Mobility, independence and the Splatt
The Split Tibialis Anterior Tendon Transfer (Splatt) operation was almost 8 months ago and it was right up there with the more challenging part of my stroke recovery journey. It was a very difficult decision for me and my family also because of the risks associated with possibly being reduced to my quality of life if the operation didn’t work out.
With 10 years of hard work, I was proud of my accomplishments and efforts, and doing this operation, I felt that I risked my independence again. I remember the first time I was not independent - after the stroke - I needed to relearn almost everything including - swallowing, speaking, bathing, walking, driving, etc so I was not keen to be vulnerable again, but I have obvious ongoing mobility issues with my inversion (e.g. my ankle rolling in) - that’s why I considering and proceeding this operation because I still have personal goals, and I have three young kids who depend on me to be the best father I can be. It was a risk/reward situation and plus I was conscious that if not doing anything, my foot could break down anyway in the future.
So far, I am doing well and I am finally reaping what I sowed for my pre-rehab efforts and seeing tangible progress in my healing. I still have a long way to go, but I am very confident that this course of action will be a good success and I am excited for the future of my mobility. Hopefully this blog post will cover or summarise some things that happened and been working towards for the past 8 months. I am very sorry that I have not posted much on here and social media also (my instagram account was hacked last year 😢).
The surgery
The amazing surgeon (Abhay Knot) operated on me at St Vincent’s hospital in East Melbourne and I stayed there for 6 nights. Besides showering, I actually never left my hospital bed room at all and the painkillers medication doing their job. I was well-cared for but I was pretty bored. I read a few books and watched movies to pass the time and the physios taught me how to transfer to my bed and to the wheelchair. I was wheelchair bound because my semi-paralysis of my (affected) right side - eg. It is still not functional, so I was not able to use crutches.
I returned home with the wheelchair and my job was basically resting for 4 weeks. We moved a bed downstairs for me because I was unable to climb stairs. During this time, I slept downstairs by myself and wore a hard plaster cast on my foot. Confronting the reality of not being able to bear-weight challenged me both physically and mentally, but I was in a positive frame of mind and mindful that it was a short term timeframe and that I would be walking soon (pending no major issues).
The pain (in my foot) was tolerable, and I was ultra careful to not bump my foot - especially when my kids were around - I had a nervous moment when I jarred my foot (see here for this blog post), but beside that, I was ok. I was very dependent on support and daily routines (toilet, showering, eating and sleeping etc) took on a new meaning as I navigated the intricacies of personal care post-SPLATT. For example, the process of showering (sitting down on a chair) and getting dressed normally takes 10-15 minutes in the morning, but after the operation it takes about 45-minutes or more and at bedtime, I normally need a wee overnight annoyingly, so I used wee bottles - perks of being a man, I guess. And I tried to elevate my leg as much as possible to reduce the swelling that became integral aspects of my daily routine.
Importantly the support was there. I was very well supported by my wife and my family (as always), but the care of the Nurse Next Door was very great - I recommend it to anyone if you need any home care. The nurses helped me to shower safely, assisted me with my wounds, preparing food, dressing and sometimes even walking round the block. More importantly they gave me some relief for my wife who was still working and parenting with our young three kids.
The highlight of this time was I had two big outings to go to our school fundraiser and concert, which unexpectedly gave me a boost to my mental health and an enjoyable glimpse back to a more normal life. Given not doing anything for three weeks I was eager to socialise with friends. The school concert was great to see our kids performing so nicely and my wife was the organiser of the ‘bogan bingo’ fundraiser function, and as she had a few drinks, I was able to drive the car home. It was an unexpected advantage of being able to drive so close to the operation because I never use my right (affected) leg for driving anyway. However I was still using the wheelchair, so I needed help for moving the wheelchair into the boot after I transferred into the driver's seat and help once I got home. With problem solving it was possible to have a great night and we raised lots of money with our school.
