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Old 01-06-2008, 05:17 PM   #1
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Implant Removal

14 1/2 months ago I had a titanium implant in my great toe (right foot). The tissue in between the MTPJ joint was totally worn away and bone was rubbing against bone. To correct the problem, my Podiatrist performed a buinonectomy (to straighten the toe), shaved down the two bones that were rubbing against each other and inserted the implant. After much suffering, unable to WB or drive (right foot) until 7 weeks, months of PT, I am still unable to walk pain free. Even though I have great mobility in my toe when I'm sitting and moving it around, as soon as I start walking, the pain commences. I am not able to wear a shoe unless it has a wide toe bed and I am unable to wear shoes with a heel more than 1 1/4 inches. Most of my shoes are those with laces or slip-ons. It took 7 months before I could get my foot into a sneaker due to the swelling. I still have swelling in the toe. It was suggested by an Ortho that I have a bone fusion. My Podiatrist, however, thinks that is too severe, should be done only as a last resort, and he wants to remove the implant (he thinks my foot just doesn't like having a foreign object, or one as large as the implant that was used, in it). He wants to attempt to move tissue into the space where he is removing the implant. He claims the toe will be a little shorter. However, I don't care about that, I just want to be able to walk again without pain. He wanted to try using a smaller implant but I just don't want to go that route again. I do trust him and I know he is trying to do what's best for me; giving me the most mobility he can as I am still very active. He has told me that only 5% of the implants he has done, has the patient experienced a problem. I happened to fall in that 5%. My surgery is scheduled for this coming Wednesday. Has anyone out there experienced a similar problem and what was done to correct it? Any imput would be greatly appreciated.

 
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Old 01-06-2008, 11:32 PM   #2
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Re: Implant Removal

Dancing Feet, your story sounds very, very much like what I have gone through. I do have a pretty long post going if you want to look it up here on health boards. I don't think I can post links, but search for threads started by user, and put in my username.

To give you a real brief version, I have had three surgeries on my right great toe, the first one cleaned out bone chips and straightened out the toe, 3 years later the second one put an implant in the MTP joint since I had no cartilege left, and three years after that, the third one was a fusion with bone off my hip because the implant bothered me so much. I was also given the same answer by 3 different podiatrists; that most people have success with the implant, but a small percentage don't. All agreed after seeing x-rays that the implant was in a good spot, had not moved since it was put in, and looked functional. However, I had swelling for 3+ years in my foot that just overall caused my foot to be sore and tender, preventing me from doing a lot of activity. Interesting of you to say this; I also had good mobility and range of motion in the toe, but if I spent all day doing yardwork, I paid for it that night with throbbing pain.

After going to see an ortho, he told me enough is enough. The implant was starting to wear down the bone of my foot and caused the overall length of my great toe to shrink. He recommended removing the implant, taking bone of my hip to lengthen the great toe because the implant rubbing on the foot was causing it be about 1.5 cm shorter than the next toe, and then fuse it all in place with a plate and screws. I had this done at the end of October, and I am very happy to say that I am so much better off now. I have zero swelling in my feet, I have started wearing shoes and walking again, and my doc expects in 6 weeks to allow me to a full return of activity, including running. He has quite a few patients who have had this procedure done, and they return to marathon running.

To give you a little more info, I am a 37 year old man. I do remember my podiatrist telling me at 33 when I had the implant put in that I was a young man and to go with a fusion is the final step, which is why he recommended against it. Once that joint is fused, there is no going back. He recommended the implant for the simple reason that I have (hopefully) 40 or 50 more years to go, and that's a long time to have a fused joint. As in, it requires a change in the way you walk. However, and maybe this is the difference in opinion between the ortho and the podiatrist, but the ortho says I will have minimal correction to my walking. I am fortunate in that I am a man; a lot of women cannot wear high heels after fusion because they can't bend their toes that way. However, that's not a problem for me. I have noticed that I have a little trouble walking down steps if I leave my right foot behind and step first with the left. However, I step first with the right and do the bending with the left foot, and it's not a big deal.

