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Old 01-21-2005, 02:35 PM   #1
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Toe fusion questions

Hi again,

I have a few more toe fusion questions (thanks in advance for your help!):


- My doc said my big toe would be shorter (obviously) but how much shorter are we talking? I haven't had any previous foot surgeries...

- One ortho surgeon said he cuts the ends of the bones before fusing the other said he scrapes the cartilage away before fusing -- is one technique better than the other? Or are they both basically the same?

- Are there certain types of shoes you can no longer wear -- like thongs? I don't wear heels now so I don't really mind that limitation. For that matter, if a fusion will eliminate the pain the shoe type doesn't really matter! (Actually, I'm used to wearing only Birkenstocks -- I guess I'm just a little curious in general!

- What is the best angle to use for the fusion? I've heard 10% and 15% -- how is it determined? I want the most functional angle -- I don't care about wearing heels (I haven't worn them for about 12 years anyway...)

Thanks again for your assistance! This board is great!

P.S. My 1st fusion is scheduled for the end of February... I'm still researching the procedure and my doc too. I don't live in the same town and am trying to find out what his 'reputation' is!

~Heather

Last edited by imhdab; 01-21-2005 at 02:39 PM.

 
Old 01-21-2005, 03:02 PM   #2
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Re: Toe fusion questions

I hope this helps...My DR never mentioned that my toe would be shorter...very intersting. I believe the norm for a women is 15* That is so you can at least wear a tiny heal...I don't wear them much either, I have a 15* but I am still swollen so I can't tell. Can't wait to go shoe shopping though! I don't see why you couldn't waer thongs...the only thing I was told is no heals higher than 1/2 inch and I might need a boxier toe and not the pointed ones that are so popular that I don't wear anyway.
As far as scraping or removing bone...my Dr cleaned up the cartladge and chisled some bone...not real sure about if one way is better...guess they all do it differently.
Good luck in Feb with your 1st fusion......
dlh

 
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Old 01-23-2005, 02:52 PM   #3
eko eko is offline
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Re: Toe fusion questions

Yes, your big toe will be shorter due to the fact they are removing the joint. It is not that noticable unless you really look at it closely. Besides in my family the second toes tends to be slightly longer the the big toe anyway.

When they prepare the bones for fusion, they remove any cartilage and trim off then ends of the two bones so that they can come together.

You will be able to wear thongs and sandels with no problems. As you already know, heel height will be the restriction. My Dr. was aiming for 15 to 20 degree angle, we ended up at 17 degrees, so my heel height is 1 1/4 inches max.

If you have any other questions, let us know and we'll do our best to answer them.

Good luck with your surgery! -eko
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Old 01-23-2005, 05:32 PM   #4
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Re: Toe fusion questions

Thank you so much for your responses!

I do have a few more questions about the angle:

- Do you have a choice on what angle they use?

- How is this determined?

- What are the pros and cons of different angles?

- Is there some angle that is the best for walking, stairs, etc.? I haven't worn heels in about 12 years so that's not a big issue but do work out regularily and want keep doing that. I am/was active and would like to stay that way!

I feel like totally obsessing about this upcoming surgery. Sometimes I can't believe that I have to have something this extreme done and other times I feel like it's no big deal. I guess part of it is the fact that (other than this board) I don't know of anyone whose ever had to have this done!

When I told my boss and coworkers what type of surgery I had to have, they all gave me this weird (horrified?) look!

Oh well! Life never seems to get boring!

Thanks again!
~Heather

P.S. Thanks again! I'll probably have a few more questions soon...

Last edited by imhdab; 01-23-2005 at 05:38 PM.

 
Old 01-23-2005, 05:53 PM   #5
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Re: Toe fusion questions

I know how you feel...people seem to think it is a strange thing to do but if it will take away the pain it is worth it. I just am begining to realise that my toe will not move...I am finding it really weird but people say you get use to it.
My Dr did give me a choice but we went with the 15* because it will enable me to walk right but still wear a bit of a heel...I am like you though and really don't wear them. I live in a 2 story home and wonder if stairs will be hard...EKO said she found it somewhat hard...I imagine I will learn as I have to use them everyday. Talk with your DR. and ask him about the angles...decide what is best for you. Some one else on the board may know more about that, I just wanted to walk without pain and not have my toe really sticking up...so far it looks OK...guess time will tell what we finally ended up with. Any more questions???
dlh

 
Old 01-23-2005, 08:29 PM   #6
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Re: Toe fusion questions

Well... one more question!

My big toe joints are shot and very painful... but in the last week or so I've noticed some pain in my small big toe joint. Did any of you experience that? Can they fix this too? -- and if so, what do they do to it? (They wouldn't fuse everything -- would they?)

Thanks again!

~Heather

P.S. Hopefully after I've been through it I'll be able to "pay it forward" and help someone down the road!

 
Old 01-24-2005, 04:24 AM   #7
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Re: Toe fusion questions

HI Imhdab,
Just reading your latest post. I just had that joint fused. Thank god they did not fuse the main joint yet.He said in time I will need that one done. The reason for not doing it now is because Im 44 and work full time and my job requires me to bend my feet/toes(squating). The DR. said that once they fused the main joint I would not be able to squat . But yes, it is possible to fuse that joint.
Sue

 
Old 01-24-2005, 05:42 AM   #8
eko eko is offline
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Re: Toe fusion questions

Quote:
Originally Posted by imhdab
I do have a few more questions about the angle:

- Do you have a choice on what angle they use?

