is bad enough before you try to carry anything. I was shoving my phone into my bra and my laptop down the front of my trousers to move them into another room!

My lovely next door neighbour came in to say hello. She is a NHS physiotherapist and examined my toes and was pleased that although still numb they were wiggling.

I had the first inkling of pain that night and so had a paracetamol before bed.  I found putting my foot up on a pillow in bed seemed to help. I took off the boot now when my foot was up which was more comfortable.

resting foot with small boot still on

resting foot with small boot still on

29 Mar

Monday Feb 9 2015 Day 1

We arrived at the day surgery ward with my dressing gown and slippers in a Waitrose shopping bag. I was nervous but feeling really positive.

I wasn’t the first to arrive. There were four of us having foot ops first thing but I don’t think they were all Hyprocures. I felt really sorry for the lady next to me – her feet were clearly a real mess. She was having a Hyprocure inserted as well as her bunions and other foot issues sorted out. She was wearing a pair of modified canvas shoes and could only shuffle as she walked and it turned out that she was only a couple of years older then me. Clearly there were others much worse off than me.

We were taken to the pristine ward and our beds and instructed to get into our hospital gowns. After the nurse had taken my blood pressure the podiatrist Registrar came for a visit to give me instructions about what to do after the op. Then the anaesthetist had a quick chat with me. Finally a nurse  gave me a lesson in how to use crutches (hop hop hop) – I wished I could have more time to practise!

 The very nice lady with the really terrible feet who was in the bed next to me had some awful news. The results of her MRSA swab had not yet come back and therefore her operation had to be cancelled. I felt sick for her.

Suddenly I was taken off to the operating theatre just off the ward. The very kind anaesthetist found a vein and I was out like a light.

before the operation showing flexibility

before the operation showing flexibility

before the operation showing other side of foot & flexibility

before the operation showing other side of foot & flexibility

I woke up on the ward with my right foot swaddled in a thick bandage with an old lady shoe with velcro fastenings. Apparently I had been sick after the operation and had a vague recollection of shivering. I was groggy but was revived with a cup of tea and toast.

Once I was properly awake my husband came to collect me. I was wheeled out to the car and went back to the hotel. I slept on and off all day and I was pain free as my foot was frozen solid.

foot bandaged and frozen

after the operation my foot was bandaged and frozen so I had no pain for some time

06 Mar

The Hyprocure Choice – My Early Experience & Questions

Like other people who have blogged about their Hyprocure experience I just want to say here that I have no affiliation with Gramedica but just want to give an honest account of what has happened to my feet. I am particularly interested in telling how it is for the British market and specifically in all honesty about the English NHS system. I suspect things will be different for Scotland Wales and NI. The majority of what has been written and what I have read is primarily American. It is all so different over there and while it is informative   about the medical side of things the health system is just so different. I have to say right here that I am so grateful for the NHS and for everything it does for all of us. Being ill or injured is bad enough but having to worry about whether you can afford medical help or whether your insurance is going to pay out just seems too cruel.

On the Hyprocure website the Hyprocure is sold as a quick simple way to solve hypronation with a short down time for the patient. I think this maybe slightly mis-leading for a large portion of the population. This is key hole surgery ( not major surgery) but a piece of metal is being inserted into the foot through a cut. This will obviously have real ramifications and a healing process can take awhile. Don’t be fooled into thinking you can have this done and then go and play tennis the next day. Obviously if you are younger it may well be a faster process but for older people you may have to be a bit more patient.

I don’t think I am probably a typical person who has a Hyprocure inserted into their foot. I am fifty eight years old and only recently acquired flat feet. I trained as a ballet dancer at one of the world’s most famous ballet schools  and sailed through the audition probably because of the fact that I have extraordinarily flexible muscles with the classic ballet dancer’s hyper-extended legs and highly arched feet. I remember always being told in the early years that I was ‘rolling in’ (ballet talk for hypronation) but I learned to develop strength in my feet and be able to shift my weight to the outside of my feet. I always had small injuries around the ankle area but I just got on with it. I think those of us who trained in ballet in the seventies or earlier had no access to the wealth of knowledge and facilities that are available today. Bearing pain was just a part of the whole process and I think I developed a pretty high pain threshold as a result and it is probably this has made me take so long to actually do anything about my painful feet.

shows flat foot

shows flat foot

even though flat footed - an arch can still be made before the operation

even though flat footed – an arch can still be made before the operation

I discovered fairly recently that my grandfathers on both my mothers and fathers side of the family could not fight in the First World War because the Army refused them on foot issues. My father was an Officer during the Second World War and he always said that  the paperwork accepting him into the Army stated that his feet were flat but serviceable. Clearly there is some kind of genetic predisposition in our family.

