Hard to believe, but 5 years ago, I was one of the first 2500 patients undergo subtalar MBA implant surgery. This site has more pictures and animations of how the implant works. It’s pretty neat stuff. of course, they make it sound like the miracle it is, but I think they give it a bit more credit than it deserves. Or maybe I’m just bitter… It’s coming up on five years since the 2nd operation toward the end of this month, I thought I’d take a minute to write down my experience with the MBA implant.

I can’t really nail down the first time I noticed it, or the first time my joint got inflamed. At the time I was sixteen finishing up my sophomore year of high-school, and was working a Mother’s Day holiday at the near-by country club. Each Mother’s Day, they open up to the public for a huge buffet, lunch and dinner. For the bus-boys at the club, it becomes an 8 to 10 hour day, paid in cash. At 16, making over a hundred dollars in one day is a really good haul, and it was well worth it — even if you were on your feet for nearly 10 hours non-stop carrying the weight of dishes, garbage, linens, etc. I worked my tail off, and by the time we got home, my feet were killing me — but it wasn’t just soreness. My left foot, right below the ankle (I described it as my ankle — it’s the same joint that hurts as when you ‘twist your ankle’) felt like someone stuck a soldering iron into the bones. I’d had this happen before, normally at band camp or an amusement park. It always went away by the next morning before.

I got up the next day, and limped all day long. I couldn’t hardly move the foot. Standing was painful. I babied it all day at school too. The slightest twist felt like someone was injecting burning oil into my foot and half-way up my calf. Shooting, sharp pain, and a constant burning sensation. After two days of this, I finally got my parents to take me to our podiatrist, Dr. Gregor. I’d been to him before with ingrown toenails and plantar warts which he removed with a laser. He’s got the best bed-side manner of any doctor I can remember, and he definitely knows his stuff. I’d highly recommend him if you live in Northeast Ohio, his office is north of Canton, in the Belden Villiage / Jackson area — at the time, he was located on Cleveland Avenue, North of I-62, in a store-front office behind the Wendy’s.

The first time I went, my mother took me. Dr. Gregor came in and started to examine my left foot. He wanted to manipulate it. The next fifteen minutes where where I learned what real pain is. Believe me, if you’ve broken an arm or leg, or fallen down steps: You do not know what pain is. I’ve broken teeth (exposing nerves), bitten through my lip, sprained my right ankle so badly the doctors said I’d have been better off breaking it… I’ve had my fair share of crap that hurts, but when Dr. Gregor took my foot in his hands, and started to point the toes down, rotate it, and flex it back up – that moment defined what is now a 9.0 on my pain scale of 1 to 10.

I grit my teeth, took deep breaths, and watched. As he was trying to move the foot, my leg muscles, the muscles in my foot, were all spasming and contracting trying to stop him. For the most part they succeeded. I wasn’t doing it. I couldn’t help it. Turns out, it’s the body’s natural defense mechanism at work. The spine was blocking some of the signals to my brain, and the spasms were reflexes sent back to try and avoid the stimuli causing the problem. He explained that I had a serious buildup of acid in the joint, causing severe inflammation. Anti-inflamatories would help in a matter of days, but the best way to get me on my feet quickly would be a steroid (most potent anti-inflamatories know) injection directly into the joint. I hadn’t been able to walk for a few days at this point. I figured how much worse can the pain get? Give me the shot.

Dr. Gregor produced a syringe with a sixteen gauge needle from the cupboards in the room (steroids are crystalline, and need ample room for injection) and filled it with a steroid. Turning back to me he said, “I’m going to use cold-spray to numb the site first, but this is still going to burn. The faster I go the more it’ll burn, so I’m going to take it as slow as I can.” Freezing cold.. A little pressure.. pop.. pause.. hellfire. 10. 10. 10. 10. pause.. the needle comes half-way out, gets re-angled to another part of the joint.. back in.. pause.. 10. Freakin’ 10. Teeth grinding. Sweating. I’m sitting there thinking about how amputation with a rusty chain-saw would be more pleasurable than this.. pause.. another re-angling.. more 10’s. The injection all told, took about 3 minutes. It was a large syringe. He bandaged up my foot, made an appointment to come back in a few weeks to check up on it, gave me a prescription for orthodics. There was no explanation except that I have bad joints that allow my foot to pronate too far, giving me the appearance of almost flat feet. (They’re not flat. I have an arch!)

