I have had toe pain for four years. Although my family doctor has told me I'd need fusion for the last couple of years, I've put it off but now, I can't stand it any more. I'm scheduled for early November. The podiatrist X-rayed my toe, got serious while showing me the pictures and told me there was no cartilage left. Most of the discussion was on fusion and recovery. However, when they mailed me the pre-op exam paper to bring to my doctor, it indicates: 1st metatarsal osteotomy, possible fusion 1st MTP joint. I called for an explanation and he said that he's been fooled by x-rays in the past - when he's gotten in there, it could be better or worse than the pictures showed - and he wants to be ready for either one. I guess I could understand that if the x-rays showed some cartilage but they didn't. And aren't these two procedures worlds apart? As in, an osteotomy would be done if the damage were relatively minor? Maybe I'm wrong, wouldn't be the first time. I've told him I don't want to require a 2nd operation in the future. I've been reading these forums for a while and know there's a lot of knowledge here so I thought perhaps someone could give me an opinion. I'm not going to ask him again until the consent appt in a couple of weeks. I've researched fusion and know it's the pits but now I just want my toe taken care of so I can walk again - sometime. Thanks for any info.
First of all, cartilege doesn't show up on x-rays. Granted, if the joint is compressed, there probably isn;t much. However, we thought I didn't have much left either but, in fact, did have some. They drilled holes in it when I had a cheilectomy with osteotomy to promote growth. I truly think it has regrown some.
All that being said, fusion is a dead end street. If the bone doesn't fuse, you have no other option but to try fusion again. You are NWB while all this is going on. The cheilectomy and osteotomy are rather simple surgeries and you probably will be able to walk from day 1. Shaquille O'Neal was back playing basketball at a little over 2 months after his. You definitely won;t be doing that with the fusion.
Frankly, I'd avoid it at all costs. My surgeon laid it all out for me from the beginning....each progressive procedure and how long each should last, considering my activity level. I opted to start conservative and see if we couldn't preserve the joint. That was 5 years ago and I haven't regretted the decision...I jog, dance, wear heels, anything I want. Take 2 Aleve every morning and that's it. I am now 61 years old.
I don't know where Tolland, CT is situated in the state but my suggestion is to contact with UConn's athletic dept or the nearest pro football or basketball franchise front office and ask who they use for this condition (it's also called turf toe, runner's toe, tennis toe). Get a second opinion from that person. I used an orthopedic surgeon who does only feet at a prominent sports med clinic. He was great...sounds like you're doc is on the right path since he's looking to do the least invasive procedure. You should be glad of that.
I understand your pain. My rt big toe had been hurting off and on for the past 2 years and got more intense at the first of this year. I went to my annual check up and mentioned to my family doc. He said it looked like I had gout. Well, being a medical transcriptionist, I knew that was rarer in females and I wasn't convinced on that quick diagnosis (that was at the end of March). So finally getting sick of the pain, I went to a podiatrist and he took an x-ray and told me in the top 10 worst cases he'd seen, mine was in the top 5. I had osteoarthritis and my joint was bone on bone, no cartilage left. He mentioned a new procedure called Hemi-CAP. I thought that sounded good, but I wanted to research things. In the meantime, I took that x-ray back go my family doc. He ran tests for gout, osteoarthritis, rheumatoid arthritis, lupus, etc. covering all bases. Everything was fine. He thought I could wait a while, no need to rush to surgery. But, my pain was pretty fierce so I went to an orthopaedist for a second opinion. He said my toe was already past the Hemi-CAP and by that time I had found out my insurance would not cover a Hemi-CAP and he said insurance probably wouldn't cover a total joint either. They consider it experimental although it has been approved. Anyway, the orthopedist recommended with me being so active that a bone fusion is the way to go. I had bone fusion on September 7. I'm now 7 1/2 weeks out. I go to the doctor tomorrow and he will x-ray again and may let me start walking. I have been on crutches for all this time. But like I said, I understand what you mean about not wanting the pain any longer. I hurt now but hopefully the pain will be gone soon. With your position, the pain isn't going away (Aleve can only do so much) and will probably only increase. Good luck with your decision!
Last edited by lyndie19; 10-29-2007 at 05:01 PM.
Reason: double up same word
hi jul, i had a 2 part cat scan with dye and that showed the dr if i was healing after a failed bunionectomy and after a failed implant. i was not and was in constant pain. i did have big toe fusion. its almost a year now and there is no pain in my big toe. go for the least invasive first.