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Old 08-31-2007, 09:19 PM   #1
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Toe Fusion Opinions

I severely jammed my big toe several years ago during sports which set in motion a degenerative condition.

Three years ago I had a cheilectomy and an osteotomy to spread the toe joint and clean the arthritic condition out. That seemed to work for a few months and then the arthritic condition re-commenced.

The podiatrist who did the first surgery recommended a toe joint fusion. I wasn't ready for the permanence of that solution so I went for another opinion. The second podiatrist said he could peform a partial hemi implant on the distal side of the toe joint as an alternative - sounded good.

Any way, now the joint is painful and cracking a lot (10 months since implant). The original podiatrist recommended fusion again but since the implant is there, the implant will have to be cut out (along with a large chuck of the phalange). Bone will have to taken from a donor site as a block and then the toe fused w/ external plates (10-12 weeks non-weight bearing).

I'm going for a 2nd and 3rd opinion.

Has anyone had a toe fusion after a failed implant w/ a bone block (either synthetic or natural)? The failure rate for this procedure was specified at 40%. If it fails what next? I'm kind of losing my optimism.

Thanks!

 
Old 09-01-2007, 01:02 PM   #2
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Re: Toe Fusion Opinions

i had toe fusion after an implant. the implant never worked at all. its been 10 months since the fusion and i have to say its incredible. for some reason about a week ago i started to have pain on the bottom of my foot under the fused big toe. i go to my dr on wednesday. do you know what the side effects are from fusion? the whole thing is not to be in pain anymore. debbie g

 
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Old 09-01-2007, 03:36 PM   #3
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Re: Toe Fusion Opinions

Thanks Debbie.

Two podiatrists stated that fusions are the way to go with toe joints such as mine. PTs on the other hand have stated that w/ a fusion, the knee and hip joints may cause problems in the future based upon the change in the foot dynamics. Both sides have convincing arguments.

All I've heard about the fusions are that the recovery is rough but once healed, the patient should have no limitations and would be pain free.

 
Old 09-02-2007, 03:27 PM   #4
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Re: Toe Fusion Opinions

did you go to an ortho? why do you think the implant didnt work? my bone pulled apart. make sure you have the best surgeon. i dont know if i did that. itrusted my pod and i guess i still do, but i will know more after wednesday.

 
Old 09-02-2007, 08:11 PM   #5
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Re: Toe Fusion Opinions

I didn't go to an ortho (main ortho clinic only has a podiatrist for foot issues), but will be seeing two additional podiatrists. I don't think the implant failed per se, but it appears that the other side of the main toe joint is still in a degenerative condition which is causing a lot of pain.

I suppose that another option would be to place an implant on the other side of the joint in lieu of fusion. I'll know more by Thursday. Hope your appt goes well!

 
Old 09-03-2007, 07:37 PM   #6
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Re: Toe Fusion Opinions

Hi Debbie G,
When you had the bone fusion, did the Podiatrist take bone from your hip? knee? or some other source? If bone was taken from your own body, are you experiencing any pain from that site? Also, do you now have to wear wide shoes? Can you wear a small (2") heel? The Orthopedic Doctor said I would be able to wear a small heel. Actually, at this point I will just be happy to be able to walk in regular shoes without pain.
The Podiatrist volunteered to call the Ortho Dr. that I saw for the 2nd opinion to discuss my case. The Pod thinks I should go with him removing the titanium implant and replacing it with the smaller implant. My Pod said he would get back to me this week after speaking to the Ortho. I thought that was nice of him. He does seem to have my best interest in mind in that he wants to keep the toe mobile. I just hope he knows what he's doing. I don't want to have to go for a 3rd surgery. I'll wait to hear from him before I make a decision. I tend to believe that if I go for a 3rd opinion from another Ortho, that he will probably agree with the first Ortho and advise me to have the bone fusion.
Let me know how you make out at your next appointment. I'll let you know what the Podiatrist says after I speak to him this week. Good Luck.