A few months later, marching band started up — and we were to be marching in the Pro Football Hall of Fame parade that year. I was also working full-time at a car dealership as a janitor, moping floor, keeping the shop clean, mowing lawn, washing cars, cleaning oil pits… you name it, I did it. It was a fun job — but I was on my feet almost 10 hours a day. The orthodics helped. If I didn’t wear them, I felt it. Common obstacles at a car-dealership like stepping on an air / water hose, slipping on some oil, or running across a parking lot would send burning shots of pain up my leg. But what really killed me was marching band. I played the quads, four toned drums interconnected, if you’ve seen a marching band on TV, then you’ve seen quads. They’re a favorite of cameramen everywhere, and they’re heavy. The set I carried was ~60lbs according to the scales in the high-school locker room.

To prepare for the parade, we street marched for two weeks, from about 8:30 AM to noon. Three and a half hours of walking in step on the paved asphalt of Louisville Ohio with 60lbs on my chest in the summer morning sun. It was hot, it was uncomfortable, and it made my foot feel like the blazes of hell. About six months after the first visit to Dr. Gregor for my inflamed foot, it was two days before the parade: I had to crawl to breakfast. I tried to stand up. My leg wouldn’t hold me. It gave out immediately. Remember those spasms? I sure do. I remember it taking almost an hour, soaking my foot in warm water, and wrapping it in an ace bandage just to stand. Walking was another story. I limped. The more I used it the more I got accustomed to the pain, and the easier it was to use, but if I stopped for a few minutes, it would be back to square one. I quit sitting down in the back of the band room when we were there. I was always moving, stretching, walking, keeping my foot moving – it made the immediate pain better, but made the inflammation worse in the end.

The day before the parade, I went back to Dr. Gregor. Steroid injection #2. Again, direct into the joint. The orthodics weren’t cutting it anymore, although they certainly helped. This time I limped out the door with a prescription for DayPro — the maximum dosage. The DayPro helped. I was able to make it clear through the rest of my summer job, band-camp, and marching season on the DayPro. It wasn’t a cure-all, it didn’t eliminate the inflammation, but it made it bearable. I was able to walk, crab-walk (sidestep with the drums on), make all my spots in band, and work. I found that swimming helped it immensely. The cold water, coupled with the reduced load but steady motion helped to soothe the joint. It was at this visit with Dr. Gregor that he outlined the further courses of treatment. I couldn’t stay on DayPro forever, and this wasn’t going to get better on it’s own. I didn’t have many options. Continued treatment with orthodics and reduced activity, or surgery, if we did nothing, he speculated that I’d have arthritis in that joint in a matter of years – probably before I turned twenty.

At the time, there were two surgical options. Option A was to cut the bones, and fuse the joint together, eliminating the source of motion thereby eliminating the inflammation. As you can imagine, this is -not- a good idea. It’s very invasive, painful, cannot be un-done, required 4 months on crutches, and has drastic effects on the mobility of a person. I know someone who had this done about ten years ago. Although she’s my parents age, she still has a large amount of trouble and greatly reduced mobility. At 16, this was not an option I was willing to even consider. I’d go with the pain of a joint that moves too much before I’d do this. This “option” seemed ludicrous to me. Option B was a tradition implant that required drilling into the bones to anchor a sort of pivot stop. Again we were talking about months on crutches, casts, damage to bone-structure and irreversible surgery. I preferred to stick it out with the DayPro until after marching band was over. If I had more flare ups with reduced activity then we’re re-examine the options. He agreed that was a reasonable option. Dr Gregor was kind enough to tape up my foot for added support for the parade the next morning, which went without incident. All 7.4 miles of the Hall of Fame Parade. Amongst the percussion section that year, I earned the nickname, “Iron Man.”

All the percussionists would get annoyed at the wimps in the rest of the band. Beth, the other quad player and I got so mad when some flute or saxophone player would sit out at practice because they were ‘tired’ or ’sore’ or whatever. Try lugging 60lbs on your lower back all day, then throw in a foot that’s causing your leg to nearly give out a few times a day. As the perc section saw it, if I wasn’t sitting out, no one had the right to sit out. I never sat out. None of the percs ever sat out. Iron Man, indeed.

