This little piggy went to market...

This little piggy stayed home,
This little piggy had jam and bread,
This little piggy had none,
And this little piggy went wee wee wee all the way home. 

I wouldn't surprise me very much if there weren't very many people who had never heard this nursery rhyme before. Depending where you live, of course, there is likely to be some variation. A quick search online suggests several alternatives to this little piggy had jam and bread. The jam and bread bit has been replaced by other types of food like roast beefs or bread and butter. And there are always people who use their own favorite foods, like chocolate! Lots and lots of chocolate... milk, dark, praline, bittersweet, hazelnut, the list goes on. This version of the rhyme has five lines. Apparently there are also versions with ten lines or several extra verses, but I have never heard them.

The primary things that accompany this rhyme, despite which foods are named, are toes. Yes, toes! The verse is a form of fingerplay, a term that refers to a song or rhyme that is accompanied by hand or finger movements. In a way, the hands/fingers perform movements to act out the rhyme. In the case of the rhyme above, each line corresponds to one toe. When a person, a mother for example, says a line, she wiggles one of her child's toes; by the time she reaches the last line she wiggles the littlest toe and tickles the child's feet, hopefully followed by laughter, smiles and all around silliness. If I substituted jam and bread with different types of chocolate, I would need a whole lot more than ten toes!

But why am I talking about toes? This is, for all intents and purposes, a blog about bone infections and external fixators. What role could nursery rhymes about toes possiblly have? Let me explain.

When I was recovering in the hospital after I got my external fixator, I noticed that the top of my biggest toes had gone numb. I could feel pressure when I pressed on the skin and even a bit of pain when I squeezed my toe really tight but, for the rest, nothing else. If I just touched the toe, there was no feeling. Despite the numbness on top of the toe, I did (and still do) occasionally experience a dull shooting nerve pain within the tow itself. I had hoped that the numbness would go away after a few days once the physical trauma of surgery started to fade, but it did not. When I went for my post-op appointment at the fracture clinic the following week, I brought the numbness up with my surgeon. He explained that this was normal and would likely spread across the top of my foot as my fixator was adjusted and the pins put more pressure on the nerves running through my leg into my foot. He also reassured me that all feeling should come back once the fixator is removed.

Given this information and the fact that the top of my toe was already numb immediately after surgery, I readied myself for the day I would wake up and realize I couldn't feel the top of my foot anymore. As time went on and the adjustments on my fixator progressed, however, I wasn't experiencing any numbness other than that on the top of my big toe. Over the last few weeks I even began to think that maybe I would get lucky - maybe no more numbness for me. In many ways I was right, but then I was also wrong.

Today I woke up to new numbness, numbness unlike that I had experienced before. But this numbness was not on the top of my foot as I had anticipated; it was throughout the remainder of my big toe. At first I thought that maybe I had slept wrong (sometimes I try to sleep on my side, although this is difficult to do because of the fixator - this position puts strain on the skin around the pin sites, causing pain and discomfort) and that the sensation would come back quickly, like when your foot falls asleep from sitting cross legged for too long. I kept expecting to get that familiar pins and needles sensation and the feeling of blood rushing back into my foot like when you finally do shift your weight or change position, but it never happened. I do have some sensation on the skin on the bottom of my toe - when I touch certain parts everything does still feel normal. Those normal spots, however, have shrunken quite a bit today alone already. I expect this will continue to happen as I adjust the fixator twice per day, resulting in an increased amount of pressure that the pins place on the nerves. More significantly, however, is that when I put my foot on the ground my entire toe does feel numb - there is a sensation of pressure, but nothing else. It is almost like it is dead weight. Not that a toes weighs that much, but it is still something you notice. It is different and not right. Something signals an alarm in your brain and your body screams at you to wiggles your toes to get blood flowing again, but not matter what you do the sensation does not come back.

On top of the numbness throughout the rest of my toe, I have also started experiencing some numbness on my inner heal/foot. I had suspected something was up a few weeks ago when I was rubbing lotion on my feet but whatever minimal numbness that I had experienced went away as quickly as it appeared. I gave it no more thought. Fast forward to tonight when I was using a loofah and realized I couldn't actually feel the loofah as I rubbed it against my heel - a whole patch of numb skin! This patch is mostly on my inner foot, very slight on the bottom of my foot and a tad bit over my ankle. Like my toe, my heel also only feels numbness and pressure when I set it on the ground. How did this spring up on my so unannounced? I have no clue. I pride myself on taking good care of my foot despite the external fixator thing and not getting my leg wet when I shower. I regularly wash my foot, trim my toe nails, loofah, and message my foot when it swells up, so I don't think this is something I simply overlooked. My best guess is that the adjustments I made on me fixator over the last few days must have hit a major nerve (possible multiple nerves) leading to those areas. As with my toe, I hope that sensation returns once the fixator is removed. I also experienced a teensy bit of tingling and numbness on the outside of my foot by my little toe during the afternoon, but it is gone now. Hopefully it will not return, but it wouldn't surprise me if it did. In fact, as this point I would be surprised if it didn't come back.

The funny thing is, the little pig rhyme came to mind the moment I realized the extent of the numbness after I showered. It has been stuck in my head ever since! There was something comical about it, especially when I realized that I had, and to some extent still am having, trouble wiggling my toes - the main point of this nursery rhyme! And that is why I have subjected you, my readers, to a post about a nursery rhyme and toes. =P

I will bring this up, of course, with my surgeon during my appointment on Friday. I suspect there is nothing we can do about it while the fixator is securely attached to my leg. And like the numbness on the top of my toe, I suspect I will find this numb, dead weight sensation a bit bothersome for a while, but then I will become used to is and notice nothing of it. Well, as little as possible when you can't feel body parts. I might get used to the feeling in my toe and heal, but I won't get used to the idea or thought that parts of me are numb. Who could?

Oh, and I have learned a valuable lesson. With all things fixator related, never assume you have overcome the possibility of specific side effects. You never know, they could always turn up.

And with that, this little piggy is going to bed.