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Old 10-02-2007, 08:39 PM   #1
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MTPJ Joint Fusion Story

This may be a long read, but I'm going to start my own thread describing my foot problem and my upcoming MTPJ Joint Fusion. (MTPJ is the joint between your big toe and your foot)

Briefly, when I was 15 I smashed the interphalangeal joint (second knuckle) of my big toe, the one furthest from your foot. My brother and I were kicking a soccer ball bare foot, and I had my foot straight against the ball rather than against the side of my foot. I did not think he was going to kick the ball, but he did, and the ball smashed against the top of my toe, basically causing the interphalangeal joint to explode. Now, unfortunately when you are 15, things feel better after a few weeks, and I figured that my toe was jammed real bad, but it would go away. Fast forward 15 years, I finally go to the doctor because the interphalangeal joint and the MTPJ both have large humps of bone growing over them, and I am in pain when I walk.

My podiatrist takes an x-ray, and is really amazed at what he sees. The interphalangeal joint had exploded into about 15 bone fragments, and as such, stopped bending. Because it was painful for me to walk properly, I also stopped bending the MTPJ (subconciously) by walking on the outside of my foot. Because I didn't bend those joints for 15 years, the cartilage had died in each joint, and my body, in an attempt to heal itself, began to grow bone over the joints, in an effort to fuse them on it's own. Interesting how the body works.

Ok, so I'll try to speed up here. First doc does a surgery to take away the extra bone growth, clean up the interphalangeal joint, and inserted a pin down through my toe into my foot to straighten everything out, which was later removed after 8 weeks. This surgery was a HUGE success, I was pain free for the first time in 15 years, and I was extremely active. One thing my doc mentioned was the hope that the cartilage in the joints would re-grow with activity, but it didn't happen. After 3 years, the MTPJ joint was painful, grinding against each other, and the doc gave me two options; joint implant into the MTPJ, or fusion. His thinking, and I agreed, was that I was 34; it is a little early to have a joint fusion for someone as young as I was. So an implant went in.

This surgery was not nearly as successful, I haven't really gotten the benefits of the MTPJ implant. My foot has been swollen since the surgery, sometimes very swollen, sometimes not so bad, but I have yet to have a pain free day since that surgery. My foot doc also passed away, and that was very devastating to me, because I truly enjoyed seeing him. He took a lot of personal interest in my well being and was a very good doctor.

Now, I know I'm not using the medical terms, but this is what the orthopaedic surgeon has explained to me. The head of the implant butts up against my foot, and where it rests against my foot, the first doc carved a bowl for the implant, sort of like a ball joint. That part of my foot is starting to degenerate, leaving space for the implant to move backwards away from my toes. The other end of the implant is still screwed into the toe, so it's pulling backwards, causing my toe to have about a 15 degree angle pointed upwards. Also, in the past 6 months, I have been dealing with a lot more pain, the area of my foot is much more swollen than normal, it burns, it's hot, it's just a mess. Completely.

The ortho has told me there are no other options; the implant needs to come out, and the joint needs to be fused together. However, because of the work already done to my foot, my big toe is considerably shorter than the other good big toe. So he needs to do a bone graft off my hips to get the bone he needs to properly fuse the joint together.

Here is where my thread is going to begin; I have the surgery scheduled for the 4th week of October, 2007. I had a handful of questions for the ortho which I will post and his answers, and plan to update this thread after the procedure, in case anyone is considering this, or is going through it. These answers are from my ortho; please don't take this as me stating medical opinion or fact. However, I am confident in the answers I have been given; if anyone feels differently, please let me know.

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? Answer: the space is too great, and the hips are the best place to get graft material. If you donate bone marrow, this is where they would take it from, so it's the best spot.

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? Answer: No, there is a saying in Orthopaedics, No bone like your own. If it comes from a donor, there's a chance that your body rejects it, and honestly, after two extremely painful surgeries, this is the end of the line for me. I don't think I can do a fourth. I didn't think I could do a third, but I really, really don't think a fourth is for me. At least I hope.

