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Old 07-18-2007, 01:43 PM   #1
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Big toe joint replacement - is fusion the answer?

Has anyone had a big toe joint replacement that has gone wrong? Mine has and I am now faced with - I think the only option - a fusion. I don't want to have this done unless it is the only option and just wondered if anyone else has gone through something similar?

 
Old 07-18-2007, 02:23 PM   #2
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Re: Big toe joint replacement - is fusion the answer?

That is the only option after the implant.

 
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Old 07-19-2007, 04:13 PM   #3
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Re: Big toe joint replacement - is fusion the answer?

Depending on your implant there is one other option. I was given this option after my implant failed, but I chose the fusion. My pod said that he could remove half of the implant and that might (might being the key word) free up some movement. However, if that didn't work, I would have to have the fusion and it would have to have been sooner rather than later. I decided that I couldn't go into a third surgery (the implant was surgery 2) knowing that it might not work and I would end up with a fusion anyway.

From my experience, the fusion was the best thing that I did. I had a bone gradt from my hip. The hip healing was almost worse than the foot. I couldn't sit by myself for a couple of days.

If I can answer any ?'s let me know.

Jennie

 
Old 07-24-2007, 03:00 PM   #4
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Re: Big toe joint replacement - is fusion the answer?

toe fusion is the final. your toe will never bend and will stick up. you will never be able to wear high heels. if you are in severe pain, have the toe fusion. i did and iam 51. recovery takes a long time, but i think in the end it is worth it. if you are not in pain, dont do it.

 
Old 08-24-2007, 10:10 PM   #5
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Re: Big toe joint replacement - is fusion the answer?

Hi Debbie,
I had a 1st metatarsal joint replacement in late May this year and still can't
bend my joint and am still in pain when I walk. My doctor wants to take out
the implant and fuse the joint, but I am very nervous about it. How long did
it take to be able to walk, wear shoes, what height of heel can you wear?
I am 53 and very active - would like to be able to play tennis etc. Basically my sport is ridng horses (competition dressage) which isn't too bad on my foot, but wearing boots is painful at present.

 
Old 08-24-2007, 10:13 PM   #6
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Re: Big toe joint replacement - is fusion the answer?

Hi Kathleen,
I too have had a joint replacement which has not worked. Joint still very stiff, only 10 degrees dorsiflexion and painful. My doctor wants to now fuse it which I am nervous about. Did you do it and how are you feeling?

 
Old 08-25-2007, 10:30 AM   #7
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Re: Big toe joint replacement - is fusion the answer?

I had a 1st mtp fusion done as well. My toe still bends but it is the joint within the toe that bends. The MTP joint does not bend. This fusion takes a long time to heal fully. Most doctors will have you non weightbearing for 8-12 weeks. It can take up to a year for the swelling to completely subside. That being said, when it works you will KNOW it! The first two attempts at fusion on my foot were unsuccessful. I kept at my doctor even when he was convinced that the joint had fused. Finally a CT scan showed otherwise. This time is TOTALLY different! My big toe does not stick up. It LOOKS just like the other foot but the end of the toe is a mm or two off the ground....in other words not noticeable. The end joint does move and can bend down to the ground to stabilise me for one legged balance. I still have sore days but it has only been 16 weeks. I can wear running shoes and when I am concentrating, I do not limp! I can wear sandals. I prefer my Ecco sandals as they have velcro at the toe and ankle straps. So far, I can wear a one inch heel with relative comfort but I am able to get into 1 3/4 inch heels....they just are not too comfortable yet. That will take more time. The joint is normally fused at about 15 degrees. If you really want to wear higher heels, the angle could be increased slightly but that would cause your toe to stick up when you are not in heels!!
To Debbie....I hope I have answered here your questions from the other thread. I am just so happy with the outcome so far this time with the fusion. Have you had a CT scan to ensure that your joint has fused?

To Lise....Good luck with whatever decision you make. If you have any other questions, I will be more than happy to try and give you my perspective. With regard to boots....you will have to find boots that have a FULL zipper or some other kind of opening. Boots with a low heel would be an option EXCEPT when the 1st MTP joint is fused and no longer bends, you CANNOT bend your foot in order to slide it into the boot! The big toe will catch on the bottom and your foot will go no farther.

Sophie

 
Old 08-25-2007, 12:34 PM   #8
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Re: Big toe joint replacement - is fusion the answer?

kathleen, what did you decide to do? it is almost 10 months for me. i never thought i would come this far. thw swelling is still there, but i can wear some of my own shoes! at the end of october, iam going to have the metal plate taken out of the toe because it irritating the toe. it should help in wearing more shoes, but i am scared to have surgery again. i still have some swelling. anybody contemplating toe fusion should know all the side effects. riding boots if they have a big toe box should be fine for you. i bet they can customize the boot for you. i am doing all my activities i did before except playing singles in tennis. i am sticking with doubles. i say dont be in pain and make sure you have the best dr and other opinions. please let me know. sophie how can your toe not stick up. mine was supposed to be 15%, but when measured it was 10. i can push the toe down with my hand because the from the bottom of the nail bed to the top is not fused. debbie

 
Old 08-25-2007, 06:40 PM   #9
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Re: Big toe joint replacement - is fusion the answer?

