Issue 6 Stories
Feature

ON YOUR FEET!

Restoring Mobility with Foot and Ankle Surgery

Dayton resident Pati Clemmer understands the importance of taking good care of herself. Over the years she has enjoyed an active lifestyle that included a membership at the Sentara RMH Wellness Center, where she took up various types of exercise, individually and in group settings. But in January 2017, all of that got put on hold when a serious accident compromised her ability to move easily.

It was Jan. 11, a Wednesday evening, and Clemmer was working out in a Pilates class with her trainer and two other class members. Suddenly, she fell off the Pilates chair she was on.

“I’ve been doing Pilates for several years, so I was familiar with what I was doing, but I still don’t know how it happened,” says Clemmer, 70. “Suddenly I was on the floor in tremendous pain.”

Dire Consequences

The staff called an ambulance, and Clemmer was taken to the Sentara RMH Emergency Department, where she was assessed and given an intravenous line and pain medication. X-rays revealed that she had fractures in both bones of her right forearm; several broken bones in her right foot; and a shattered calcaneus, or heel bone, in her left foot.

The orthopedic physician on call that evening was Robert Kime III, MD, of Hess Orthopaedic Center & Sports Medicine in Harrisonburg. Dr. Kime saw Clemmer in the hospital, where she had been admitted, and began treating her injuries, starting with the arm.

“It was a pretty serious break,” Dr. Kime says. “We straightened out the bone, and then I put her arm in a splint.”

He had to use a splint rather than a regular cast due to the surrounding swelling, Dr. Kime explains. The next day, he put a splint cast on her arm, and about a week later, after the swelling had gone down, he put a regular cast on her arm.

Her arm wasn’t the only area where swelling was a problem, however. Swelling in her feet prevented those injuries from being treated upon her arrival at the hospital, so Clemmer was sent to a skilled nursing facility in town to wait for the swelling to subside.

“They didn’t want to send me home because of the stairs at my place,” Clemmer recalls.

Heel Reconstruction

Several days later, Clemmer met with Chad Moorman, DPM, podiatric (foot and ankle) surgeon at Hess Orthopaedics. Since the fractures in the midportion of her right foot were nondisplaced—meaning the bones were still aligned properly—a boot was all that was necessary to keep her from further injuring that foot while the fractures healed. Her left foot with the shattered heel bone, however, was a different matter, and surgery was scheduled at Sentara RMH for Friday, Jan. 27, to correct that issue.

“Dr. Moorman essentially had to rebuild my heel,” says Clemmer, who spent several hours in surgery. The procedure—open reduction with internal fixation—required the insertion of a stainless steel plate and 11 screws into her heel to hold things together. She also received donor bone to help restore the anatomy of the crushed heel.

The surgery is a complex and difficult one, according to Dr. Moorman. “Imagine if an egg dropped on the floor and you tried to put it the shell back together,” he explains. “The heel bone can collapse on itself like a broken eggshell. The goal of this surgery is to get the subtalar joint, a joint under the ankle joint, back up to its normal anatomical position, in order to limit post-traumatic arthritis and restore function of the joint.”

Clemmer was discharged from the hospital that Sunday, Jan. 29, and then went to stay with a friend who happens to be a nurse, and who has an apartment in her home that would make it easier for Clemmer to get out to her various follow-up appointments.

“I stayed with my friend for more than a month while I healed,” says Clemmer. “I kept the boot on my right foot for about eight weeks, and I had a soft cast on my left heel, which Dr. Moorman changed every week while the incisions healed.”

In the meantime, another friend, Glenn Martin, built a ramp at Clemmer’s home so they could drive a golf cart to her door, which helped her get around with less walking. “I still could not navigate steps,” she says.

Getting Back to Active Living

Clemmer kept the cast on her left foot for four months and then wore a tall boot after the cast was removed. She was only able to begin putting increased weight on the reconstructed heel gradually—starting with just 25 percent of her body weight and then increasing the amount until she could bear 100 percent of her weight.

Today, more than a year after her mishap, Clemmer still has challenges with her feet, but she continues to improve.

“I get along as well as expected, but my left foot still swells up when I walk on it very much,” she says. “Dr. Moorman told me at the outset that it could easily take up to a year and a half for me to heal fully. I haven’t been able to go on long walks, and I’ve been warned not to do anything with my feet involving pounding or absorbing impact.”

A major concern for Clemmer is to avoid falling again, says Dr. Moorman. Once she fully heals, she should be able to do low-impact aerobic activities like walking, bicycling or swimming, but probably not jogging, running, or faster-paced sports like tennis or basketball.

Dr. Moorman isn’t sure why Clemmer’s fall from the Pilates chair resulted in such extensive injuries. Underlying osteoporosis—a condition that results in weakened, fragile bones and is seen especially in women as they age—was one possibility. However, Clemmer had a bone scan in summer 2017 that showed no evidence of osteoporosis.

“Unfortunately, sometimes the severity of an injury just comes down to falling in a certain way,” he says. “It was probably just bad luck.”

