Bring It On!

A Decision of a Lifetime and a Plea for Help

September 13th, 2008 | by Steve O |

Most of you know that read this blog regularly that I was in a motorcycle accident back in July that did significant damage to my lower left leg. In fact the accident did so much damage to my ankle and foot I fit the criteria for a below the ankle amputation and it almost happened.

After some quick discussions with my doctors they decided that it might be possible to save my foot. So I have spent one complete month in the hospital, one month at home and currently I am back in the hospital trying to save my foot.

But I have come to a crossroads in this process and unfortunately I have to make a decision on whether to keep my foot or proceed with the reconstruction. I have provided below what I hope is enough details and I’m not looking for anyone to make a decision for me I’m just looking for, based on the information below, the pros and cons of keeping my foot (which I mainly already know) and the pros and cons of amputation and getting a prosthetic (which I know absolutely nothing bout).

In my accident I had three things happen to my leg. I broke both bones in my lower leg (I forget the names), I had severe damage done to my ankle and foot and I basically had all the muscle and tissue ripped out of the inside portion of my ankle. This included my heel being torn off or torn down to the middle of my foot.

The bones have all healed or are almost healed. The tissue and skin around my ankle have been replaced by doing what’s called a flap, they took the Lat muscle from my back and wrapped it around my ankle. They then did a skin graft to cover the muscle. Both the donor site and the receiving site are just about healed.

The problem with all of this is my heal. It was healing fine and coming along with everything else up until my doctor took out the two pins that were holding my heal to my bone (actually that was fine too). During the Labor Day weekend the heal became infected (the infection set in around where the pins were taken out) which caused the heal to become detached from my foot and I was admitted to the hospital where they have been treating me for the infection and at the same time trying to get my heal to reattach itself to the bone.

I need to take a step back and explain to you that the heal had severe damage done to it during the accident. I lost some of the fatty tissue that makes up the heal and a large amount of skin on my heal was either lost during the accident or died off in the days and weeks following the accident. My doctors have explained that the fatty tissue that makes up the heal and the skin on the heal are very specific to the heal and cannot be replaced. Once it’s gone, it’s gone and so goes the foot because you cannot walk without your heal.

OK, back to the present, currently the heal has almost adhered completely to the bone but not fully and my doctors fear that it still might not happen. Now, if the heal does attach all is good and we will move forward with the continued reconstruction and physical therapy of my foot, if it doesn’t then my doctors have expressed that amputation is the only alternative. So far it looks like the heal will reattach.

The doctors have stated that it is a very real possibility that another infection could happen in the future and I will be faced again with the decision to amputate or move forward with reconstruction. It is here and now that I am faced with the decision to move forward with reconstruction or proceed with an amputation.

The doctors have stated that if I proceed with reconstruction it will take anywhere from 18 to 24 months assuming we have no other set backs (and at anytime I can lose my heal which would mean amputation). At the end of the reconstruction I will obviously have my foot but I will have very limited range that will restrain me from running or walking up steps properly and other things that require me to fully extend my foot. I will always have the possibility that my heal pad will sheer down, causing the need to amputate. There is also the real possibility of arthritis setting in which would require fusing of the bone thus reducing my range of movement even further. They also cannot guarantee that I will not live without pain after the reconstruction is done.

If I choose the amputation route I avoid all of the above. The doctors have explained the phantom pains I might feel over the years and they explained that every once in a while the bone might need to be filed down. Other than that there seems to be no other negative aspects of doing an amputation and that is where I am seeking any and all advice.

What are the positives and negatives of living life with a below the knee amputation? Would the quality of life be better than the quality of life if I kept my foot?

Any help and advice you all can provide is greatly appreciated and if you know of someone with a below the knee amputation I would greatly appreciate their input.

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  1. 9 Responses to “A Decision of a Lifetime and a Plea for Help”

  2. By squid on Sep 13, 2008 | Reply

    my father had a below the knee amputation. he experienced phantom pains and a great deal of pain in general on a consistent basis. he was able to walk sufficiently with prosthetic, but hated wearing it as he said it was extremely uncomfortable/painful after a while, and required all sorts of special accessory sock-things, medical maintenance, etc. this was about 10 years ago though, and i know that your options will most likely be better prosthetic-wise, he couldn’t afford a very-nice leg, and significant advances have been made in prosthesis since.

    really, nobody can make this decision but you. don’t let anyone try to talk you into anything if you are not 100% sure you are comfortable with it, because if you do end up regretting your choice there is no going back. my suggestion would be to try to find others with similar conditions, with and without amputations, talk to them about their experiences and gather as much information and insight as you can. at least it will give you more of a first hand view of how you might feel sometime down the road for either option. you certainly should be able to live a full and happy life with whatever you choose. i am deeply sorry that you have to make a decision of this magnitude, and i hope that whatever happens you come out of it happy, healthy, and ready to embrace what the future holds. good luck!

  3. By steve on Sep 13, 2008 | Reply

    The day my son was born, I had a friend in the hospital in the room above who had an infected foot. The infection got so bad that when he stepped off the curb in front of his house the infection had literally split the bone up to his knee. He had no choice but amputation about 4-6 inches below his new.

    He is in his mid 50’s. He put on the new leg and walks without a cane and unless he is wearing shorts, you would never know he had a fake leg.

