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Old 07-04-2012, 02:47 PM   #1
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My experience with Toe Fusion Surgery (4th week and counting)

My apologies if you are looking for a quick get in and out post. I intend to post 2 or 3 lengthy items to help folks set expectations and plan out their own recovery from toe fusion surgery. Hope this is helpful.

Overall, my experience has been good. My surgeon seems to have done a good job and I appear to have been a good candidate for the surgery. I am a healthy 55 year old active guy. Hopefully in 3-4 weeks I'll return to normal level of activity. I doubt I'll be cycling or actively working out at the gym, but I fully hope to be walking and driving by that time.

Why did I have the surgery? After first being diagnosed with degenerative arthritis in my toes in 1996 I stopped running. I started wearing orthotics in all my shoes. About 5 years ago I stopped dancing. About 3 years ago I started to gradually cut back on my hiking. About eight months ago I stopped walking around a lake near my house. Since I am just 55 years old, I decided that having surgery was a better option than living with limited mobility. I considered the costs/benefits and decided that the benefits outweighed the costs.

Was I concerned with having the surgery? Absolutely. An ortho specialist wanted me to consider surgery about five years ago. I decided that I wasn't in enough pain to consider the risks. Once I stopped walking more than a few 300 yards at a time I decided in the past year it was time to consider the risks. Surprisingly, the surgeon was not too positive on the benefits of the surgery. I believe he was conservative in estimating the success and satisfaction I would have experience with the surgery. I looked beyond his estimates to find studies online. Results of my search are summarized below:

In 2005, Brodsky, et. al., presented results of a retrospective study and indicated that “patients with a first MPJ fusion function extremely well and most athletic patients continue participating in sports with the advantage of greatly diminished discomfort.”2 Surgeons performed a first MPJ arthrodesis on 53 patients (60 feet), who ranged between 21 to 79 years old. These patients engaged in weightbearing activities ranging from activities of daily living to recreational sports and exercise.2 The researchers performed postoperative functional testing on 45 patients. Of those 45 patients, 64 percent could stand on their tiptoes, 94 percent could kneel, 87 percent could squat and 98 percent could pick up a small object from the floor.

The following are the results of patient answers to a functional questionnaire

• 100 percent could ascend stairs
• 96 percent could descend stairs
• 100 percent could walk less than one block
• 96 percent could walk one to six blocks
• 90 percent could walk over six blocks
• 75 percent returned to jogging
• 80 percent returned to golfing
• 92 percent returned to hiking
• 75 percent returned to tennis
• 98 percent returned to work
• 45 percent had no shoe limitations
• 47 percent required comfort shoes
• 8 percent required prescription insoles

In considering the above stats I focused on the "returned to" data. It was likely a small sample, but I found the data reassuring.

How did I prepare for the surgery? Hindsight suggests I should have planned much better for the operation. This is one of the reasons I'm spending the time with this post. I waited until the last few days to develop a game plan. Rather than wait until last minute I suggest making a realistic assessment of the surgery's impact at least one week before the surgery. Start the assessment from the moment you wake up on a given day. Imagine that your foot will be in a cast and you can not allow it to touch the floor for the entire day while you attempt to complete a normal day. You'll find that from the moment you roll out of bed until the next morning when you wake up that your life will be dramatically changed.

Eventually I went through this effort, but it was once I was wearing the cast. As a result, I placed canes and stools strategically around the house. Other examples, In order to clean out my cat's litter box I staged a stool on the floor and kept a cane near by to help get up/down and to push the litter box around. In order to do my laundry I bought a "grabber" to pull clothes out of the dryer. In order to comfortable to get up/down from toilet I equipped my toilet seat with handrails (I did not go with the raised toilet seat, but some folks might want to consider that option).

Fortunately I rented a knee scooter as well as obtaining crutches for mobility around the house. The knee scooter is an ABSOLUTE NECESSITY. I found that I rarely used the crutches in the house and used the knee scooter almost exclusively. After two weeks they cut my cast off and provided a bulky aircast. The aircast allowed me to put pressure on my heel without risking pressure on the toe/foot. Once I had the aircast, I continued to use the knee scooter at the grocery store and for extended "walks" (mailbox, pick up news paper) at home. Depending on how bit your doorways are you might find the crutches will be helpful for certain rooms.

Overall the knee scooter was the most important tool. With it, I was able to not only move around the house/neighborhood, but I was able to cook and clean. I hated shelling out $95 a month to rent the scooter, but it has been worth it.


Things I wish the doc/nurses had told more (or told me more explicitly)


1. When I was released from the hospital, I rode home in the front seat of the car. DON'T MAKE THIS MISTAKE!! The foot should be elevated. Especially after the surgery. The blood pooled in my toe and I left a trail of blood through the house when I got home. The doc removed and replaced the cast to insure they had properly completed the operation. Sooo... ride home in the back seat with your foot elevated. It should have been common sense, but the orderly rolled me to the car and opened the front door for me. For the first two weeks, you will be far more comfortable if you keep your foot raised. The toe will swell and get uncomfortable otherwise.

2. It's OK to sleep without the boot! For the first two weeks you'll likely want to keep the cast/boot on constantly, but eventually you'll want to get a decent night's sleep. Check with your doctor to see when it's OK to sleep without the boot. My doc initially told me to keep the boot on at all times. I called him after a week of bad sleep and he agreed to let me take the boot off at night.

3. Stay on top of your meds, be aware of constipation and keep a close eye on your diet. I found that I was able to cut back on the pain killers after 3-4 days. However, there were sometimes when the pain was pretty bad because I delayed taking my pain killing meds. Take the prescribed amount at the prescribed times and cut back once you are comfortable.