After marching band was up for the year (best year we’d had in years – competition scores were hitting ranges our school hadn’t seen in almost 10 years) I went back to working at the banquet hall at the country club after school. When there was a party, I’d be there for a few hours, hauling stacks of plates, linens, garbage. My foot continually flared up. I was off the DayPro. It kept getting worse and worse. Knowing that a return visit to Dr. Gregor would be the last Steroid injection he could give me for a year, and the only course of treatment from here out was surgery, I didn’t want to go back. Eventually, it got bad enough after an all day pig-roast, that I had to go back.

I got the last shot, and we talked about our options. It turned out, Dr. Gregor had heard of a new implant, co-developed by a doctor he studied under that addressed the very problem I was having. It hadn’t been approved by the FDA yet, but they were accepting clinical trials. The operation was fully reversible, only a small incision on both sides of the foot would be made. There was no drilling, no damage to bone, just soft-tissue and one ligament would be cut and sutured. There was just one catch. I’d have to be approved as a clinical trial. Dr. Gregor agreed that this was the best option, and we decided to go ahead and pursue this.

A few weeks later I was back at the doctor’s office. He’d gotten all the information and I was cleared as a candidate for the operation. I was one of 2500 people at that point world-wide who would be be undergoing or have undergone the operation. If it worked, my inflammation days would be over! Included in the information he got back was a video that outlined the whole operation, and followed a little boy who’s feet were seriously pronated. Far worse than mine. At the end of the video, just a few weeks after surgery, he was outside running and jumping, playing basketball. His feet were almost completely straight – it definitely worked for him.

It looked like this would do the trick. We scheduled the surgery for the last day of school before Christmas break. I left after a few hours of class (had an exam that morning) and we went to the outpatient one-day surgery center for Aultman North. Dr. Gregor was there, and everything looked good. I went in to surgery, saying, “Left foot. Left foot. The right foot is the wrong foot. Left foot. Left foot.” They knocked me out under general anesthetic. The surgery took about 15 minutes. I woke up about an hour later, they kept me there a while, gave me something to drink, and then prepared to send me home. I got this nifty surgical boot and a set of crutches.

The post-operative instructions were easy enough. Crutches for two days, after that, walking only with the boot on. Keep the foot elevated, don’t get the bandage wet, come back in a week and we’ll change it. I played a lot of computer games that weekend by putting a footstool under my computer desk and propping up my legs. :-) After two days I tried to not use the crutches. It hurt like crazy to put weight on it. Almost as much as it did before the surgery when it was inflamed. Only this time it was a dull cutting pain, rather than sharp shooting pain. It was much more bearable. After a few weeks I was allowed to get my foot wet again. After about five weeks I got the go-ahead to ditch the surgical boot. It was still sore. It still pinched a bit, and it was still uncomfortable, but it didn’t get inflamed!

Looking back, I’m not sure it ever didn’t hurt after that operation. I always limped. I didn’t realize it, but I never could stop limping. Over time my foot would get achy sore if I was on it long. It gradually got worse, very very gradually. I grinned and beared it assuming this was normal for something made out of titanium being stuck in between bones in your foot. The pain continued, I kept bearing. My parents occasionally would ask about it. They knew I was limping, they knew it hurt. By the time summer came it was bothering me again, but it was a different pain. I noticed what I thought to be some swelling below my ankle, but didn’t think much of it. Some days were better than others.

I had three jobs that summer. Full-time Janitor from 6 – 3:30 at Louisville Elementary School (best job I’ve ever had), from 4:30 to 10 (or 11:30 when I had to close) I worked at L.A. Grinders (a restaurant) as a busboy. On weekends I did the banquet-hall busboy / dishwasher thing. Marching band that year was rough. I’d been made section leader (against my own personal desire) moved to snare, and had 8 freshman on the line. Myself and one other person had previous marching experience. We all worked out tails off, and to this day my hat goes off to that crew. Those freshman worked their tails off. The season ended with the highest percussion score and overall scores our school had seen in over 12 years. Like I said, we all worked our tails off.