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? Answer: Cast, yes. Painkillers, yes. Drive, no, because it's my right foot getting worked on. Crutches, yes. Walker, wheelchair, nurse, no. One other note, my ortho is going to have me admitted overnight because of the hip graft. He is going to have the bone graft surgeon take material off both sides so that I am even, not favoring one side over the other. Also, the second surgeon is involved so they can both be working at the same time. (I feel sort of sick and lightheaded even thinking about the procedure)

4. After the first 2 months, what's next for recovery? Is there any physical therapy required? Answer: PT for my foot, no, because the joint is going to be permanently fused. However, I should go to PT to have someone analyze my gait, which will change and should be adjusted correctly.

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? Answer: No, the hardware, consisting of a plate and screws, should stay in permanently if there are no complications. It can come out if needed, as the toe, foot, and bone graft material will eventually be fused together naturally, growing and healing as if it is one solid bone. The doc says that can be done under a local anesthetic, but I don't see how. I had a local when the pin was pulled from my foot, and I almost passed out from beinglightheaded and sick watching the procedure. This one I'll have to revisit as I progress through the recovery. Hopefully, my foot is not swollen and it doesn't have to come out.

6. 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? Answer: There are a lot of women who try to wear heels after this type of procedure and they have trouble doing so. Fortunately, I don't wear heels, so I should be ok. The ortho doesn't forsee any issues with footwear.

Ok, that's quite a string I have going, hope I haven't put any of you to sleep. The surgery is a few weeks away, I will post again as I get closer to the date, and will also update quite often afterwards, as I will be home for recovery with nothing else to do. Wish me luck. Foot problems are terribly depressing to deal with, I sympathize with all of you going through your foot pain.

 
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Old 10-03-2007, 09:13 AM   #2
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Re: MTPJ Joint Fusion Story

I sincerely wish you the very best on on your upcoming surgery. I recently had a lapidus bunion surgery which was quite an overwhelming experience for me, and I have to do the same on the other foot which isn't doing too well while I recover from my surgery foot. Foot surgeries are really quite depressing, I can relate to that a lot. I can't do many things with my seven year old daughter that I easily did before. I prayed a lot to God and wondered why some people have to deal with so much misery. Just try to take it day by day. Hopefully, the surgery will be another complete success. I guess we all just have to hope for the best and be grateful for the people that love us and be proud of the things we can do.

 
Old 10-03-2007, 03:01 PM   #3
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Re: MTPJ Joint Fusion Story

DB-Did you read my long reply to your other post with the 6 questions? I was the last respondent in the chain. I wish you nothing but the best, your history is very similar to mine but I hope your recuperation and healing will be better than those of us who required fusion revisions. Did your doctor say anything about putting something over the hip bone to reduce the possibility of chronic pain there? Good luck.

 
Old 10-03-2007, 04:18 PM   #4
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Re: MTPJ Joint Fusion Story

First off, I want to wish you the best in your surgery and recovery. You can look under my posts because I had a MTP fusion also. I had a Keller first then the fusion with bone graft (frozen bone from bone bank) and plate and screws. I was NWB for 12 weeks because bone grafts take longer to start fusing. I still have my plate and screws since my surgery 5/06. I am not bothered by them unless something hits the top of my toe. I wear tennis shoes, flip flops (without the toe strap), sandals and hiking shoes/boots and casual slack shoes. There are a few of us that have had their fusion stories told here so you can check through the various posts.
Again best of luck.
Janie

 
Old 10-03-2007, 07:20 PM   #5
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Re: MTPJ Joint Fusion Story

hi db, i am glad you started your own thread. your ortho seems quite with it. my plate and screw removal surgery is in 2 weeks. i am not having a local asit is a 30 to 40 minute procedure. the hardware is being removed because it is irritating my toe and foot. hopefully you will not need that. you seem to have the best answers. i wish you good luck and all the best. it sounds like everything will be fine. patience is a virtue-its a long recovery and please follow all the drs instructions. post again if you feel like it before surgery. debbie g

 
Old 10-03-2007, 10:28 PM   #6
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Re: MTPJ Joint Fusion Story

Thank you everyone for the kind words. It's funny, we are all faceless strangers on this board, but I think we all feel the same towards each other, an empathy and a real desire to see everyone pull through their procedures. I am married, and my wife is fantastic, but sometimes I feel that she doesn't understand what I'm going through, not just physically, but mentally as well with this. It is depressing, and I think that's not a subject that gets touched on enough in these boards. If anyone new to the strings feels that way, please know that you are not alone with that.