Regarding constipation.. The more/longer you take painkillers the worse your constipation. You can't escape it. I took senna and dulcolax religiously after the surgery. That along with drinking a lot of water and eating a ton of fruit and vegetables prevented the constipation from being too painful.


How to stay sane?
This has been more difficult than the physical recovery. I loaded up my Kindle with books, but found that during the first two weeks I could not focus for extended periods to read. Instead, I watched a lot of TV. Having friends visit and talking on phone were extremely helpful. Having a social visit each day has helped. Also, trying to stay somewhat fit has been important for me. I have continued to do situps and pushups. Not only does this help with overall health, but you'll find that having limited mobility requires strong core/back/abdominal muscles. Keep these in shape and you'll minimize the discomfort of wearing the cast/boot.

This is probably more than enough to start. I'll add one or two more updates over the next month.

 
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Old 07-05-2012, 12:58 PM   #2
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Re: My experience with Toe Fusion Surgery (4th week and counting)

hi thanks for putting up that info. i had the fusion 6 years ago. i do everything. my only drawback are cute womens shoes. i need a wide toe box, no more than 2 in heels, cant wear flip flops and in the summer shoes are harder to wear. speedy recovery to you.

 
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Old 07-09-2012, 07:56 PM   #3
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Re: My experience with Toe Fusion Surgery (4th week and counting)

This is a great helpful post from someone who's been there, done that! And I am about to go in for my THIRD revision fusion surgery on the MTP joint! Non-union of the (cadaver) graft, now broken hardware.....I'm the outlier ortho patient!

 
Old 07-24-2012, 12:28 PM   #4
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Re: My experience with Toe Fusion Surgery (4th week and counting)

Sir

I have been looking for this desciption for months,and really appreciate the details of what you wrote. I am 57 and am told fusion is my only option - end stage degen. arthritis. I have been very active always - still play basketball,( until this year when the pain in toe was too great) go to gym a lot ... walk, hike, even beach football on occasion.....

I am trying to get a true appreciation for how this will impact my activity level. I read that study and don't get how one can stand on a toe that is fused.....I don't see how one does yoga with all the toe curls....if you have any thoughts I would appreciate it.

 
Old 07-24-2012, 03:49 PM   #5
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Re: My experience with Toe Fusion Surgery (4th week and counting)

Hi,

Yoga? Didn't recall seeing that in the study, perhaps you read a different version/text of the study. I agree that yoga could be problematic. Especially the balance poses. But I imagine some poses which you couldn't do because of the pain will be easy to do (especially lunges). Yet to be seen since I'm still limiting my weight to about 45 pounds of pressure on the repaired toe/foot.

I'll add another update at some point. I might even add one now while it's on my mind. The transition to partial weight bearing has been a bit interesting.

Regards,
Mark

 
Old 07-24-2012, 08:28 PM   #6
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Re: My experience with Toe Fusion Surgery (4th week and counting)

if one can practice balance with toe fusion thats great it actually can be done. in terms of everything elsemi cant see what is stopping you again except for wearing high heels!!!!!!!!!

 
Old 07-25-2012, 06:46 AM   #7
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Re: My experience with Toe Fusion Surgery (4th week and counting)

Thanks. Didn't mean to say the study talked about yoga. It is something I tried to start doing but the toe curls were a killer.

I really hope you do continue to post your progress. I am planning on this surgery probably in September and my reservations relate to how this will inhibit activity post surgeryand whether I really won't limp forever. I just want to go in with my eyes open and expectations realistic.

 
Old 07-25-2012, 11:37 AM   #8
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Re: My experience with Toe Fusion Surgery (4th week and counting)

Quote:
Originally Posted by Mark27606 View Post
Hi,

Yoga? Didn't recall seeing that in the study, perhaps you read a different version/text of the study. I agree that yoga could be problematic. Especially the balance poses. But I imagine some poses which you couldn't do because of the pain will be easy to do (especially lunges). Yet to be seen since I'm still limiting my weight to about 45 pounds of pressure on the repaired toe/foot.

I'll add another update at some point. I might even add one now while it's on my mind. The transition to partial weight bearing has been a bit interesting.

Regards,
Mark
I have done yoga since my fusion. In many ways it is easier than before the surgery when my foot was in pain. I could not do the plank pose pre-surgery because that amount of toe bending hurt. I can now do it again, possibly slightly modified from the "normal" person position, but still a plank. Balance is interesting, but very possible. It is just a slight modification. Our bodies are quite adaptable!

I have also returned to curling post surgery. I am right handed, so my right foot is the one that goes behind when I throw the rock. That is the foot I had surgery on. I felt that I had to get to know my "new foot", but that also has been much better post-surgery.
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Old 07-25-2012, 11:43 AM   #9
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Re: My experience with Toe Fusion Surgery (4th week and counting)

Mark, this is an excellent idea for a thread! I wish I had seen it before I had my surgery, but I managed. I was lucky that I did not have a cast. I have a plate and screws system and was able to heel weight bear as tolerated from the beginning. I was able to put weight on my entire foot at six weeks.

Hartbar, it is my understanding that fusion is recommended for people who are active. I know my fusion has given me my life back. I decided to proceed with surgery when my foot was not even happy with the Keen hikers. I cannot think of any activity that I could not do because of my foot......ballet dancing on pointe might be out of the question, but since I am not a dancer, that is not an issue. Last summer I walked in the Weekend to End Women's Cancers in Vancouver. That was a two day, 60 km walk. Vancouver has many hills, so we walked up and down hills. I had no problem. I have also since hiked up steep hills (small mountain?) in Whitehorse. My foot did not cause any problem....in fact, it would have been much better than pre-surgery.
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