If the story ended there, there wouldn’t be much of a story. There also wouldn’t be much about the MBA implant that’s sitting on my bookshelf at home.

The first week of marching band I knew something was seriously wrong. My foot had been giving me trouble incessantly that summer. Stripping and waxing floors (and the slip-slide skating that comes with it) was taking it’s toll on my foot. Shortly after marching band started I found myself in the same place I had been the year before. I woke up, got out of bed, and hit the floor. My leg wouldn’t hold me. Once again I crawled to breakfast. My parents, who knew for some time something wasn’t right had finally had it with my stubbornness. It was time to go back to Dr. Gregor. That’s when I showed mom and dad the now very prominent lump on the outside of my foot below my ankle. It stuck out as far as the ankle did. I thought it was swelling when I first noticed it, but now it was unmistakable. It was as hard as bone.

I called off work for the day, went to band practice wearing my old surgical boot, and made it though the rehearsal. Iron Man had to train a crew of freshman, and weakness was not acceptable. “Pain is weakness leaving the body”, I said. So there I was. Surgical boot, unable to stand without it, marching around the field. People who went gimp (sat out) that day nearly got my boot up their backside. I actually confronted one of them. They had nothing to say to Iron Man. (hahaha)

That afternoon I went to Dr. Gregor’s with my dad. Dr. Gregor looked at my foot, poked it, prodded it, asked a few questions about how long it had hurt (always, since the operation) and then we took X-Rays. I had never seen him look like that before. He knew what I already knew. Something was terribly wrong. I sat in the room with dad reading magazines waiting on the X-Ray results. After about twenty minutes Dr. Gregor returned looking as pale as the paper sheet on the exam table.

“It moved, didn’t it?” I started the conversation.

“Um. Yes. I don’t know what’s happened. I want you to take a look at these X-rays if you can make it down the hall.”

“Sure! I gotta see this!”

“Frankly I don’t know how you can even stand up, much less walk. Your threshold for pain has got to be the highest I’ve ever seen.”

I took that as a serious compliment.

He continued, “I just got off the phone with the company that’s manufacturing the implant, they want to review the case with us. We have to take this implant out, if you want to put in another one we can. We should know more in the next few weeks.”

We got to the X-Rays. I’ll never forget looking at the before – after – after pictures. Before the operation, immediately after the operation, and nine months post-op. In nine months, the implant managed to screw itself further into the space between the bones. 1.3 centimeters further into the joint. The lump I felt on the side of my foot was a bone. In fact, every bone in my foot below and in front of the implant was seriously out of alignment. How was I standing up? Had to be sheer will. My foot was being deformed – badly.

I left the office with a prescription for the maximum adult dosage of Celebrex to ease the discomfort. It helped immensely. I wanted to try and put off the surgery until after marching band again, but since this time my foot was being deformed I was overruled. In retrospect that was the right move. I was to have surgery in mid September, a month and a half from the day I saw the X-Rays. I had about six weeks to get the Freshmen in shape before the guy a year younger than me took charge and made things difficult.

In a week we had the answer to what went wrong. Of the 2500 surgeries performed at that time, I was the thirteenth to have something go wrong. Lucky number 13. That was me. My case was the conclusive case that solved most of these problems. It seems if the implant is too large in diameter, the result is that it screws itself in further. My case closed the book on that mystery. Glad I could be of service. It turned out, during the first surgery I was between two sizes of implant. The company rep who was there suggested to go with the larger one, figuring I’d grow into it. Woah! Wait a second! Before that operation I was checked with X-Rays left and right. I distinctly remember hearing at one point, “The growth plates in your foot are all closed, so your feet won’t be getting any bigger.” The company rep didn’t know. I don’t blame anyone. I’d have probably done the same thing. But the fact of the matter is: I wasn’t going to grow into it. Not ever, and definitely not within nine months.

Mid September I had the second operation. They re-opened the previous scar (which healed so well you could hardly tell it was there) removed the old 10mm MBA implant and replaced it with an 8mm implant. There was another company rep and this time another specialist on hand for this operation. With the implant removed, my foot went back to it’s original shape, but things were stretched out. The new, smaller implant needed more time to get grown-in, and my foot needed to re-adjust to the right shape. Dr. Gregor after the operation said, “If this one moves, we’ll have to do something else. I stitched it to everything. If it was soft-tissue, it got stitched. This one isn’t going anywhere without letting you know immediately.”