Maybe a smaller implant would have been better for me, I don't know. None of the three pod's I went to though felt that anything was wrong, I just seemed to have swelling that went nowhere for years. In fact, when the ortho opened me up, he said it was pretty gross what he saw; there was a lot of old fluid and bone dust from the implant grinding on my foot. It's a little late in the game since you are scheduled for Wednesday, but then again, it's your body. If you are having doubts and want another opinion, by all means go get it. I'm sure you remember that once you are cut open, there's no going back to the way it was before, for better or worse.

There are no guarantees in the world of medicine, sometimes a doctor is negligent, but I think in most cases when things don't work out the way you want, it's not because of physician error. Most doctors I think take great joy in helping their patients to a full recovery from what is bothering them, and I think they feel very much for us when things aren't going well. Maybe I am naive, but that's the impression I have gotten from the guy I am seeing now, and the docs I have seen in the past. Anyway, if you want my opinion, and it may not fit everyone's situation, but I would say go with the fusion. Go to an ortho and get a lot of information, ask a lot of questions, do some research. I have had tremendous success with my fusion and look forward to doing some running this spring. (there is a post on this board with questions to ask before surgery, it's pretty good)

Good luck, and please let me know how you make out.

 
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Old 01-07-2008, 08:37 PM   #3
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Re: Implant Removal

Dbgoalie, thanks so much for your response. I'm glad your bone fusuion is working for you. I did give the bone fusion serious thought. I went to an Orthopedic surgeon in NYC. His recommendation was that if I wanted to have only one more surgery, I should go with the bone fusion. The one main reason I was apprehensive about doing it is the fact that, unlike you - 37 years old, I am a 60 year old woman. I am very concerned about invading another part of my body in order to get the bone needed for the fusion. I am very active, in pretty good health, but I am worried that I might stir up a problem in another area of my body given my age. I was also told that there was no guarantee that the bone fusion would work in which case they would have to try again. I also want to be able to wear a heel now and then which, up to now, I have not been able to do because of the inclination of the shoe and the swelling in my toe (which by the way never seems to go away - as you stated, also). I work in the Corporate world and it has been very depressing for me not to be able to dress like I used to because I have to wear low wide shoes and am unable to wear a dress for special occasions because I would look pretty silly in shoes with a velcro strap.

The Podiatrist seems to believe he can take care of my problem without having to do the fusion. I do think he wants to see me walk without pain and be restored to normal physical activity. I truly believe he is very sincere, and he is a well-respected doctor as I did my homework before choosing him. Today, I was having second thoughts; thinking that, at least I am able to walk even if it's in sneakers or the like. What if after this surgery, I am worse off? However, I must think positive and leave it in God's hands. I guess the worse thing that can happen is that I will end of having the bone fusion. However, at this point, I feel I need to exhaust all other options, first. I am trying to prepare myself mentally for the long road ahead as it is still very fresh in my mind what I went through with the last surgery.

I pray I'm making the right decision. Right now, my doctor has me taking Celebrex (an anti-inflamatory) prior to my surgery and for 3 days after. I must say my stomach isn't handling it too well and was unable to sleep last night. I'm a little concerned about taking too many meds especially since he has prescribed that I take 2 percocets every 3 hours after the surgery. (The last time, nothing helped the pain. I had taken 3 Vicoden and 3 Percocets within a 16-hour period before I began to get the slightest bit of relief and I had packs of ice on my foot 'round the clock.) Not looking forward to this. I keep saying "this time it won't be as bad." After surgery, I will post as soon as I am able.

 
Old 01-07-2008, 11:02 PM   #4
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Re: Implant Removal

For what it's worth, I think you are making the right decision on trying other avenue's before the fusion. My ortho only wanted to use bone from my hip; he says that in the ortho world, there is a saying 'there is no bone like you own.' The reason I asked about synthetic substitutes or bone from a cadaver was because I have a friend who had a bone graft off the hip for his neck vertebrae, and he told me it was extremely painful. He wasn't lying; I felt like I had been hit by a car on my right side when it was done, but I'm fortunate to say that I am probably 80 to 90 percent now with the hip, it is close to being painfree for me. I had some apprehension about the bone graft because like you said, that opens up another area on your body, another area that might develop infection, and worse case, what if it hurts and never goes away?