My feet weren’t always pain free after I gave up dancing but it wasn’t until I was in my forties that I began to have consistent foot pain. Any long walks or worse, bouts of just standing about (drinks parties or visits to art galleries were the worst!) began to be quite difficult. I had a bad case of plantar fascitis which lasted for a year and then vanished. One day I noticed that a bone bump had ‘popped’ out of the inside of my right foot about halfway down my foot – it was hot and painful. I went to see my GP who referred me on to an Orthopaedic Surgeon at a very well known local Orthopaedic Hospital. After x-rays the surgeon explained that I had an Accessory Navicular which is basically an extra foot bone which some lucky people are born with. He could operate on me and shave down the bone which should reduce my pain. I asked what could go wrong and he very truthfully said that he would have to detach my main tendon to get at the bone. In a few rare instances the tendon could not be re-attached successfully which meant I would not be able to walk. I was out of there like a shot! I would continue to bear the pain rather than not be able to walk.

I discovered Fitflops (a sort of spongey soled shoe). The impact on day to day walking seemed substantially improved.

I found an amazing osteopath, Paul Morrisey who has a clinic in Croydon. Paul is an extraordinarily talented man and treats lots of dancers and professional athletes. Besides giving me general osteopathy (which will improve most things I believe) I paid him to give me a course of extra-corporal shockwave therapy on my accessory navicular. It was a long shot as there are no studies out there on it’s effect on AN, but it made a huge difference to the pain on the side of my foot ( in fact it disappeared!). The pain in my arch going up my leg (although temporarily diminished) however was still there.

And then finally I had an accident which changed everything. On a beautiful day in June I scrambled up a sand dune in sandals and badly twisted my right ankle. We were off on holiday to Canada for two weeks and so I hobbled and bore the pain and somehow managed to survive. I really had wrecked it badly though – occasionally I used hotel wheel chairs to get to our room and in airports. I woke up one night in a hotel to use the loo and I couldn’t put any weight on my foot – it was extraordinarily painful.

The first day back I saw my GP who suggested some physiotherapy to start with. I also made an appointment with Paul Morrisey the osteopath. When I saw Paul he suggested orthotics as he could see my feet had really deteriorated. I have had custom made orthotics before and they never really helped ( I could never adjust to that stone-in-the shoe sensation) but when the Paul’s orthotics arrived they made a huge difference. I also started wearing lace up trainers all the time. My feet needed all the support they could get.

I saw the physiotherapist three or four times but she said that I really needed to see an orthopaedic surgeon and wrote to my GP. She said that I had had a huge trauma and my foot was going to need some time to heal but  that my foot’s position was so compromised that something a bit more radical was needed.

In the meantime I was doing research on the internet. Because of the success with Paul’s orthotics I felt there had to be something out there that ‘changed’ the foot’s position. I stumbled upon the Hyprocure website. I then found several blogs and I began to think this might be a possibility. It certainly looked like so much of a less invasive procedure than a tendon transfer and if it doesn’t work it can be removed.

My appointment with the orthopaedic surgeon who was in fact a foot specialist arrived. This surgeon is a really well respected man and he was extremely pleasant. After he saw the results of my MRI and x-rays he felt the best option for me was a tendon transfer and calcaneal osteotomy (although it is worth saying here that the tendons from my toes – which are used to replace the main tendon – were also be very badly damaged so it appeared that whatever was done might be a bit of lash-up).

I had extensively read about these operations online. This  is a really major operation being non weight bearing for the better part of three months and and a further three months partial weight bearing in a plaster cast. Although thought of as being a really excellent operation my next door neighbour who is a physiotherapist confirmed what I had suspected – it is really an operation that you have when all other options had been explored. As a physiotherapist she was the one who dealt with things when they go horribly wrong and the statistics were of about an eighty odd per cent success rate. This meant that it was about a twenty per cent failure rate – what happens to those people? They had already had their tendon whipped out so there was nothing reversible about a tendon transfer. Also no one mentions the effect on the rest of the body/leg having being in plaster for an extensive length of time has.

I asked the surgeon about the Hyprocure.  He knew about the Hyprocure, in fact he had recently been to a Foot and Ankle conference where apparently there had been a lot of discussion about it. He said from his point of view there was not a reliable enough study to judge properly.  All the information that he had found had either been put out by the manufacturers or was not properly documented.  From his point of view he just couldn’t find any hard facts. I really appreciated his view.

I told the surgeon that I didn’t feel ready for a tendon transfer and he said if things changed he would always be happy to see me again.

 I went to speak to my GP and she suggested I get a second opinion.