I was told to stay on crutches for six weeks, was given a larger surgical boot that went knee-high and was inflatable like an air-cast. I was told to wear that for twelve weeks. I was not happy. Previously I was told to stay off of it for two days. Now they want me off of it for twelve weeks? During the height of marching season and wearing the boot in speech and debate season? The boot really caused problems for character transitions there. I couldn’t move my legs or snap my feet, and I didn’t like that. I managed to talk them into letting me go four weeks on crutches, eight weeks in the boot, depending on how the healing went.

After a week of crutches I would pump the boot up nice n’ tight around my foot and leg, and stand without support for short periods. After three weeks or so I was taking a few steps on it when no one was looking. I got the all-clear to walk without crutches after four weeks, but still wasn’t allowed to march – even with the boot for another two. When I had crutches I quit going to practice after school. I was useless. I attended games, played in the stands, and helped musically, but on the field I was out for the count. From what I heard, my presence was missed.

After all the leg spasms that nearly brought me down in the middle of the field, steroid injections, maximum dosages of anti-inflamatories, summers I spent lugging 60lbs around for 8 hours a day on an inflamed foot without giving up. I was Iron Man for two years straight. Now I was gimp for eight weeks. A sideline decoration, toting crutches, and a surgical boot. I was gimp. People in the band understood though. It wasn’t my decision. The doctors made this one for me, and they were right. To avoid long-term consequences, I needed the 2nd operation. To make sure this one was going to hold I needed to stay off of it.

After eight weeks, I was allowed to walk without the boot, limited activity. I was also allowed to march with the boot if I could. I had no problem donning the boot, racking the drums, and heading out like that. I marched four or five competitions with the boot on, never breaking a form. Some were hard to reach — crab walking with a 4lbs boot on one foot that’s bulky as all get-out wasn’t easy, but it was better than being gimp. All white shoes on a field, except this one guy with a huge black boot on his left foot.

Nearly twelve weeks after the surgery (mid November as I recall) we went to Columbus for the state finals. I brought my left marching shoe, one I hadn’t worn in months, as I refused to march in the state competition on Astroturf in that cursed boot. My brother and I had a long-standing tradition of having some of the highest toes in the band, and I’ll be danged if I’m wearing a boot and can’t move my foot on my last field march. I knew at that point everything was fine. I was confident in the 2nd surgery. It never hurt like the first one did. In fact, it was oddly comfortable.

Even marching twelve weeks later didn’t hurt this time, when walking 12 weeks later after the first operation was painfully. Talk about a sigh of relief and a welcome turn of events.

It’s been six years since the first operation. I don’t have any pain. My foot looks fine. The scars all healed exceptionally well. You can’t even tell where the exit-point of the bar they put completely through your foot when aligning the implant is without really looking for it. I have full use of my foot, only on a few occasions have I had any soreness, and that normally comes after being on it for 8 or more hours in a day. Even then, the next morning when I get up, the pain is gone. The MBA implant has been a definitely change for the positive for me. I can walk, run, bike, swim (not that I do any of these all that often), but my foot works. I don’t think about it much anymore — unless I nearly twist my ankle. Then I sometimes worry. The last time I had a problem with it was over a year ago, there was a sharp change in barometric pressure here and my foot nearly locked up for a day. It didn’t hurt, but it just felt like it needed to pop. About three days later I was stretching in my chair when it did pop. It had been sore for three days and instantly, it felt like things just snapped back into place, and it’s not hurt a bit since.

Over all, my surgery has been a success. I thank Dr. Gregor for suggesting this, and for being able to perform the operations. I had a roommate who’s badly arthritic for a year, and we both used to joke about feeling it in our joints when a storm was coming. I have no doubt that I can feel it in that joint, but it’s not painful, just an odd sort of stiffness until I get it moving. A small price to pay compared to what I had been going through. If it weren’t for the MBA implant, I’d probably not have a subtalar joint today. It’s only been six years… but I haven’t limped in at least five.

This entry was posted on Wednesday, September 1st, 2004 at 3:56 pm and is filed under Banter. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.