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Old 12-03-2011, 01:20 PM   #1
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options following unsuccessful cheilectomy?

Hi, am new to this board and would really appreciate your advice on the following:

I had a cheilectomy done on the big toe on my left foot on Oct.7, because of rapidly progressing arthritis. Doc said "you're actually way too young for this" (I'm 40 and have always been very active). He explained there are no guarantees, that most people are helped by this surgery, but a tiny percentage are not. And that sometimes the surgery can aggravate the arthritis. Am now starting to worry that I am one of those unlucky few. I feel I am worse off than before the surgery.

After two weeks the stitches came out and my toe was completely stiff, worse than before surgery. The nurse thought I'd done a fusion. The doctor recommended physical therapy, which I've been getting for several weeks, as he had noticed the joint was unusally stiff during surgery.

Unfortunately, two months post-surgery, I see little progress, if any, and am very worried. When the physical therapist (or I) work with the joint, it's possible to get a little better range of motion. But only if first pulling on the joint in an outward motion, then pushing the toe up. For this to happen, there's a serious popping/cracking sound and I can literally see and feel the joint jumping. It's as if there is a ridge or something in the way, hindering the range of motion. Walking, when there's no such pulling, outwards, motion, I can't make that happen.

Also, due to the stiff joint, now the other joint in the big toe has started aching quite alot due to it having to bend more. Which makes it even harder to try to work with the joint where the cheilectomy was done. Of course, my gait is uneven and this is already taking its toll on my back and neck.

As I've recently been to see a specialist to rule out reumatoid arthritis, he ordered new x-rays of my hands and feet, since that's where I have the most problems. On the x-ray it looks as if there's basically no cartilage (or space) left in the joint now. Considerably less than in spring when I last did x-rays.

Has anyone experienced anything similar? What's your advice? Am so so disappointed and worried.

What could my options be at this point - am guessing a fusion? What's that like in terms of shoes, gait, running?

Am going back to see the surgeon Monday.

Thanks alot & hope you're all enjoing the weekend!

 
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Old 12-03-2011, 05:57 PM   #2
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Re: options following unsuccessful cheilectomy?

I'm sorry you've had this happen. I've had cheilectomies in both great toes (most recent was June 15 of this year). You should be able to move the toe pretty well by now. I went to a dance on August 5th and had no problems dancing (I scheduled the surgery so that I could make this dance).

I have a question. You said you've only recently seen a specialist. What kind of doctor did the surgery if it wasn't a specialist?

And no, a fusion is not next necessarily. My surgeon, sports med ortho who is foot and ankle board certified, is doing resurfacing like they do for knees and hips. Look for information on "arthrosurface" as this is the appliance he uses.

You're location is listed as only FL. What part of the state are you in? Might have some recommendations for you.

 
Old 12-04-2011, 04:18 AM   #3
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Re: options following unsuccessful cheilectomy?

Thanks for replying Titchou, it was a foot surgeon who did the cheilectomy. He sent me to a reumatologist just to make sure I don't have RA since my mother does. But 99% sure I "only" have OA.

Will definitely look up resurfacing and talk to the surgeon about it.

I'm in Fort Lauderdale.

Glad to hear your feet are doing well!

 
Old 12-04-2011, 08:31 AM   #4
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Re: options following unsuccessful cheilectomy?

Check with FAU's athletic department to see who they use. Am sure Coach Schnellenberger has someone excellent on call for them!

 
Old 12-04-2011, 09:21 AM   #5
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Re: options following unsuccessful cheilectomy?

thanks a lot! will do

 
Old 12-04-2011, 08:18 PM   #6
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Re: options following unsuccessful cheilectomy?

Hi Foten -

Oh, that is disappointing! I can imagine how frustrated you must feel. I agree with Titchou that there are alternatives to fusion.

I have another option you may want to investigate as a potential remedy.

Five months ago I had surgery for Hallux Limitus / Hallux Rigidus - an interpositional arthroplasty in which a biologic material was inserted in the first MTP joint to preserve more bone and the overall function of the MTP joint. A cheilectomy was part of this surgery. I posted about it here on HealthBoards: http://www.healthboards.com/boards/showthread.php?t=861078.

My doctor is an Orthopedic Surgeon, foot and ankle specialist, fellowship trained at the Hospital for Special Surgery in NYC.

I started PT 2 weeks after surgery (mainly to reestablish a proper gait and strengthen my foot, legs, knee and hip) and I resumed fitness walking and yoga one week after that and have only progressed each day. The range of motion in the operated toe equals that in my good toe, and I have no restrictions on activity levels. I walk outdoors 3-5 miles a day / 2-4 days a week. I also practice yoga daily and I no longer have to modify poses that require dorsiflexion of the big toe. I am amazed at my "new" toe and the strength it has.