Sharon, I did talk to my ortho about the bone graft site and covering it to aid with recovery. He mentioned that graft site gets filled with some sort of wax-like substance that will eventually dissolve; it is supposed to help with recovery.

I do like this ortho, and I trust his answers. I think he sold me on the fact that he has some guys and girls who have returned to long distance running. I plan on putting that statement to the test a year from now, that's my goal.

One thing I didn't mention to the doc, and I will either before the surgery or during the follow up visits is that I really enjoy playing ice hockey, and I wonder if my playing the last few years hasn't contributed to the failure of the implant. I play goalie, and I have had a few shots to the feet, which would hurt like the devil. I wonder if that initial shock and stress from the puck has had an affect on the implant. The nice thing about skating is that the foot remains flat in the ice skate; it doesn't bend or flex other than the stresses of your weight and force against the ice. The toes will stay flat and level in the skate, which for me made it possible to play all these years with a damaged toe.

One last note, I know it's time to get it done. I wanted to wait until the spring because I have a 2 week old boy now, along with my 3.5 year old daughter, and to get laid up for 8+ weeks as non-weight bearing will put quite a burden on my wife. Also, I am resigning from my job, as I have not been there a year and am not eligible for a FMLA while recovering. But I played a game on Saturday night, coached on Monday night, and then played a game right after practice, and I had to stay home from work on Tuesday because my foot was so swollen and painful. Out of 10, I was at an 8. It was bad, so for all the flip-flopping back and forth I have done the past few weeks, wondering if I can put this off until the spring or summer, it just won't work. I need this now and have actually started to look forward to getting it done. I'm past the stage of being afraid of the pain and the recovery; I am looking at 9 to 12 months down the road, and I am going to hold the doc to his word, that I will be pain free and able to run like the other patients he has.

Debi, good luck with your hardware removal. I sort of think I want mine removed no matter what. My thinking is that playing goalie and the risk of taking shots to the foot, if the hardware is there, the bone and the hardware will take a stress, but if the hardware is gone, it will be just the bone by itself taking the hit, which is painful, but I don't think carries the risk that hardware joined to bone will have. This is something I will discuss with the doc, so I'll have an answer to that one later.

I will post again prior to the surgery to get my thoughts out there to the world. I am looking at my board as a long-term diary of what I am feeling and going through in case anyone else is considering the same procedure in the future. Plus, just writing it down and sharing it with people who understand is helpful and theraputic.

 
Old 10-04-2007, 03:48 PM   #7
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Re: MTPJ Joint Fusion Story

hi db, do what your dr says, but i am just wondering if you didnt play hockey would you be in pain. also congrats on the new baby! why did you have to quit your job? depression is so hard to describe, but it sure helps venting and having people on these boards respond because nobody else understands about our lives and activities and how the foot affects everything.

 
Old 10-04-2007, 10:10 PM   #8
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Re: MTPJ Joint Fusion Story

I never asked about playing hockey; it was a question that I didn't want to ask, because I didn't want the answer. Even if I was told not to play, I don't know if I would give it up. I know that sounds dumb, but in some ways, everything I have gone through with my body has been worth the experiences I picked up along the way. Does that make sense? However, this time around, I will ask the doc what he thinks about hockey. I also coach, so if I can't play, I still have that to look forward to.

I resigned from my job because I started new in June and am not eligible for an FMLA or short term disability. Also, I wasn't completely happy there, and didn't want them to hold the job for me to come back to work and leave anyway. Does that make sense? I'll have the surgery and the recovery and work on something. I do computer network administration, so I've got skills that are in demand still, just a matter of finding the right spot for me.