My thoughts are with you. Isn't it funny how people with foot pain are sympathetic with each other? I think it's because so many people don't go through major surgeries like this and just think it's a toe, how bad can it be? But we know, so please keep posting here, I want to know how things turn out for you. One piece of advice with the pain killer medication, try to drink lots of water. I find them to be very dehydrating. I was NWB for almost 8 weeks, but my wonderful wife always got up to get me some water when I asked, and was filling it for me when I wasn't asking, so drink your water. Good luck.

 
Old 01-08-2008, 04:57 PM   #5
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Re: Implant Removal

i think the fusion is the answer. i also went through the same exact stories. the implants have a low rate of working. my fusion was over a year ago. i can do everything i did before. i play tennis, work out and ski. believe it or not i am actually wearing 2 in. heels and some higher. i cant walk long distances in high heels, but i am able to keep them on foe a long time. i have done so much research in terms of shoes. i know what brands look and feel good and i know what the shoemaker can do and sometimes it is miracles. i had this done when i was 50. i did give away my 3-4 inch heels and now i look back and say what was i thinking? i am 99lbs, i like to dresss well and wear great shoes. the only thing is, i dont want to be in pain. i am my active self and i feel great. yes, i wish this never had to happen, but it did. i would not even consider walking around in sneakers and flats. i am saying this to only help with your decision. it can be done. if you want more answers on anything, just post. debbie g

 
Old 01-09-2008, 05:24 PM   #6
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Re: Implant Removal

dbgoalie, Thanks for the support. Yesterday, I came down with a stomoach virus and was violently ill. I guess the stomach discomfort I was feeling was not only from the anti-inflamatories but the stomach virus brewing. I had to contact my doctor and he postponed the surgery. I am just thankful that the virus didn't hit me today (after I would have had the surgery). I don't know what I would have done! The doctor agreed as he would not have known if I was vomitting from the anesthesia or what. Now, I have to reschedule and psyche myself up again. I'll post when I know when I've been rescheduled.

 
Old 01-09-2008, 05:36 PM   #7
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Re: Implant Removal

debbieg, Thanks for your input. Did you have your fusion at the time they removed the implant? From what area of your body did they take the bone for the fusion? Did you have any problems with that area? How long was your recovery period? I know you said you were 50 years old when you had this done. I'm 60, and 10 years is a big difference when you get up there in age. I feel a lot differently now than I did 10 years ago (arthritis, etc.). I was scheduled for surgery today but it had to be postponed because I caught a stomach virus and was violently ill (as I stated in my response to dbgoalie). Although, I have made the decision to have the implant removed and have the doctor move the tissue around in my toe to fill the gap, I am praying this won't be in vain, and that it will avoid my having a third surgery.

 
Old 01-10-2008, 03:04 PM   #8
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Re: Implant Removal

i had the fusion when they took the implant out. recovery was a long time. had a cast for 9 weeks and the boot for 4 weeks. i started to go into sneakers after that. my foot did swell quite a bit. it was hard finding shoes, but new balance worked. i also wore boys gym shoes because they are wider. the compression sock helped the most. i was more swollen because my 2nd toe was repaired, also. whatever age, its not easy. i just hope you dont have to go on and have a 3rd surgery. would another opinion help?

 
Old 01-10-2008, 08:15 PM   #9
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Re: Implant Removal

Debbie G: I did go for another opinion. I went to an Ortho Surgeon in NYC. in August (I'm still paying for the office visit and X-rays). He told me that if I wanted to have just one more surgery to have the bone fusion. My Podiatrist concurred with that statement. He said that is the final surgery as you can't do anything else after that. My Podiatrist tried to contact this surgeon twice but he never returned the call. He wanted to discuss my situation with the doctor as he has done that with other patients. He said they discuss their cases frequently. However, it was evident that the surgeon I saw had no intention of contacting my Podiatrist. The surgeon had told me that there was no guarantee that the bone fusion would work either in which case they would have to try again. In any case, I could not afford to have the surgeon do the bone fusion as his fees are exorbitant to say the least. He is an out-of-network doctor and my insurance pays close to nothing. The one visit to his office cost me $736. I can't even imagine what his fee would be for the bone fusion. I've decided to take the route of just removing the implant and see what happens. I've been rescheduled for surgery next Wednesday.

