Tarsometatarsal joints (midfoot fusion) surgery - Foot Problems Message Board

TripleM · 10-27-2007, 06:59 PM

I have severe arthritis in the Tarsometatarsal joints of #2 and 3. Celebrex and the usual OTC anti-inflams do not work well. A midfoot fusion was suggested.
I live on a farm and am very active in the fields. The ground is hilly and uneven. I do all the ground and machinery work that is required on a working farm. I also ride horses.
My surgeon wants to do a midfoot fusion using a graft from my tibia. He indicates crutches for 6 weeks and back to work in 3 months. How realistic is this and what can I expect during and after the procedure. Will I be able to negotiate the uneven fields and ride horses or will my foot be stiff and "non wobbling".

Has anyone had this procedure? If so, what were your results?

Please advise.

tazzy0429 · 10-31-2007, 02:05 PM

I have had a midfoot fusion due to a crush injury and the imminent arthritis that would be a result with out the fusion . They fused my first three cunniforms and the heads of my first two metatarsals. Let me start off by saying I will try to give as unbiased a view as possible about the surgery and the recovery as well as mobility afterward. I went into surgery at a daysurgical center assuming that I would be going home afterward. That was not the case. I had to stay one day. I had the option to have a nerve block installed into my leg during surgery that would serve to block pain via a medication pump for about three days after surgery. I could feel nothing below my knee which was wonderful while it lasted. I was in a jones dressing in the hospital which is basically a piece of casting material that runns along the back of your leg and under your foot with soft material bound around it and a lot of fluff for padding inside. Upon leaving the hospital I was placed in a short leg cast below the knee. I went home the day after surgery. Every thing went well until my nerve block pump became disloged and was leaking out of my leg instead of going into it and so it had to be removed.
Two days after surgery I swelled in my cast making it severly painful and my toes were turning blue, so I went back to the doctor and he cut it off and put on another. Six hours after that I was at the emergency room having the second cast removed. I ended up back in the jones dressing until that too was removed so many times that I was put in a soft cast. That was the first month, although I don't remeber all that much because to keep the pain at bay I took oxycodone and hydrocodone every three hours alternatingly. At about four weeks post- op I developed a blood clot in the back of my leg and was put on Lovenox injections that I had to give myself twice a day. I also took cumadin for about 7 or 8 weeks. I was on crutches forever it seemed like and benifited when a friend let me use thier wheel chair. At about maybe 3 monthe I was put in a fracture boot and allowed to put weight on it. It was to painful and so it took another 2 months before I could walk without crutches. I am a year post-op now and cannot walk without my fracture boot. I have orthodic inserts that were made for me but using them gives no releif. I am however going back under the knife to re-do the surgery because I ended up in a non-fusion which is were they think all the pain is coming from. I still take meds for pain releif although they don't help as much as the narcotics I was on. I can tell you that walking on anything uneven is not good for me. It hurts bad but I don't know if that is from non-fusion or what? I have seen lots of people who this turns out well for though. they just don't post as often as the ones that have or had problems. There are lots of things to think about with this surgery but I am re-doing it in spite of what I went through because once they do it they remove the cartlige between the bone to be fused and that is really your only choice. I am very outdoorsy, I hunt, horseback ride, used to water ski, fish and love gardening. I have not riden in 2 1/2 years but that does not mean your wont be able to. I just figure you would want to know the bad senarios as well as the good because in my experience it pays to be prepared. I have had 2 kids by c-section and the pain after my surgery did not even compare, it was much worse than I thought it would be. I became depressed because I kind of take care of everything and I am very independant. I was not prepared for those feelings at all but my family is a good support system.
I hope some people who had a good outcome with this surgery post as well so you get to see both sides. I still think I would go through this again from the beginning if i could do it all over. In spite of my difficulties. Remember the ultimate decision is yours to make so just don't rush into it. Talk to all your family and friends as well as you doctor to get as much info as you can then sit down and really think about it. I did and I am still doing it again.
Keep us poated on what you decide......and God Bless You!!!!!!

TripleM · 11-01-2007, 06:59 PM

Dear Tazzy0429,

Thank you so much for your report to me. It was very enlightening and abit unnerving as to what can go wrong. Have you read other folk's stories on how the outcome was? I am VERY worried about the possibility of not being able to walk on uneven ground or to horseback ride. Sidewalks around here are non existant ......so no matter where I go, it will most likely be uneven ground. Also, was your surgery done by a surgeon who specializes in foot orthopedics? Did they ever tell you what caused all the repeated swelling and the clots?

As you said, I want to be sure this is the way to go before I do so. Hopefully, someothers will respond to my plea and give me some more insight.

I will keep you posted as to my decision.

tazzy0429 · 11-09-2007, 12:08 PM

My surgery was done by an Ortho that specializes in feet, Dr. Teasdall. He is at Babtist Hospital in Winston Salem. The swelling he said was because I just didn't seem to tolerate a cast very well. The blood clot unfortunately is something that runs in my family. They treated it agressivly even though it was not deep vein. My father died at 56 due to a blood clot. He also had alot of other things going on medically and none of them had to do with his feet.
This time i made a list of questions so I could ask alot of things and not forget or leave out anything. I also made a list of pros and cons so I could really compare them. I talked to my doctor and my family.
I have read some on here who had a great outcome with this surgery. I just don't happen to be one of them YET. You see thats me being optimistic!!!Well I am trying . I am not looking forward to re-doing the surgery but hope this time it has a sunnier outcome.

rwood1948 · 11-11-2007, 12:31 AM

TripleM - I also have have severe arthritis which started first in my hands, then knees & for the past year my feet. I am in complete agony. I can hardly walk. When my orthopedic surgeon first suggested midfoot fusion surgery, I was not for it at all, opting to have cortisone injections instead. My foot felt better for maybe 10 days at the most - had another set of shots 1 month later (Oct 30 2007)- and guess what? No help at all. So after running it through my head for about a week I told my doctor that I couldn't go on with the pain and/or inability to walk so let's talk surgery, specifically midfoot fusion. We both knew what the pros were, so he went over the the cons with me such as: 1) being off my feet for approx 8-9 weeks 2) the possibility of bones not fusing 3) the bones fusing, but at a slightly different angle 4) me adjusting to the new angle blah, blah, blah. I left his office on a high note knowing I was going to my surgery and the side affects (cons) mentioned ----- not gonna happen to me. Well when I found this website 3 hours after leaving my doctor's office and read about all of the problems everyone had, I couldn't believe it !! I was ready to scream. I have been obsessing about my surgery situation ever since.
PS I also am the primary caregiver to my very sick husband (liver transplant in 2000, diabetic, has high potassium (which can be lethal), he gets all sorts of major infections, spiking fevers, cellulitis and is in & out of the hospital about 3-4 months per year and needs another transplant in the near future). I wait on him hand and foot day in day out.
So, be that as it may, I am in the same situation as you are re: I need to have midfoot fusion surgery and can anyone guide me along my journey? I hope your feet (and mine) will be happy feet one day. Thanks for listening.