 
Old 10-05-2007, 07:54 AM   #9
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Re: MTPJ Joint Fusion Story

Was so interested to read your post as I am due to have surgery for a big toe fusion on 30th November, following a failed implant. I am therefore having to have bone grafted from my hip - which is the bit that worries me most! How painful is it???? Can you let me know when you've had yours done just so I can be prepared?
Also how long does the pain go on? It's bad enough using crutches if the rest of your body is fit but I can't imagine it if you've got pain elsewhere.

Kathleen-1

 
Old 10-06-2007, 03:05 PM   #10
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Re: MTPJ Joint Fusion Story

I will keep updating as this goes on.

Good luck with your surgery as well, we won't be that far apart. How many surgeries have you had on your toe so far? Are you in pretty good spirits leading up to this one, or are you depressed? I have actually gotten over the depression and am now looking forward to being recovered. I am optimistic for the future; kind of like I don't care how painful it is, there has to be a light at the end of the tunnel. That's what the doc is selling me now, and I have to have faith that it's going to work. Really, my goal is to respond to this thread in a year, Oct. of 2008, and tell everyone that I just ran a 5K and everything is fine.

Last edited by dbgoalie; 10-07-2007 at 02:16 PM.

 
Old 10-08-2007, 01:28 PM   #11
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Re: MTPJ Joint Fusion Story

good luck db. i hope i am where you want to be. my surgery is oct 18 for hardware removal.

 
Old 10-08-2007, 05:25 PM   #12
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Re: MTPJ Joint Fusion Story

Good Luck with your surgery. I had an implant in my big toe in the joints in the toe. Implant failed had a fusion a couple of years later with a graft from the hip. The hip was a bit painful to recover from. I needed help sitting down (yes, even for the bathroom while I was NWB), getting up, etc. Talk toy our doc about getting an ankle block before you wake up. The ankle block kept me from feeling my foot for about 36 hours. Only had hip pain for the first day or so.

I did have my hardware removed because it was irratating my foot. That surgery was about one year and 4 months after the fusion. It was by fair the easiest surgery of the 4 I had had.

Jennie

 
Old 10-10-2007, 01:14 PM   #13
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Re: MTPJ Joint Fusion Story

Quote:
Originally Posted by jdm1 View Post
Good Luck with your surgery. I had an implant in my big toe in the joints in the toe. Implant failed had a fusion a couple of years later with a graft from the hip. The hip was a bit painful to recover from. I needed help sitting down (yes, even for the bathroom while I was NWB), getting up, etc. Talk toy our doc about getting an ankle block before you wake up. The ankle block kept me from feeling my foot for about 36 hours. Only had hip pain for the first day or so.

I did have my hardware removed because it was irratating my foot. That surgery was about one year and 4 months after the fusion. It was by fair the easiest surgery of the 4 I had had.

Jennie
how is your toe now? i am having hardware removal from toe fusion next week. debbie g

 
Old 10-13-2007, 02:58 PM   #14
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Re: MTPJ Joint Fusion Story

Thank you Jennie, I will ask about the nerve block when I meet with the anesth doc. My surgery is scheduled for Monday, October 29th, so I will be sure to update everyone again as soon as I can get online.

Debbie, good luck with your removal, that's coming up in less than a week. Let us know how it goes. That is something that's in the back of my mind, but for now, I am focusing on the procedure and trying to look long term, not on the short term pain, but on the long term gain. (I just thought of that, I like it, feel free to use if you like)

Kathleen, stay tuned for my postings concerning the hip graft. I'll be honest with you, but I don't want to scare you off either.

 
Old 10-24-2007, 12:36 PM   #15
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Re: MTPJ Joint Fusion Story

OK, my surgery is scheduled for Monday the 29th, 12 noon. I am nervous about it and a little bit depressed. The last few days, whenever I do anything big or small, like walk to the mailbox, take out the trash, even change the cat litter, I know that within a week, those will be things that will cause me a great deal of discomfort and pain. However, I am optimistic that this next surgery, number 3 on my toe, will be the last, and that whatever pain I am in on Monday night, each day will be a little closer to the end. Talk to everyone sometime next week, give me a few days after the procedure and I'll let you know how it went.

 
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