An internet search for "interpositional arthroplasty first mtp joint by GC Berlet" will return a pdf result which gives a very comprehensive overview of this surgery.

Please let me know if I can give you any other information. I hope your visit with the doctor tomorrow is helpful.

 
Old 12-05-2011, 08:51 AM   #7
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Re: options following unsuccessful cheilectomy?

They are basically the same procedure - one wih titanium and one with cadaver material to cushion the joint. Each has its own pros and cons such as someone with a titanium allergy/sensitivity would be a candidate more for the other and one with certain other health issues might be better suited for the titanium. But the procedure is certainly one to look at before going to fusion. And I believe the titanium route is a little older than the cadaver material. (But I could be wrong)

 
Old 12-05-2011, 03:09 PM   #8
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Re: options following unsuccessful cheilectomy?

Actually there is more of a difference than similarity with the two procedures. The arthrosurface is an implant arthroplasty that inserts hardware into the toe; there is no hardware with interpositional arthroplasty - it was developed to preserve bone, not replace it so it is less invasive than an implant.

The spacer tissue used in the interpositional technique can either be an allograft (human cadaver) or xenograft (porcine) - in either case the regenerative tissue grown from allografts or xenograft is rendered immunologically inert. That means that the infectious agents present in the host tissue are chemically deactivated.

Additionally, the incision is on the top of the foot (dorsal); it is on the side of the toe (medial) for the interpositional technique.

 
Old 12-05-2011, 05:32 PM   #9
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Re: options following unsuccessful cheilectomy?

Thanks for the detailed information. And I mainly meant that some people are "philosophically" opposed to cadaver material. There are such folks and it's good there are alternatives.

Oddly enough, the first cheilectomy I had the incision was on the side. The one I had this summer was on the top. I think the incision on the top was sensitive longer than the other one - but that was 10 years ago and how well does one remember after all that time.

And one other caveat, though the arthosurface is an "implant", it is NOT a hemi joint replacement - which is an entirely different animal.

 
Old 12-05-2011, 07:39 PM   #10
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Re: options following unsuccessful cheilectomy?

Good to know the differences between the two different implants - I really appreciate the fact that we can all help educate each other on these boards so that we can better communicate with our health care providers. Also good to know all the options that are available - helps in choosing the the best one.

Interesting observation about the incision site - when my surgeon told me where it would be I was concerned that it would be too sensitive when in contact with a shoe - well, it hasn't been since the beginning, even when it was a bit raised and looking like an earthworm after the surgery. Now with the help of regular Vit E oil massage and using a silicone scar patch, it is almost flat and is beginning to fade nicely.

 
Old 12-06-2011, 04:10 AM   #11
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Re: options following unsuccessful cheilectomy?

Absolutely, Grace. We learn so much here. I've also had a neuroma removed on the left foot. And my gallbladder removed. So in those 4 surgeries in the past 10 years, I've never used anything on the incision site to fade the scars. The cheilectomy site from 10 years ago is not visible at all. The neuroma one is if you look closely. The gallbladder ones arenot visible at all. And the cheilectomy one from this summer is slightly red, nothing raised, and I dare say it will be gone by summer. It's something I've never thought about with any of the procedures. I know some people scar worse than others but it looks like I'm one that doesn't....but I also didn't really care. No one was going to be inspecting my feet that closely anyway!

 
Old 12-06-2011, 12:24 PM   #12
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Re: options following unsuccessful cheilectomy?

Many thanks for sharing this Grace!

I googled the words you suggested, but don't seem to find a pdf, unfortunately (rather some academic articles) - is there any way you might be able to post the site? I'd really appreciate it.

The doctor said yesterday he could feel the ridge that's hindering at least a bit more range of movement and said he could try to take off more of the joint. However, he's also hesitant to do so since he thinks there's something going on with my joints in general and wanted to await the results from the reumatologist (who I'll see on the 14th). Basically, he was worried that more surgery might make it even worse than now. So we decided I'd try to work very very hard with the joint for a while longer, incl. PT as much as possible, and check back in January, given that it's still fairly recent.

Do you have problems with other joints, or limited to arthritis in your feet? I have problems with my wrists and thumb bases too, plus some neck/back issues, so I definitely have something going on system-wise. Perhaps generallized arthritis, perhaps something else.

Take care & thanks again

 
Old 12-06-2011, 12:28 PM   #13
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Re: options following unsuccessful cheilectomy?