 
Old 01-11-2008, 06:36 PM   #10
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Re: Implant Removal

well, good luck to you. maybe the surgeon can write a letter to the insurance company. is there an ortho in your network that you can see? if so, insurance will have to pay. remember this is your foot-you NEED it.

 
Old 01-11-2008, 08:27 PM   #11
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Re: Implant Removal

Hey Dancing Feet, I thought I would reply here on your board to what you wrote to Debbie G. You mentioned that your ortho feels that the implant will start to wear down the bone of your foot, and I agree with that. (mind you, I'm not a doctor) My ortho said the same thing, in fact, when I first saw him in the summer of 2007, he told me it was getting bad, and that he would need to take bone off my hip to make a proper fusion. Now, I could wait as long as I wanted to get the surgery, but the longer I waited, the more bone he would need, and the more bone you need to fuse together, the more risk you run. So, I really wanted to wait until the summer of 2008, but after discussing with him and my wife, everyone felt that the sooner the better.

I really don't know what advice to give you. I think both options you have in front of you have an upside. The fusion would be final, at least in the sense that there is nothing else to do. There is always a chance of the fusion not taking, and then you would need another procedure, but in most cases it is final. But your podiatrist makes an interesting argument in suggesting tissue in place of the joint. But if it doesn't work, you will need another surgery. Then you throw in your insurance concerns, and I really don't know what to say.

I have had a great experience with my fusion, everything is going better than I ever hoped for. But that is no guarantee, there are no absolutes in medicine. I had an implant that I was told would work great, and heard from other people, other patients in the office of the pod I was seeing who told me how great it was, and it just didn't work for me. I struggled for 3 years after the implant was put in, and that was very hard to deal with. So I can't tell you to go with the fusion because it worked so great for me because it may not work for you. In the end, you need to make a decision that you feel certain about, because if you go into it with doubts and it doesn't work out, you will really torture youself during recovery. If you need more time, than take it. But go with your gut feeling, don't doubt yourself and what you decide.

 
Old 01-12-2008, 09:32 PM   #12
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Re: Implant Removal

Dancing Feet, Hi!! See my posts this evening that I made on other threads concerning this issue. In addition to what I state there, like you I am 60 years old. I thought my doctor was going use my hip bone, but he used "donor bone," from a cadaver. It's working very well for me. The x rays show everything is coming together as it should. Don't be afraid to try the donor bone route. A lady at work has a daughter who is a surgical tech. She said that donor bone surgery is becoming very, very popular.

Last edited by JeffH; 01-13-2008 at 12:05 PM.

 
Old 01-13-2008, 11:54 AM   #13
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Re: Implant Removal

dance, i had bone taken from my heel and that worked out fine.

 
Old 01-13-2008, 12:07 PM   #14
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Re: Implant Removal

I've also heard of that. It's supposed to be much less painful than taking it from the hip. I believe that I needed too much bone for the fusion for it to be taken from the heel.

 
Old 01-13-2008, 07:38 PM   #15
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Re: Implant Removal

I also needed too much bone to be taken off the heel; that's why mine was taken off my right hip. (right foot is the bad one) My ortho was a big believer in the saying 'There is no bone like your own', and presented it to me this way: there is no guarantee that your body will accept even your own bone being fused in place, but your own bone presents the greatest chance of fusion. Meaning, a donor bone is nice in that you don't have to deal with recovery of your own donor site, but there's a chance of rejection, and if you want to go with the greatest odds of fusion and of being done one time, go with your own.

I won't lie to you, my hip was extremely painful after surgery. I am a 37 year old man, I couldn't imagine doing this at 47 or 57. You also run the risk of having another incision, another site that could get infected. But, the pain did go away over time. I am just now starting to get back into exercising and doing things around the house, and there are times when I get into a position that the hip hurts, but all in all, for me it was worth it.

 
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