Degenerative Joint Disease

Life for Michael Blackwell, 65, has been one of strenuous physical activity. For years, he was a long-distance runner, and he used to drag logs through the woods and cut his own firewood. Originally from Northern Virginia, Blackwell and his wife, Jean, moved to New Market after he retired several years ago, looking forward to spending more time participating in the activities he enjoyed so much.

Then in 2014 he began noticing something was wrong with his left ankle. According to Blackwell, he told his family physician that it felt “like something like a tendon had slipped.”

“At first, I noticed it only when I was going up inclines,” he says. “My wife and I would walk our dogs, and I was fine on level ground. But then the problem progressed to the point where I couldn’t walk on level ground, either, without experiencing that painful feeling.”

His family physician referred him to Orlando Cedeno Jr., DPM, a board-certified podiatric surgeon with Harrisonburg Foot & Ankle Clinic. X-rays revealed that Blackwell had no cartilage between the bones of his foot and lower leg.

“Michael had arthritis in his left ankle due to degenerative joint disease,” says Dr. Cedeno, who explained the treatment options to Blackwell. The first option involved fusion of the ankle, in which the foot is fused to the leg at a 90-degree angle. Fusion results in a stiff, nonmobile joint that requires the patient, working with a therapist, to learn how to walk with a nonbending ankle joint. Blackwell’s other option was to have a total ankle replacement, which was the solution Dr. Cedeno recommended.

A Difficult Choice

“I was devastated when I learned that I needed an ankle replacement,” remembers Blackwell, who decided to mull over his options before going forward. “I didn’t want the fusion, which would basically leave me crippled for life, but it was scary to face the replacement.”

Two weeks after seeing Dr. Cedeno, Blackwell opted for the ankle replacement, and his surgery was scheduled for Jan. 4, 2015, at Sentara RMH.

To prepare Blackwell for the surgery, computed tomography (CT) images were taken of his left ankle and sent to the company that makes the implants used in the joint-replacement procedure. The implants are made specifically to fit the individual patient’s ankle, based on the CT images.

During the procedure, the surgeon uses X-ray guidance technology to make the proper cuts. The implants are then placed in the ankle joint, and a cartilage-like polyethylene substance is placed between the implants to increase mobility in the joint. Finally, the repaired joint is stitched up to heal.

“The newer ankle-replacement systems we use today, like the STAR ankle by Stryker Orthopedics that I used with Michael, require minimal cuts, compared to those that were in use when I was in training,” observes Dr. Cedeno. “The procedure has definitely advanced in recent years. “

Slow, Steady Recovery

Blackwell’s surgery went well, after which he was in the hospital for two nights and then was released to go home, under the care of his wife. He first wore a cast and then progressed through a series of braces to help stabilize his ankle as it healed. Several weeks after his surgery, he began rehab.

“It was quite a while before I could put weight on the ankle,” says Blackwell. “I used a scooter to help me get around.”

Today, three years later, the couple lives in Keswick, Va., just outside of Charlottesville. Blackwell still has some pain in his ankle if he walks too much, but the pain goes away with rest. He uses an ice pack to help reduce the occasional swelling he experiences, and he has been able to give up the cane that he relied on for a while during his recovery.

“I feel like it’s taking a long time to heal, but I’m definitely getting better,” says Blackwell.

He and his wife still walk their dogs, and he enjoys other activities as much as he can.

Excellent Care—Locally

Clemmer says she is glad she was able to receive the care she needed locally, where she felt most comfortable.

“The staff at Sentara RMH took such good care of me,” she says, “and I can’t say enough good things about my doctors at Hess Orthopaedics—especially Dr. Moorman. Their skill, patience and compassion were exceptional. They explained everything to me and helped me so much after my fall.”

Blackwell is equally positive about his caregivers and surgery experience.

“Everybody at Sentara RMH involved in my care was just great—they treated me like I was the president,” he says. “And Dr. Cedeno is a great guy. He gave me his cell phone number and said to call him if I had any questions or issues at all.”

For the physicians and staff members at Hess Orthopaedic Center & Sports Medicine, Harrisonburg Foot and Ankle Clinic, and Sentara RMH Orthopedics and Sports Medicine Specialists, it’s important that community members understand that they don’t have to travel out of the Harrisonburg/Rockingham area for the specialized care they need—whether it be general orthopedic care, sports medicine care, spine care, podiatric care, joint replacement or pain management.

“We offer safe, effective specialty care locally, including advanced foot and ankle surgery,” says Dr. Cedeno. “We’re very capable of helping people get back to the lives they enjoy.”

“My advanced training enables me to care for patients with acute traumatic injuries of the foot and ankle, and to follow them through the long term with advanced reconstructive procedures and implants like total ankle replacement and minimally invasive surgery,” notes Dr. Moorman.

Adds Dr. Kime: “If you can get the same type of care here in Harrisonburg—and we feel in many respects that the care we provide locally is superior to that offered in other places—why would you go anywhere else?”

 


For more information:

Hess Orthopaedic Center & Sports Medicine

4165 Quarles Court,

Harrisonburg, VA 22801

540-434-1664

hessortho.com

 

Harrisonburg Foot & Ankle Clinic

Please note new location:

2105 Evelyn Byrd Ave.,

Harrisonburg, VA 22801

540-434-2949

harrisonburgfootankle.com

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