 
Old 09-04-2007, 05:32 PM   #7
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Re: Toe Fusion Opinions

hi dance, they took it from my heel and it was no problem. i dont want a 3rd surgery either. i will post tommorrow if i know anything. also, i do have to wear wider shoes and i can wear a 2 inch heel as long as i dont have to walk a long time.

 
Old 09-17-2007, 05:20 PM   #8
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Re: Toe Fusion Opinions

Your story sounds very similar to mine. I had a fracture that was never diagnosed and therefore healed wrong. In 99, I had a surgery to "save" the joint. After several months, I knew that it didn't work - still in considerable pain. In 00, I had a joint implant. After a few months, we knew that didn't work. I never regained mobility, but the pain was gone, so I ignored it. I was told at the time of my first surgery, that eventually I would probably end up with a fusion.
After living with the pain for a while, it got too unbearable. I went to see an OS. My first surgeries were with a podiatrist. In Feb 04, she did a fusion with a bone graft from my hip. The graft almost hurt worse that the foot. I couldn't sit or stand or change positons without help for a number of days. I was NWB for about 6 weeks or so. Then I was in a CAM walker for another 4-6 weeks. Sorry I can't remember the exact time frame. In June 05, I had the hardware removed. It was the easiest a quickest recovery. I did go to PT for many weeks after each surgery.
I have basically been pain free in the fusion foot since. My high heel wearing days are over, but I am fused at a slight angle - 15%. I can do most anything I want, and I am party tricks. Because of the angle of the fusion, I do not leave a big toe print if I step directly down. I have to roll through on the foot for the big toe to appear.
If I can answer any more ?'s, let me know.

Jennie

 
Old 09-20-2007, 10:09 PM   #9
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Re: Toe Fusion Opinions

Hello everybody, I am new to this board so please forgive me if I am long-winded. I am a 37 year old man who tries to be as active as can be, although the pain level I experience on a daily basis prevents a lot of what I like to do. However, I try and play ice hockey as much as possible, and usually it's not so bad, as the skates do not bend my toes.

Reading these accounts are very close to my heart, as I am going through very similar experiences and would love any and all opinions.

I'll try to be brief with my history.

When I was 15, I completely destroyed the end knuckle of my big toe. I was kicking a soccer ball with my brother without shoes on, and when my foot was straight against the ball, he kicked and it shattered that knuckle. Unfortunately, I was 15 and just thought it was jammed real bad and it would feel better. Well, it did, and for the next 15 years, I just walked wrong, on the outside of my foot and I stopped bending that toe completely. By age 30, I had a huge growth of bone around both joints, and I finally had good benefits so I went to see the doctor.

He x-rayed my foot for the first time after the initial injury 15 years earlier and was shocked at what he saw. My end knuckle of my big toe was shattered into about 20 pieces. How I was functional after that injury was beyond his comprehension. To fast forward through all the treatments, he performed surgery, cleaned out both knuckles, inserted a pin (later removed)to straighten the toe, and was hopeful that with the toe knuckles again being functional, cartiledge would re-grow and I would be good from then on out.

The procedure was a huge success, I was pain free and had full motion for 3 years. In fact, I went back to playing adult league baseball which I had given up years earlier and was a catcher. I am sure that all of us on this board knows what kind of toe flexibility that requires.

Ok, now 3 years have gone by and the knuckle is arthritic, and I can feel the bones grinding on each other. Same doc, who I was pleased with, gave me the option of either an implant or a fusion. He says that for someone who is 33, an implant is a better choice, becuase once it's fused, it's fused. There is no going back, and he thinks in someone so young, he would prefer to see the joint moving. So, I have the implant, and it really never worked as advertised. I have had constant swelling in the foot, it's very sensitive, the range of movement has never been that great, and now, on top of everything, where my foot bumps up against the implant, that part of the bone is started to degenerate. This means that the implant is going to keep moving backwards with the cavity, in turn pulling up on my toe since it's still screwed into the toe. My big toe now has about a 15 degree angle upwards and is causing me a lot of pain.