She referred me to a Orthopaedic Hospital which has a really excellent reputation. Unbeknown to me I ended up seeing one of the top banana elder statesmen orthopaedic foot consultants who I later discovered was partially responsible for bringing the tendon transfer to the UK from America. I am glad to say that many of these elderly diva consultants are disappearing from the NHS. They are being replaced by a generation of doctors that recognise that many of their patients have working brains and now with the internet have access to information that a few years ago was only for the medical brigade. The prima donna consultant shouted at me because he could not make his computer work so he could view my x-rays, he shouted at me because he didn’t know my first orthopaedic foot specialist personally, he shouted because he had the wrong pen. When I asked about the Hyprocure he went wild. He said there was never a single instance when a Hyprocure had helped anyone’s foot and why people were importing rubbish from America was beyond him. I listened and quietly left him head butting his desk.  I have to say I can stand up for myself but anyone for whom English is not their first language or suffers from a lack of confidence could be severely traumatised by a doctor like that. I wonder if he was worried that his private practise was going to be affected by a flood of Hyprocures!

I now started to look for surgeons who did Hyprocures. I did not think at that point that the Hyprocure would be available on the NHS (I think the original surgeon had said that it wasn’t). I was also not sure that I could afford the operation privately but it was impossible to know without  knowing what it cost. I was entering into the murky waters of Private Medicine in the UK.

Gramedica (the maker of Hyprocure itself) provided me with a list of surgeons in the UK that had been trained in the technique of inserting the stent. Many of them were at the opposite end of the country so I crossed those ones off the list. This actually left just a few names. I googled some of them to get a sense of who they were and approached them asking them what the cost of the operation would be. This was when I discovered how coy private consultants can be.

Some never replied to my enquiry. Others might reply that their initial consultation fee was £275. But how much was the operation? Well the Hyprocure stent itself is a £1000. But how much is the operation? I never ever got a straight reply from any of them (although googling some more I discovered there was a clinic that had a price list and stated that a Hyprocure operation was around the £4000 mark). I suspect these consultants primarily dealt with private health insurers who just doled out the money and weren’t used to dealing with someone who wanted to discuss price.  I have to say if any of them had a business head on them they would have a defined price list however much that would be. I suspect American consultants are much more used to discussing price whilst here because of the very nature of the NHS money becomes a verboten subject!

I did notice that some of these private consultants were also consultants for the NHS. I then discovered by reading on the internet that the NHS was providing the Hyprocure for children. I thought this seemed odd that if something that was considered ‘experimental’ was being ‘tried out’ on kids. This then made me look for any NICE guidelines (National Institute of Clinical Excellence) for the Hyprocure in the NHS. I found them and was surprised to read that in essence they recommended it as long as the patient was made aware of the risks. I suddenly realised that there was probably no reason why I couldn’t have the Hyprocure on the NHS.

I went back and approached one of the private consultants Steve Kriss (who was also working  for the NHS) and asked him if he would do a Hyprocure on the NHS. He had been one of the people who was much more open and ready to answer questions. He had worked at some of the best hospitals in the country and had also qualified as a acupuncturist which made me think he was quite interesting.  He said if I was a suitable candidate he might be able to do it on the NHS. He suggested that if I gave his email to my GP they could sort out an initial appointment. I was ecstatic.

I then made a discovery. Steve Kriss  was not a orthopaedic surgeon but a podiatric surgeon. Podiatrists are not doctors but train for three to four years to qualify as a podiatrist and then for a further ten years to be able to do surgery on feet. They are a bit like dentists – they are highly trained in a specific area of the body.

An appointment arrived through the post and my lovely husband drove me the two and a half hours to where  Steve Kriss worked at West Berkshire Community Hospital. He was a very no nonsense kind of guy. He had looked at my MRIs and X-rays online and examined my feet and said because they were so flexible they would be ideal for Hyprocure.  He said that because I was out of the hospital’s Health Authority an application would have to be made to my own health authority who would be paying for the procedure.  The rules had changed on how to do this so he was no sure how long it would take but it would not be quick. He asked me to contact him monthly by email to remind him to give me an update.  Although I didn’t realise this at the time I have to say here that my GP referred me to Mr Kriss rather than choosing the Choose and Book method. I don’t begin to understand the difference but all I know is that it created a lot more paperwork (and work in general) for Mr Kriss. I am hugely grateful to him for all the time and trouble he took on my behalf.

So I sent a monthly email to Mr Kriss to get regular updates. The replies often read as follows: I submitted the evidence of this product with gathered information from NICE then applied to get confirmation that your commissioning group will pay for costs … the procedure has to be approved by the Orthopaedic governance meeting but this can only happen once the initial board agrees to move this forward… I presented on the procedure to the orthopedic governance meeting and it was approved…. it went back to special surgery committee and am awaiting the results… And then finally we have the go ahead!! This was about six months after I had initially seen Mr Kriss.

I visited Mr Kriss again for him to have another look at my feet and X-rays. Then once I had a firm date for the operation I went for a pre-op appointment. This was just what you might expect :blood tests, blood pressure and swabs in my throat and nose to  test for MRSA. I was set to go.

xray profile weight bearing

before operation – xray weight bearing

xray with stent weight bearing

subsequent xray with stent weight bearing

Click here to go to my first blog page dated February 9th (Day) 1   2015 

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