- How is this determined?

- What are the pros and cons of different angles?

- Is there some angle that is the best for walking, stairs, etc.? I haven't worn heels in about 12 years so that's not a big issue but do work out regularily and want keep doing that. I am/was active and would like to stay that way!
Most of the time they have a standard angle they shoot for, one for men and one for women, just based on the way shoes are made in general. My Dr. did make an exception for a guy once who only wore cowboy boots and required a greater angle then normally required for a male.

Fifteen to twenty degrees works great for walking, it permits me to roll of the front of my foot when walking, and to go up on my toes when reaching for something up high. Someone noted that I had problems with stairs, that has gotten much better. Fifteen degrees may sound like a lot, but it is the angle of the two bones once fused, it does not look the high when you look at your foot afterwards because the bottom on your toe is less than fifteen degrees off of the floor, so your toe is not sticking straight up.

Talk to your Dr. on how he determines the angle, it he can't answer the questiosn, then perhaps he is not the right Dr.

Hope this helps! -eko
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Old 01-24-2005, 08:34 AM   #9
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Re: Toe fusion questions

Eko...i am glad to hear you are doing better with stairs...that was my concern as i live in a 2 story...
Heather...I also had pain in the little joint but it hasn't hurt since the surgery, i thought it was just refered pain and didn't want that joint fused so at least I can wiggle it some...talk to your DR about it though if it bothers you alot, they can fuse them both...we did discuss it but decided against it as my DR did not feel it was needed and I really didn't want to. Have you decided which DR you are going to use yet?? Are you sticking with DR # 2??
dlh

 
Old 01-24-2005, 06:56 PM   #10
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Re: Toe fusion questions

Heather,
Just wanted to add my two cents. I had the bones scrapped. However, I was in a slightly different situation. Because of my previous surgeries, my big toe was already shorter. Therefore when I had the fusion, I had to have a bone graft. My dr. took a piece of bone from my left hip (same foot that was done) and filed down the edges of the bone.

My angle of fusion is about 15%. I have found that I can wear heels about 1 - 1 1/2" high. I have found that I actually perfer a shoe with a little cushion under the ball of my foot.

I live in a two story house and don't have any problems with the stairs. However, I did go up and down on my bottom for many weeks. Easier than using the crutches.

jdm

P.S. I am almost one year post op and fusion was the best thing I ever did.

 
Old 01-25-2005, 05:59 AM   #11
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Re: Toe fusion questions

Hi everyone and thank you SOOOO much for all the information!!!

Well, I've decided to go with Dr. 2 who IS on my insurance plan. (No way can I afford a doctor who's not.) Since I first posted I did have heard some good things about him... plus, he did his foot/ankle fellowship at Mayo/Scotsdale -- that's a good sign, right? (He's an ortho specializing in feet/ankles and apparently does LOTS of fusions...)

I'm scheduled for late next month and have doing lots of research on what to expect, what gadgets and things I need to purchase, etc. They told me yesterday I may be out of work for a whole month?! YIKES! I've also been practicing going up and down stairs on crutches... WOW! It's really difficult and I'm afraid I may fall down the whole flight! I'm checking this board for tips on stairs but in the meantime how did you manage? I may have to scoot up and down. (Having 3 cats doesn't help either!)

Thanks again! This board has been sooooo helpful!

~Heather

 
Old 01-25-2005, 08:36 AM   #12
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Re: Toe fusion questions

Heather,
If you are only out of work for a month be happy! I will be out at least 2 and maybe longer but I work on my feet (I renovate houses)
I can use the crutches on the stairs but because I am so clumsy I actually walk up them on my knees...great workout for the hams!!! I hold onto the rails and kinda "hop" down on my other foot...hard because I have PF in that foot but it gets me up & down the stairs. There is a thread here, tips on surgery...have you read it? Some good advice there.
dlh

 
Old 01-25-2005, 09:23 AM   #13
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Re: Toe fusion questions

You go up the stairs on your knees?! Wow, I'll have to try that! Does it work for going up as well as down? I did try scooting backwards going up the stairs -- GREAT exercise for your triceps! I've also upped my arm/upper bod weights & exercises at the gym too.

Thanks for the suggestions! I'll try it tonight and let you know how it works.

 
Old 01-25-2005, 01:28 PM   #14
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Re: Toe fusion questions

I either hold onto the rails and hop down or scoot down on my bottom...it works for me!!! But the knees going up works well, you just need to brace yourself. You will need that upper body strength, i wish I had trained.

 
Old 01-25-2005, 02:02 PM   #15
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Re: Toe fusion questions

Up and down the stairs is somewhat dangerous. Especially when you really get the hang of it and let your guard down. Even when you get very good at going up and down the stairs with crutches, be very very slow and careful. I fell twice due to going to fast and not paying enough attention.

Training may help, but crutches are their own beast. Prior to my surgery I was swimming 1.5 miles a day, doing 150 push ups and lots of dips and pull ups and still found that the crutches totally kicked my butt. I went Christmas shopping with my wife for 2 hours and thought I might just have to spend the night in the Galleria because I was unable to go anymore.

It will be tough and you will be sore.

 
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