Now, I have seen an OS, and he says enough is enough, it's time to have the whole thing fused. However, because my big toe is so short, he has to do a graft, and chances are he can't get enough off the heel and will have to take it off the hips. Can anyone who reads through these boards give me some advice, answers, questions to ask of the OS before having it done, etc?

Also, does anyone here with big toe problems ever get depressed with what they are going through? I mean, it's a toe, and look at what it has led to. I will now have 3 surgeries, years of pain, years of trouble walking, on and on and on. It just seems so surreal some time. Does anyone else get depressed, or wonder why we can see people who have lost an entire leg, or some people with two fake legs running marathons, but I have trouble just walking from my car to my office?

One last thing, and this would be something for people who have had the procedure done: Can you walk or run pain free? I find it so hard to believe, I mean, this has been going on for 20 years. Running is something I actually have had dreams of when I sleep, but it's seems so impossible. My OS tells me that he has had a dozen marathon runners come in and have the procedure done and they have returned to running, and continue to run to this day. How in the world is that possible? I just don't know if I can believe that.

Thank you all of you, and I completely empathize with anyone reading these boards.

 
Old 09-21-2007, 06:14 AM   #10
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Re: Toe Fusion Opinions

dbgoalie......welcome to the board. Your years of frustration with the toe is understandable. Unless one goes through with the constant pain they can't understand. Wearing shoes and walking can be a challenge. Quickly, my story is I have had a Keller procedure 11/05 that caused my toe to remain floppy and I couldn't walk correctly. Then in 5/06 I had my big toe fused with a bone graft that was taken from the bone bank (frozen femur) to lengthen my toe and then plate and screws. Because of the chronic nature of my foot my toe is stiff from tip to base. I have other toes that have issues as well. There are those on this board that had a graft from their hip and maybe they can address their issues with that. As for me, I am happy that I didn't get a bone graft from my hip because I had researched that pain remains in that area long after the foot pain. The chances of non fusion with frozen bone is greater but I took that chance. I am pain free in that area and I go barefoot, wear flip flops without the strap between the toes, hiking boots and tennis shoes. No heels but that's ok because I don't wear heels.
If you have a good pair of running shoes and one that allows your foot to roll with your running gait then you shouldn't have trouble running. Your toe would be angled up to allow for normal gait. My other foot will need done in the future and I would rather have a fusion myself than the implant because I figure only having one surgery on a toe is better than 2 or 3 (I have had three total on that toe). Of course that is my experience hence the reasoning! I don't know if I have helped you but letting you know that you aren't alone. The boards is a great place to hear how other people have dealt with their foot issues.
Janie

 
Old 09-21-2007, 01:03 PM   #11
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Re: Toe Fusion Opinions

I just had my 3rd operation on my big toe. I had an implant last November and it didn't really help. Now my toe is going to be allowed to "fuse" in place, I guess meaning that there is no PT and the scar tissue will form around the joint thus limiting its motion - anyone hear of this before?

dbgoalie - I too walked on the outside of my foot for years which subsequently damaged my knee as well.

Sorry to hear what you've been through.

 
Old 09-21-2007, 03:31 PM   #12
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Re: Toe Fusion Opinions

first, ra17, what do you mean fuse in place. i know tou had the implant done last nov, but did you just have toe fusion surgery? i am very interested to know what the dr has said to you. goalie, hi i had toe fusion last nov and i finally found out the toe fused. oct 18 i am going to have all the hardwear removed because it is irritating my toe. i am 51 and was always a very active person. i can play doubles in tennis, run on the treadmill and walk a lot. the key is to find the most comfortable shoes you can. i have used shoe stretchers and i am able to wear up to 2 inch heels if i dont have to walk a lot. you will be able to run and do everything hopefully. i did stop playing singles tennis, but i might start again after the next surgery when i am 100% healed. there is hope for everyone. i think i was the most depressed person when this happened. it is almost a year and i feel so much better. i will never feel the same as before because i love wearing high heels and fashion shoes, but we all have to accept ourse4lves the way we are. i also went back to skiing which is my favorite. post back. debbie

 
Old 09-21-2007, 07:28 PM   #13
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Re: Toe Fusion Opinions

Hi Janie, Debbie, and Ra. Nice to hear from you. Debbie, I might give you a run for being the most depressed person out there. It gets frustrating sometimes, because I think people who don't have foot pain don't understand AT ALL what is going on. In fact, when I tell them about the toe, it almost gets brushed off, like how can it hurt that bad, what's wrong with you, you are just being a baby, etc. Anyway, it depresses me sometimes, but that's my issue to deal with.