    My mother on the other hand had polio as a kid and has such a deformed foot, I often wonder why she didn’t just have it removed and replaced with a prosthetic. She has battled the pain in her foot her whole life that it has caused problems in her knee and hip. She had quite a few surgeries on the foot to fuse bones, put pins in…etc. Her bathroom cabinet looks like a small pharmacy. I often wonder if she chose the other route if things would be different. She was on vacation a couple of years ago in Mexico, like the first or second day of a week trip and simple walked onto one of those pyramids near Cozumel and snapped her bones in her feet. What was she gonna do in Mexico except visit La Pharmacia? (who doesn’t visit that when you are down there, :)).

    I’d fear brittle bones and arthritis when I got older if I were you and long term effects of pain meds on your liver… But it is your decision.

    Can you shift a bike’s gears with a prosthetic is the other question because I assume, you will get back on a bike someday?

  4. By Lazarus Long on Sep 13, 2008 | Reply

    Steve-O:
    Good luck with this bro; I’d hate to have to make this call myself.
    But it sounds like you have already made a decision, and you just don’t like it.
    BLUF: which alternative gets you back in the game faster? Whatever your game may be, which choice gets you there?
    Stay strong

  5. By Liberal Jarhead on Sep 13, 2008 | Reply

    Been thinking about your situation, and it sounds as if you’ve weighed the pros and cons of both choices - safety and quality of life, in terms of mobility and of being able to do the things you love most, seem like they’re the trumps. Take care, good luck, and know that a lot of us have you in our thoughts and hearts.

  6. By Tod on Sep 13, 2008 | Reply

    SteveO: As Squid mentioned, this has to be YOUR decision alone. I’ve never known anyone with a prosthesis so I can’t comment on first or second hand experiences. However, I have seen a few newsmagazine shows over the past several years that have shown the incredible progress made in this area: very light but strong metals, better joints, interchangeable feet, and more. About the feet - they showed a runner who hand his “everyday” foot with a shoe on it and his running foot, which was a curved piece of metal that had quite a spring to it, allowing this guy to do his runs (not simply jogging, either).

    Oh, I just recalled that when I was visiting an offsite project, I saw a fella working in another area of the office who wore a foot. As I was there for a week i could see more or less what his habits were: Came in wearing it but took it off for most of the day, hopping around if he needed to move about the office, putting it back on at lunchtime and at the end of the day.

    To help you decide, do a google on “prosthetic foot” and you’ll find quite a few sites for the artisans and engineers who create these.

    In any case, I echo the others when I say Stay Strong and enjoy life.

    Best,

    -Tod

  7. By Lisa on Sep 13, 2008 | Reply

    That is a really tough decision. I am not going to tell you what to do but if it were me I would probaly go for the amputation to avoid future problems(easy to say now) I too have a friend with a below the knee amputation and she does very well although she had it since she was 7 years old. But there also is a down side to her amputation as it is another thing to contend with. She can’t go swimming because it can’t get wet although I am not sure if they make a prothesis for swimming or bathing.
    She does bowl on a league and leaves me in the dust when walking.She keeps thin which is also vital to relieve the pressure.It has over the years affected her hip alignmnet and she has to wash the gel sock that covers the stump every night and rub it down with alcohol once a week( which she didn’t do for a year after getting her new limb )and wound up getting a staph infection so the cleaning part is very important.
    Sorry you are stuck wth having to make this decision but it does sound like it may be inevitable down the road anyway and it does sound like the alternative is going to be very agonizing.
    Good luck with your decision.

  8. By Jet Netwal on Sep 14, 2008 | Reply

    The only people I know who have lost part of their bodies voluntarily are cancer victims, which is a no brainer. When it’s cut or death, the decision is far simpler, both for the individual and their families.

    You don’t mention how your wife is taking this, and I know her feelings weigh on the decision a lot.

    I think what you’re really pondering here is whether it’s cheating to amputate if the heel reattaches and reconstruction could proceed. I don’t think anybody wants to put themselves through 18 months or more of pain and frustration. Doctors have to make sure you understand the risks and the downside of your choice. I’m assuming that you also heard the good side too, that you can function, intact, and could live a relatively normal life.

    As you make your choice, don’t forget to focus on the good as well as the potential problems. We tend to get so immersed in the downside, and that’s just part of the picture.

    There’s also this: if you continue with the reconstruciton and down the road still have to amputate, you’ll never feel like you didn’t give it your best shot. If you know in your heart now that undergoing additional reconstuction is more than you can take on, you’ve given it your best shot already. No regrets in either scenario.

    ::hugs::

  9. By Steve O on Sep 14, 2008 | Reply

    Thanks Jet. The twist to this is that the doctors have stated that after reconstruction i will only have a 30% range of motion on my foot, meaning that when I walk up steps my foot will not have the full range to push off to get to the next step. Same if I come to a curb. I will have to stop and use my good foot to get over it. Running will be very limited. Then the arthritis sets in and they have to go in and fuse bones, reducing even more my range of motion.

    Yes, I can keep the foot but I’m not see too many plus’s.

  10. By Paul Merda on Sep 15, 2008 | Reply

    I got nothing for you on this one Steve O, other than a good luck and I hope whatever decision you make works well….

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