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Old 09-18-2011, 05:38 AM   #1
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cheilectomy eight years ago - now toe is painful again

Hi

This is my first post. I'm based in the UK.

I had a cheilectomy approximately eight years ago after injuring the MTP of my right big toe in my late twenties.

The operation worked very well, and I've been able to do most things apart from run since then.

I've now got some pain in this joint, and virtually no upward or downward movement at all. My main worry is that I'm starting to get a lot of pain in the joint above - the interphalangeal joint, I think it's called - the pain runs under my foot too. As there is such little movement in the main big-toe joint (MTP) I am concerned that this is transferring stress to the upper part of my toe and through the ball of my foot. It's so painful that I need to walk on the side of my foot.

I wondered if anyone has had experience of a cheilectomy that started to fail (or of pain transferring to the joint above) and what the options are. My surgeon at the time said I'd have up to ten years before the toe would need to be fused. I'm now in my mid-forties, and am quite active, and very much want to be able to preserve my toe if poss...

Many thanks everyone.

 
Old 09-18-2011, 02:44 PM   #2
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Re: cheilectomy eight years ago - now toe is painful again

Very possible that the "warranty" on the cheilectomy has run out. Without x rays, it's difficult to say what your options are. Fusion is one. Another cheilectomy is another. A third viable option is resurfacing though I don't know if they do that yet in the UK. It's similar to the resufacing they can do for knees and hips with a titanium plate to coer the bone and act as cartilege, so to speak. Of course, some people do hemi implants but they have a high failure rate and I do not recommend them.

I've had cheilectomies in both big toes - the right on this summer and the left one about 10 years ago. If and when either joint needs a redo, I'm going with the resurfacing. You can research "arthrosurface" for more information on this.

Go see a good foot ortho and see what the xrays say.

 
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Old 09-18-2011, 05:45 PM   #3
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Re: cheilectomy eight years ago - now toe is painful again

Many thanks, Titchou, for your feedback - I shall look up arthrosurfacing.

Have you found that your 10 year old cheilectomy has the same range of movement now as when it was first done? I hadn't realised until quite recently just how much mobility I have lost in the MTP joint - virtually no upwards movement and only a little downwards movement. It has obviously reached a limit and now putting too much strain on the knuckle above as a result.

I may need to start a new thread on this - but interested also in finding out more about toe fusion. From the what I can tell it's just the MTP joint that's fused. But what if there's a problem also with the joint above, the interphalangeal joint - would that mean the whole toe is fused right through and all movement in the toe is lost? I don't think I like the prospect of that ...

thanks again.

GGB

 
Old 09-18-2011, 05:47 PM   #4
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Re: cheilectomy eight years ago - now toe is painful again

Many thanks, Titchou, for your feedback - I shall look up arthrosurfacing.

Have you found that your 10 year old cheilectomy has the same range of movement now as when it was first done? I hadn't realised until quite recently just how much mobility I have lost in the MTP joint - virtually no upwards movement and only a little downwards movement. It has obviously reached a limit and now putting too much strain on the knuckle above as a result.

I may need to start a new thread on this - but interested also in finding out more about toe fusion. From the what I can tell it's just the MTP joint that's fused. But what if there's a problem also with the joint above, the interphalangeal joint - would that mean the whole toe is fused right through and all movement in the toe is lost? I don't think I like the prospect of that ...

thanks again.

GGB

 
Old 09-18-2011, 05:51 PM   #5
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Re: cheilectomy eight years ago - now toe is painful again

gah - not sure why my reply has appeared twice as I only posted it once! Sorry!

 
Old 09-18-2011, 06:09 PM   #6
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Re: cheilectomy eight years ago - now toe is painful again

The funny thing about that is that the previously done one was absolutely killing me as well. X rays showed "precious little" cartilege left in that joint. I did the right one because it was the easy fix and wanted time to think on the resurfacing. I also hoped that being able to walk, dance and run properly on the right one would take some of the load off the left one and maybe it wouldn't hurt so much. The surgeon agreed that was a good plan.

And, guess what! It's what happened. The left doesn't hurt near as much - hardly at all! So, I'm just chilling for a while and seeing what happens. BTW, I am 65 now.

 
Old 09-18-2011, 06:27 PM   #7
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Re: cheilectomy eight years ago - now toe is painful again

Thanks, Titchou. When I think back on my experience, having the cheilectomy made such a positive difference in many ways - and I'm now beginning to feel the loss of that as my toe seizes up again. btw, my left foot is fine, it's only my right foot that's a pain - literally! (& which I injured years ago).

I'm not wary of toe fusion per se, I simply want a functional toe so that my body isn't thrown out of balance so much. Who'd have thought that one toe could cause so much bother?!

I'm going to get my toe reassessed as soon as possible - I'll let you know how it goes!

 
Old 09-19-2011, 03:42 AM   #8
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Re: cheilectomy eight years ago - now toe is painful again

True! Most people don't realize though that the entire body is balanced by the big toe.
People who lose their big toes have a tough PT learning to walk without it. Keep us posted!

 
Old 09-19-2011, 12:03 PM   #9
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Re: cheilectomy eight years ago - now toe is painful again

Hi ggb-

12 weeks ago I had surgery for Hallux Limitus Rigidus - my surgeon performed a cheilectomy and a capsular arthroplasty with xenograft interposition.

I posted about it here on healthboards.

I chose this particular surgery with a board certified & fellowship trained foot & ankle orthopedic surgeon. Previous to this surgeon, I had consulted with both a podiatric surgeon and another orthopedic surgeon and both of them indicated that fusion would be my only alternative.

According to my surgeon, capsular interposition arthroplasty (can use either allografts or xenografts) are relatively new treatments (over the past 7 years) that have provided a viable alternative to fusion. There is some information on the web - search for interpostional arthroplasty of the first MTP joint and capsular interposition arthroplasty

You may want to ask your doctors about it.

 
Old 09-19-2011, 12:46 PM   #10
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Re: cheilectomy eight years ago - now toe is painful again

Thank you, Grace404, that's very helpful, and I hope your foot is healing well after your own surgery.

I have an appointment to see my GP on Friday and will ask to be referred to see a specialist consultant. Will be interesting to see what options are available to me. My big toe joint feels pretty much fused at the moment and am worried that I'm developing arthritis in the toe joint above. Ho hum.

best wishes, ggb.

 
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