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Old 07-09-2012, 10:23 PM   #1
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Hallux rigidus surgical options

Hi all,

I am a 30 year old Australian and have been diagnosed with advanced osteoarthritis in my first MTP (big toe) joint. The orthopaedic surgeons I have seen have all recommended arthrodesis (aka fusion). I don't want to fuse my toe at my age because I am concerned about the longer term impact it will have on my other joints due to altered biomechanics and because of the impact it will have on my recreational sports (running, tennis and surfing). I have seen a couple of podiatric surgeons and they recommended interpositional arthroplasty, in particular interpositional capsular arthroplasty which uses your joint capsule as the spacer.

Has anyone had experience with interpositional arthroplasty and who are the top surgeons who regularly perform this? Does anyone have a view on using a podiatric surgeon versus an orthopaedic surgeon? In Australia, there is a lot of tension between these two professions!

I am willing to travel to receive the best treatment.

Thanks in advance for your help!

 
Old 07-10-2012, 04:47 AM   #2
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Re: Hallux rigidus surgical options

You are doing the right thing to research all your options. Having it fused should not limit your activities. They fuse it at an upward angle so that rolling off it while jogging, hiking, dancing etc can still be done. You'd even be able to wear low heels (probably not over 1-1/2 to 2"). Recovery is rather long though.

Arthroplasty is gaining in popularity, whether using cadaver material, patient provided material or using a titanium plate (like in hip or knee ressurfacing).

My suggestion normally here in the US is to see a sports medicine orthopedic surgeon who is Foot and Ankle Board certified, usually searching for one by contacting football, basketball teams, major college athletic departments or professional dance companies. Those types of actitivites often have this type of injury/condition and whoever they use is typically very well versed in options. I don't know how that would translate in your country.


Here, also, I don't recommend ppodiatrists because they don't have as much training as orthos do.

Hope this helps.

 
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Old 07-10-2012, 04:54 AM   #3
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Re: Hallux rigidus surgical options

If you are questioning whether you should do the surgery you should probably hold off. You might want to get a second opinion. I had toe fusion surgery just 5 weeks ago. I'm quite happy with it so far, but I held off for 3-4 years and I'm glad I delayed the surgery. I only underwent surgery when I determined that my quality of life had degraded to the point when it made sense to take the risk. 3-4 years ago, a doctor was pushing me to get the surgery.

 
Old 12-26-2012, 12:56 PM   #4
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Re: Hallux rigidus surgical options

I need some advice. I was diagnoised in 2009 with hallux rigidus and the Orthopaedic sports medicine surgeon recommended a chillectomy. I wasn't in any pain and could not justify having surgery. I was having stiffness in the joint long before I went to see the surgeon. I have developed a bump on top of the toe but still not alot of pain. I went to see another surgeon this year 2012 and he said if I wasn't in pain to wait. I have done so much reading about this surgery and don't won't to wait too long. I have very little ROM and will more than likely need a fusion. I would appreciate any advice. I am 59 years old and in good health.

 
Old 12-26-2012, 02:28 PM   #5
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Re: Hallux rigidus surgical options

Just thought I should update this post. In late August 2012, I underwent a minimally invasive cheilectomy and had two scopes sent into the joint by a top orthopaedic foot and ankle surgeon in Australia.

I would highly recommend having the minimally invasive cheilectomy because he performed the surgery through three 1 cm incisions over the top of my foot rather than through a larger incision. The incisions healed really quickly. I was able to walk (i.e. hobble) out of the hospital in a heel weight-bearing surgical shoe and didn't need to use crutches. Not all surgeons know how to do the minimally invasive procedure or have the equipment for it so you might need to ask around. The first two weeks you should be pretty inactive and elevate your foot as much as humanly possibly. This helps reduce swelling and promote wound healing.

Unfortunately my joint is severely damaged and I'm still in a lot of pain post-cheilectomy so it looks like I'm heading for a fusion and am currently doing my research into this. But I'm really pleased I tried a cheilectomy first. I can no longer walk for exercise because I get lots of swelling and pain afterwards to the point where I limp and yelp if I put too much pressure on it. I'm hoping a fusion will allow me to walk for exercise again but I'm doing my research before thinking about any further surgery.

I have had 2 foot surgeries to date (a scarf and akin osteotomy bunion correction and a cheilectomy). My advice to anyone considering foot surgery of any form is:

1. Don't do it unless your problem is seriously affecting your quality of life. You need to ask yourself this question and answer it honestly. E.g. not being able to wear 6 inch Jimmy Choos is not a good enough reason . The recovery is really long and your operated foot will swell for up to a year (some people I know have permanent swelling issues post bunion surgery). If you're not in pain and your activities are not limited by your problem then don't touch it until they are. Foot surgery is complicated and it's just not worth the risk.

2. Get a top sports medicine doctor to help guide you and direct you through the process of scans and surgeons. I have found them more proactive and better connected than GPs.

3. Get numerous opinions from surgeons. I saw about 10 surgeons before deciding to go ahead with the cheilectomy. Some people thought this was overkill but I genuinely got something out of every appointment whether that be a new idea or procedure, or corroboration with the advice of other surgeons. I didn't get any second opinion for my first surgery which was a bunion correction in Feb 2010 and I regret not doing this because I don't think I would have gone ahead with it had I sought other opinions. My bunion didn't cause me much discomfort at the time and my first MTP joint was damaged by the surgery which has now led to my current arthritis problem.

4. Don't lose hope - ever!! Keep jumping each hurdle as it comes and focus your energy on controlling the controllables!

Best of luck everyone and I hope you all get happy outcomes!

 
Old 12-26-2012, 03:28 PM   #6
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Re: Hallux rigidus surgical options

The main concern is whether you wait too long and don't have enough cartilege left to have a successful cheilectomy. Then yuo are looking at a fusion. If it's impacting your activities now, I'd have it done. I had one done at age 55 and the other foot done at age 65. The recovery is fairly easy and you really aren't down but for a few days. I was off work from Wed thru Monday both times. Be sure the surgeon is foot and ankle board certified and that he does a lot of these. Most sports med orthos would qualify.

 
Old 12-31-2012, 01:21 PM   #7
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Re: Hallux rigidus surgical options

Thanks for your advice. It helps alot. I'm going the first of the year to see another surgeon and get his opinion. I'm not in pain just every now and then it aches. All the reading that I've done, the majority of the people that have had foot surgery suggest not having it until it starts affecting your quality of life.
Thanks and will let you know what the new surgeon tells me.

 
Old 12-31-2012, 01:56 PM   #8
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Re: Hallux rigidus surgical options

Hmmm, my surgeon is planning to fuse my big toe on my good foot after reconstructing my other foot -- it (my big toe) just flops. He said it wasnt a big deal and you leave the office in a walking cast, similar to Titchou's experience.

Bigsoretoe -- I love your post about when to have surgery. It it a difficult decision to make. But 12 opinions??? WOW, that is a LOT of research! Good for you -- no regrets!

 
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arthrodesis, foot arthritis, hallux limitus/rigidus, interpositional arthroplasty



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