Janie, I am very happy for the results you got going with the bone bank. The research I have done, it is risky, I don't know if my doctor will do it. That's one of the questions I have for him. I am intersted to know how you and Debbie are doing now that you are both towards the tail end of your recovery, I am encouraged to hear that you are walking and are happy with your results. Debbie, good news about the hardware being taken out, from what I understand that's not nearly as bad a procedure as when it's put in. Please keep in touch and let me know how that goes. I am a LONG way from that, but I would like to know.

I have decided tonight to cancel my upcoming hockey season and leave my team to find another goalie for this year. It's only adult league hockey, but I really enjoy it, and I am going to miss it this year. Plus, as I get older, the chances of not playing anymore are greater. (Family, job, team falls apart, etc) Anyway, I am going to have the surgery sooner than later, and these are the questions I am going to ask the OS when I see him next week. Please let me know if I missed anything. Also, I am going to start my own thread in a few days, kind of taking my ordeal from start to finish in case anyone else out there is going through or going to go through the same ordeal. Ok, here goes:

1. Is the space between my toe and foot small enough to take a graft from my heel, or does the graft need to come from my hips?

2. Do you advocate taking a graft from a donor rather than from my hips? What is the risk involved with taking if from a donor?

3. Immediately following the surgery, what is the recovery time? 6 to 8 weeks non-weight bearing I know about, but will I be in a cast? Will I be on painkillers? Will I be able to drive? (My foot that needs the work is my right) Will I walk with crutches? A walker? Will I need a wheelchair? Would I need some sort of home care nurse to come in during the day?

4. After the first 2 months, what's next for recovery? Is there any physical therapy required?

5. Does the hardware inserted come out at some point? Does it stay in forever? What's involved with removing the hardware if it does come out?

6. Being a man, I don't wear high heels (at least in public, just kidding, that's a joke) so I don't think shoes should be an issue for me, but I already have wide feet, will I have trouble finding shoes that fit? Should I look to wear only running shoes, or boots? Am I limited in my shoe choices and if so, what are they?

Ok, that's all I can think of, if any of you have any other questions, please let me know. I am pretty confident in the OS I found, he actually has a patented toe joint implant that he designed, and he has a lot of current patients who are long distance runners that have their MTPJ fused together. I don't know how these guys and girls go back to running, it sounds impossible to me right now, I can't even walk to my car without wincing, but he claims these people are doing it and continue to do it without issue. Talk to everyone soon.

Dave

 
Old 09-22-2007, 10:06 AM   #14
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Re: Toe Fusion Opinions

DBGoalie,
I posted a list of questions in a thread on this message board. Check it out. You may think of more questions appropriate for your situation. The only thing I think may be missing from your list is something related to infection. You can ask your surgeon his infection rate and the hospital's.
You may also want to know if your surgeon will be completing your surgery from start to finish or if he has a resident/student perform a portion of it.
Good luck!
Step

 
Old 09-22-2007, 12:39 PM   #15
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Re: Toe Fusion Opinions

hi db, quick reply- i dont know about the graft. iwas in a cast for 9 weeks. idid not go for physical therapy because my toe doesnt bend, but i think if they can get the swelling down on yor foot it might be worth it. swelling can be horrible and that causes pain. ice and elevate. the hardwear hopefully does not have to be removed-only if it is bothering you. you will find shoes even if you have to go to an orthopedic shoe store. it takes a year for the swelling to down. the dr should give you pain killers, but make sure you are not allergic to them. i know EXACTLY how you feel. i have given up so much, but the end result is what counts-NO MORE PAIN. my friends and family cannot understand toe pain either. post your thread and when is surgery? debbie

 
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