Debbie, If you looked at my feet, you wouldn't be able to guess which one had the fusion! Both have scars and both have issues with the joint. One has been fused and the other will have to be fused in the future because I have the same issues with that one. As of now....you would never guess. The toe doesn't STICK UP at all! Yes...there is an angle mtp joint to distal end of toe but it is countered by the opposite angle of the metatarsal from the cuneiform to the mtp joint (this is also known as the height of the arch). Maybe since my arch is high....my toe doesn't stick up. I'm not sure why yours does....maybe you should ask? Also, I see that you are having the hardware removed. It MIGHT be an idea to ask for the CT scan before the surgery so you don't have any surprises! Swelling is one of the signs of a non union. There are posters here who THOUGHT the joint was fused only to find out differently during hardware removal. SoCalSharon....are you around? I think that was you wasn't it? My doctor also said mine had fused...the first time and the second time...I knew differently! Take care, Sophie

Last edited by sorefootsophie; 08-25-2007 at 08:09 PM.

 
Old 08-27-2007, 02:32 PM   #10
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Re: Big toe joint replacement - is fusion the answer?

Hello All,
Good to hear the progress. My 2nd surgery was a metal hemi-toe implant in the MTP which had to be removed because it "didn't seat properly". Dr. said a new implant would eventually have to be removed followed by fusion so I chose fusion. I had a bone graft from my hip and mtp fusion in 7/05. I had frequent swelling and redness so my new doc removed the hardware in 4/06 and discovered a non-union which was not visible on an xray and even if we'd waited the full year, it wasn't ever going to heal. In 7/06 he did a "revision" with bone glue he created with bone from my heel. The heel does not bother me at all, but my hip, 2 years later, is still painful often. Apparently, this is not uncommon, so I don't recommend it. The pod who did my revision said he never recommends it for this very reason. 6/07 I had a ct scan which confirmed a union (finally) so in July I had the hardware removed since I had a lot of irritation from it. That was 5 weeks ago today and I'm finally seeing an end to the pain (almost 5 years since my first procedure). The hardware removal was pretty easy comparatively. Just a twilight sleep which I came out of easily, percocet for a week followed by vicodin for a few weeks. The nerve was really angry after being disturbed 6 times . I'm now feeling much better and get my xray next Tuesday so I'll let you know what he says. Regarding the fusions: It's impossible to predict if yours will fail or not and it takes a full year to heal. Be patient or don't chance it. Before my first surgery (at age 42) I had power walked 3 marathons and was really into hiking and mountain biking. Now I'm 47 and have been mostly sedentary as the these surgeries have run my life. Maybe I'll hike this year though .
Sharon

Last edited by SoCalSharon; 08-27-2007 at 02:34 PM.

 
Old 08-27-2007, 02:39 PM   #11
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Re: Big toe joint replacement - is fusion the answer?

hi sophie, my dr will only remove the hardware with a ct scan. there is still some swelling, but i can fit into shoes i couldnt 8 months ago. i guess the ct scan will know for sure. sharon, how long is recovery from the removal of hardware and were you in a cast or surgical shoe? debbie

 
Old 08-27-2007, 02:44 PM   #12
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Re: Big toe joint replacement - is fusion the answer?

Well, the jury is still out on how long. It's been 5 weeks and most afternoons I spend elevated still and can only wear a couple of my pairs of sandals. I am doing better though and actually ventured through home depot without the electric wheelchair cart today!! I was in a surgical shoe for about two weeks. Take care.

 
Old 08-31-2007, 09:01 AM   #13
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Re: Big toe joint replacement - is fusion the answer?

Your situation seems similar to mine. My dilemma is while the smaller implant surgery can fail, I'm told that the bone fusion can fail as well. How long did it take before you were able to wb and get your foot into a sneaker? My last surgery, it took 6 months before I could wear a sneaker. Presently, 10 months after surgery, I am able to wear a sandal. However, I cannot walk for long periods as the pain accelerates. I was out of work for 7 weeks with the last surgery when I was told I would be back at work in 3 weeks. Now I'm being told that if I have the surgery with the smaller implant, recovery will be quicker since he won't be cutting any bone as in the last surgery. From reading messages on this board, people are saying that after the bone fusion they are having hardware removed. What kind of hardware are they referring to. Is it something that is installed while performing the bone fusion? Thanks for your input.

 
Old 08-31-2007, 01:06 PM   #14
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Re: Big toe joint replacement - is fusion the answer?

hi dancing feet, the hardware is only removed if it is irritating the toe. it is a metal plate and screws. i am going to have the plate removed because its hurting my big toe on top. it should be easier to wear shoes after it is taken out. debbie g

 
Old 11-12-2007, 07:26 PM   #15
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Re: Big toe joint replacement - is fusion the answer?

Hi Everyone!

I must say I'm so glad to have found this message board with people who KNOW what I'm going through. I little history about me. I'm currently a 33 year old male who had a Head Procedure Bunionectomy back in June 04'. The results were terrible. First off the doctor told me to walk out of the hospital. I don't know about you guys but I couldn't put a ounce of weight on my food after the surgery. It took weeks somewhere around 6-8 for the swelling to go down. I was never happy with the results of my surgery. My foot hurt so bad that a little over a year and a half I had to have foot surgery again....this time my 2nd surgery was a metal hemi-toe implant in the MTP. Oh my I thought my first surgery hurt like hell. This one was so painful for so long. I had it done in Dec of 05'. I went to my doctor so many times complaining about the pain. I got a cortisone shot in the side of my foot shortly after surgery. I think that was the worst pain I've ever had. Anyway....here I am almost 2 years later and my right foot hurts so bad at times I can't walk really well. My level of activity has really fallen off. I used to rock climb and was advit runner. Both of those days are no long gone. I must say I'm scared of the thought of having another surgery. My doctor has now told me the only thing left to do is to fuse the joint.
Ugh....I can't believe a foot could hurt so much. I've known people with hip replacements who had less pain than what I seemed to have had. Thanks for any support you guys can give me.

Austin

Last edited by austinexs; 11-13-2007 at 04:07 AM.

 
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