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Old 11-21-2008, 02:42 PM   #1
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Osteotomy or fusion for hallux rigidus?? HELP!!

Hi - I've been reading up on these boards and very surprised to see all who've been down this road. About 3-4 years ago I noticed stiffness (inflexiblity) in my left big toe. At the time I was running a good bit & figured I injured it & it would get better. After it got worse & the bump bigger on top of the joint, I saw 3 docs - 2 podiatrists & 1 orthopedic...all different opinions for treatment of course. I have late stage 3/stage 4 hallux rigidus. Pod 1 says do the osteotomy pretty soon to avoid fusion. Orthopedic says osteotomies are for bunions and won't work & to just wait until it's bad enough & do fusion. Pod 2 said it should be my decision - but there is high probability that osteotomy won't work because it's stage 4. I hate the idea of having a fusion (because of recovery time, stiff toe, no hi heels, etc) if I can prevent it - but at the same time don't want to have osteotomy & then fusion if it doesn't work. None of the doctors have mentioned a Keller bunionectomy, which I read about on this thread somewhere.....

To make matters worse, my other toe is heading the same direction. It's about stage 1 or 2, and both podiatrists say it's a good candidate for osteotomy. I'm 43 & pretty active...would love to get back to running which I don't do much because I'm working much. Thanks in advance!!

 
Old 11-21-2008, 04:09 PM   #2
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Re: Osteotomy or fusion for hallux rigidus?? HELP!!

Get away from the pods. You need a sports med ortho. You don't say where in NC you are but my standard recommendation is to call the nearest pro football or basketball team's front office or the nearest major college athletic department and ask who they use for "turf toe" - also known as runner's toe, tennis toe. That is what you have. Very common among runners. I had it in both great toes.

I had a cheilectomy with wedge osteotomy(clean out of bone chips,grind off spurs, wedge cut bump on top of toe, drill holes in existing cartilege to promote growth) 6 years ago. Great results. Jog, dance, wear heels, whatever and I am 62 years old. Do some research on Shaquille O'Neal. He had the same condition and had it repaired while he was with the Lakers.

Good luck and let me know if you have any questions.

 
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Old 11-21-2008, 05:42 PM   #3
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Re: Osteotomy or fusion for hallux rigidus?? HELP!!

i totally agree. fusion is the last step. when you see the right person, you will know.

 
Old 11-21-2008, 11:55 PM   #4
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Re: Osteotomy or fusion for hallux rigidus?? HELP!!

With all due respect to Tichou, not every hallux rigidus is "Turf toe", sports med othopods are not necessarily the way to go and not every foot needs the same procedure. I researched a lot over 2 years, saw 2 orthoped surgeons and a couple of Pods who all gave me different advice. It all depends upon exactly what is wrong with your foot and what you hope the function to be afterwards. Also with respect to the docs, no one knows what shape your foot is in until they open it up and see. I did not want a fusion because I wanted to dance and so I wanted even limited ROM. In the end, my podiatrist did a cheilectomy to repair the joint and also a kind of osteotomy (bone cut and reposition) different from Tichou's to try to prevent the hallux rigidus from coming back. The ortho guys were flippant and wanted to do more extreme and risky procedures. My surgery was 5 months ago and I couldn't be happier. I had about 50% of cartiledge left and went from 10% range of motion to 45%. Pod predicted I would get 25% so I am doing pretty good.

By the way, drilling does not promote cartiledge regrowth. (Cartiledge does not grow.) Healing from drilling causes scarring and it is the scar that then acts like cartilege. My Pod did not do that because he did not want to disturb the cartiledge I do have. Learn about your condition & ask a lot of questions. In my case, I also asked some PTs their opinion about the outcomes of various surgeons. It was very helpful because they often see the fall out. In the end, I was and am very happy with my surgery. Should have done it years ago. Sorry about the spelling.

In the end, you will have to go with someone who you trust and who respects your wishes. I told my pod No Fusion, no matter what he saw when he opened my foot and he agreed. I would have rather lived with even 10% ROM with pain. The ortho guy said he wanted to fuse it if HE saw fit. Simple choice. i love my Pod. He gave me my life back.

Last edited by dncergrl53; 11-22-2008 at 12:04 AM.

 
Old 11-22-2008, 06:45 AM   #5
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Re: Osteotomy or fusion for hallux rigidus?? HELP!!

In my case, repositioning was not necessary. My was a classic case of turf/runner's toe from years of running and wearing high heels every day. And the growth of the cartilege or scar tissue - whatever term you want to use - did occur with me as I now have more cushioning in that joint. Additionally, my experience with the best pod here was that he was flip about the whole thing and did not want to do the whole procedure. He wanted to leave out the osteotomy and told me to never run again or wear heels. (BTW, I still use him for podiatric things and he still complains about my jogging - calves too tight, etc) My sports med ortho, Dr. John Gould, wanted to do the whole procedure and told me I could run and wear heels again. Looks like he was right and I am glad I went with him instead of the other.

 
Old 11-22-2008, 08:22 AM   #6
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Re: Osteotomy or fusion for hallux rigidus?? HELP!!

The point here, is that it is important to find the best individual who will listen to you and meet your needs. Hallux rigidus only means the hallux (big toe joint) will not move (rigidus) or is limited (limitus). There are many different reasons for that and the solution should match the problem.

Tichou, I really wish you did not tell me at first to search out doctors who treat turf toe and to go see a sports medicine doctor. Turf Toe is slang and does not apply to everyone. You confused me for months at first when I was deciding what to do. I had hallux limitus but did NOT have turf toe. The damage in my toe joint and the biomechanics of my foot was much more complicated than that.

The other thing is that if people ask if their doctor drills to grow the cartiledge and the doc says no, that does not mean the doc is missing something. Our poor doctors had to cope with patients having partial and erroneous information.

Last edited by dncergrl53; 11-22-2008 at 12:48 PM.

 
Old 11-22-2008, 03:10 PM   #7
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Re: Osteotomy or fusion for hallux rigidus?? HELP!!

Thanks all. Your info is all very helpful & confirms that I still have some homework to do and should not just settle on the fusion down the road when it gets unbearable. I just find it hard to believe that there's no other options except fusion, especially since I'm not in a whole lot of pain. We live in Charlotte so it may be worth my while to see the Panthers doc.

I'd be interested to know what "stage" your limitus/rigidus was when you each had surgery. One pod says mine is a late 3 or 4.

 
Old 11-24-2008, 09:57 AM   #8
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Re: Osteotomy or fusion for hallux rigidus?? HELP!!

Hi Bigtoe..LOL love the name,
Each person is different and their recovery can be different. Ask questions when you see the doc. I had an osteotomy with a wedge for hallux rigidus. My pod felt that I would have better range of motion after I recover and felt that someone my age would do better with the osteotomy rather than a fusion. I am still active at 57 so I did not want a fusion. The recover has been long and sometimes frustrating. I am working on ROM and it improves every week. I went from 10 degree bend to a 35 in 6 weeks. I am told that it will improve even more in the next 3 months. I still have some swelling but that agonizing pain that I had pre surgery is gone. Good luck!

Kathy

 
Old 11-24-2008, 11:40 AM   #9
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Re: Osteotomy or fusion for hallux rigidus?? HELP!!

My doc said that full recovery can take up to a year but that it is, at least, linear. In other words, each day is improvement rather than back and forth like some surgeries (I had a Morton's Neuroma removed and it was definitely not a linear recovery!) I feel I am as good as it was at the end of the first year - 5 years later. And none of that horrid pain - even when I'm bad and dance for 2-3 hours solid!

 
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