Hi foten, how disappointing to have the surgery not give you the results you expected. I have had a fusion and am just popping in to let you know my experiences. I'm not promoting the fusion for the record.

It is my understanding that fusion is indicated when there is little to no cartilege left in the joint and for people who want to be active. My joint was bone on bone and had very little mobility. My surgeon offered me two choices, a cheilectomy or a fusion. He felt that if the cheilectomy worked in my situation, it would likely only last a year. He felt the fusion would be my best option. I was a bit overwhelmed by this because I thought there was a choice in the middle. The podiatrist suggested something that may have been like the arthroplasty involving soft tissue. It would have saved and increased the range of motion in my joint. I did some homework and decided on the fusion because I could see that was where I was headed anyway. Since I'm not interested in annual foot surgeries, I decided to go for it.

I had the surgery on Oct 28, 2009 and am really pleased with the results. The joint was fused at a 20 degree angle, which makes it feel like I have more range of motion than before ironically. I think it was painful at about 10 degrees before. I can now walk with a normal gait and for miles. In fact, I participated in a two day, 60 kilometre walk for cancer in the summer and my foot did very well. Well, except for the blisters, but that's another story. I am walking daily and curling weekly. I have done yoga. Basically, I feel that I have gotten my life back. I was 52 when I had the surgery. This joint had been a problem for over 10 years and I wished I had done something sooner. Maybe a cheilectomy would have been an option earlier, who knows.

I am glad that I did not choose the procedure recommended by the podiatrist. I do not think that would have been a good choice. The research I did suggested it was not a reliable procedure. I would also be cautious about implants or joint replacements. They also do not seem to have good success. Maybe things have improved in the past two years though, who knows.

Good luck with your healing. I hope the cheilectomy has done what it was supposed to do, and that it has just be a slower healing process for you.
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Life is too short to wear tight shoes. ~ May you have happy feet in 2013.

 
Old 12-07-2011, 01:00 AM   #14
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Re: options following unsuccessful cheilectomy?

Dear Northwind, thanks so much for sharing that with me!

I am indeed very concerned about having to do a fusion already (I'm 40), so it was nice to hear that you are content with it.

My worries are about what I'd be able to do afterwards in terms of physical activity, gait changes (since I have back/neck problems since several years), what shoes I'd be able to wear (doesn't the top of the toe rub against the shoes something terrible? my big toe is the longest toe).

Also, do you have any other joint issues? I'm waiting for results from a reumatologist. The surgeon who did the cheilectomy thinks I may have something affecting my joints in general, which could be a reason the surgery didn't turn out as expected. So I'm wondering if that could also be something affecting a fusion, if so.

Have a wonderful day & thanks again!

 
Old 12-07-2011, 07:36 AM   #15
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Re: options following unsuccessful cheilectomy?

Hi Foten -

Sorry about that, but HB rules prevent me from posting the site here and I don't think I can PM you yet, so let's try again. Use just these words in the g***** search and the pdf result should be the second hit: "interpositional arthroplasty first mtp joint"

In my feet, I only have arthritis in that one big toe. The doctor feels that it is because of overuse (it is on my dominant side) or injury. I also have stiffness in my ankles, resulting from some severe sprains over the years - my doctor refers to that as post-traumatic arthritis. I've been pretty physically active my entire life (i'm 58 now) and in my 20's wore high heels all over the streets of Manhattan before the famous 12-day transit strike of 1980 drove me and many of my fellow "hoofers" to start wearing sneakers on our forced walks to work. After that, I saved the heels for special occasions and became a dedicated low heel, comfort shoe disciple!

I also have arthritis in my spine and neck, some of which was starting (age!), but was exacerbated from a fall I took down a flight of stairs when my cat tripped me. That may have also impacted my toe. Prolotherapy treatments and Active Release Technique (ART) sessions helped relieve the worst of the symptoms and I practice yoga on a daily basis to keep my joints moving and flexible and I try to walk a few miles, 3-4 times a week.

My paternal grandmother had rheumatoid arthritis and was severely crippled by it, but fortunately I have not been affected by that type.

At this point, there is nothing for you to lose by continuing with the PT and as Northwind suggests it may be that you just need a bit more time with it. May I also suggest that you try some relaxation exercises, I know that it helped me in my recovery by forcing my mind to just focus on the present and what I was able to do and not what I was unable to do. I actually found the lamaze relaxation tape I used 25 years ago and started playing it again!

Best wishes to you, keep us posted and let us know if you need any more information or just an ear to vent to!
Grace

 
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