Starting rehab (inpatient therapy for 2 weeks)
After five weeks, I returned to Hospital to start my rehab at Epworth Hospital in Richmond, where I started walking on the first day (with a walking stick). I actually started weight-bearing at home a few days before starting my stint in rehab because I saw the surgeon and he was happy with my progress, granted it was a very early stage. The surgeon gave me a ‘forefoot unloader’ which postoperatively made it more stable for walking because foot support was crucial. Basically this simple device allows me to walk with good stability because I was still using the hard plaster cast.
I started quickly with a good routine at the hospital. With no kids waking up early, I woke up early, motivated, took a shower and a breakfast before starting my first session of Physio at 9:00am in the morning. The nurses helped me to shower and get dressed, after one or two days, I did it myself and felt great and empowered. I had a second session of Physio at 1:00pm daily and I copied this routine for the whole of my two week journey - I was very diligent. At the breaks, I had lunch, I rested and I elevated my leg because the physio sessions were very taxing for my body - I was stuffed after one hour of strengthening, weights, balance and cardio exercises.
Luckily I always liked physical rehab (like Physio) and I was in my element, and it was easy to motivate myself especially when I was working with the leading physios in the field, like Gavin Williams, Michelle Kahn and Reece Edwards. Reece is an elite marathon runner and a few weeks later after my stint in rehab, he actually won the Melbourne Marathon!!! Everyone at Epworth was so excited - it was an unbelievable performance from him.
Like doctors and nurses and allied health professionals, I am always amazed by the orthotics interventions that people assist with issues to overcome them. Unbelievable technology and modern medicine is a godsend. The first day of rehab, my orthotist (Steven Owens at Orthotists Plus) removed my cast and measured it with a new custom-made rigid AFO. I was a little bit worried about swelling on my foot, but I was reassured from the physios that this was a normal reaction from this operation. I am still using compression socks now that helped me alleviate the swelling.
Initially, I was told to wear my AFO all the time - besides in the shower and in bed - however I was not confident enough to sleep without it because I was worried about moving my leg at night - especially with my very poor sensation - but eventually I gained trust in my foot and I was comfortable to sleep without it. I am still wearing it now because of the intricacies of the operation, the foot needs to be strong enough to heal properly. The 12 months time frame for constant wearing of the rigid afo was expected for me but it could be longer or shorter depending on how responsive the foot is.
Overall, I benefited hugely from my stint in inpatient rehab, which resulted in returning home with a great deal of independence.
Discharged home permanently and getting stronger
Before the procedure, I was very focused with my Prehab for a one year period and after the operation, I basically continued where I left off - besides that I was using an AFO which has bearable challenges. I re-engaged with my OT therapy, and I am doing lots of physical rehab exercises - at Epworth Hospital for an outpatient hospital two times a week with Liz Moore, as well doing neuro Pilates (Rachel Taylor at Neuro Solutions), seeing a personal trainer (Dave at Gelbart’s Gym) two times a week including focusing on my Splatt rehab exercises and of course, doing my home exercise program. Head down, bum up.
Just before Christmas, my physios introduced walking without the AFO which feels like a small step but actually I was a huge change with my functionality. Using two legs and weight-bearing without the AFO was a mini-milestone for me. The physios were conservative with my treatment and I was allowed to walk around in my house and our sessions in Epworth, and I obeyed their orders. One of the changes was I was able to shower standing up - I was careful and conscious about not falling over with water and not slipping - but fingers crossed, I have no falls so far.
The first time I walked without the AFO was very awkward, as expected, but I was amazed by the way my foot was moving in the right direction - e.g. my foot was not inverted and it felt more comfortable and stable and the swelling is definitely reduced. Witnessing the gradual transformation of my leg, gaining strength, and achieving newfound flexibility is exciting for me and this process.
Recently, I actually had forgotten that Liz took videos about my ankle/foot before the surgery to compare it to current.
Before Splatt:
After Splatt:
And this is a recently video on how my foot is turning the right way now:
It is pretty self-explanatory, but I can’t believe the ankle was inverted so much, and I put up with this instability for 9 years without any aids (beside the soft AFO I wore while running). Saying that, I suffered lots of rolled ankles at this time, which partly explains why I decided to do the Splatt operation. I hope that decision will be a game-changer for me and my mobility in my life.
All the best
Paul
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