14 1/2 months ago I had a titanium implant in my great toe (right foot). The tissue in between the MTPJ joint was totally worn away and bone was rubbing against bone. To correct the problem, my Podiatrist performed a buinonectomy (to straighten the toe), shaved down the two bones that were rubbing against each other and inserted the implant. After much suffering, unable to WB or drive (right foot) until 7 weeks, months of PT, I am still unable to walk pain free. Even though I have great mobility in my toe when I'm sitting and moving it around, as soon as I start walking, the pain commences. I am not able to wear a shoe unless it has a wide toe bed and I am unable to wear shoes with a heel more than 1 1/4 inches. Most of my shoes are those with laces or slip-ons. It took 7 months before I could get my foot into a sneaker due to the swelling. I still have swelling in the toe. It was suggested by an Ortho that I have a bone fusion. My Podiatrist, however, thinks that is too severe, should be done only as a last resort, and he wants to remove the implant (he thinks my foot just doesn't like having a foreign object, or one as large as the implant that was used, in it). He wants to attempt to move tissue into the space where he is removing the implant. He claims the toe will be a little shorter. However, I don't care about that, I just want to be able to walk again without pain. He wanted to try using a smaller implant but I just don't want to go that route again. I do trust him and I know he is trying to do what's best for me; giving me the most mobility he can as I am still very active. He has told me that only 5% of the implants he has done, has the patient experienced a problem. I happened to fall in that 5%. My surgery is scheduled for this coming Wednesday. Has anyone out there experienced a similar problem and what was done to correct it? Any imput would be greatly appreciated.
The following user gives a hug of support to dancing feet: Lindalouise1968 (05-17-2011)
Dancing Feet, your story sounds very, very much like what I have gone through. I do have a pretty long post going if you want to look it up here on health boards. I don't think I can post links, but search for threads started by user, and put in my username.
To give you a real brief version, I have had three surgeries on my right great toe, the first one cleaned out bone chips and straightened out the toe, 3 years later the second one put an implant in the MTP joint since I had no cartilege left, and three years after that, the third one was a fusion with bone off my hip because the implant bothered me so much. I was also given the same answer by 3 different podiatrists; that most people have success with the implant, but a small percentage don't. All agreed after seeing x-rays that the implant was in a good spot, had not moved since it was put in, and looked functional. However, I had swelling for 3+ years in my foot that just overall caused my foot to be sore and tender, preventing me from doing a lot of activity. Interesting of you to say this; I also had good mobility and range of motion in the toe, but if I spent all day doing yardwork, I paid for it that night with throbbing pain.
After going to see an ortho, he told me enough is enough. The implant was starting to wear down the bone of my foot and caused the overall length of my great toe to shrink. He recommended removing the implant, taking bone of my hip to lengthen the great toe because the implant rubbing on the foot was causing it be about 1.5 cm shorter than the next toe, and then fuse it all in place with a plate and screws. I had this done at the end of October, and I am very happy to say that I am so much better off now. I have zero swelling in my feet, I have started wearing shoes and walking again, and my doc expects in 6 weeks to allow me to a full return of activity, including running. He has quite a few patients who have had this procedure done, and they return to marathon running.
To give you a little more info, I am a 37 year old man. I do remember my podiatrist telling me at 33 when I had the implant put in that I was a young man and to go with a fusion is the final step, which is why he recommended against it. Once that joint is fused, there is no going back. He recommended the implant for the simple reason that I have (hopefully) 40 or 50 more years to go, and that's a long time to have a fused joint. As in, it requires a change in the way you walk. However, and maybe this is the difference in opinion between the ortho and the podiatrist, but the ortho says I will have minimal correction to my walking. I am fortunate in that I am a man; a lot of women cannot wear high heels after fusion because they can't bend their toes that way. However, that's not a problem for me. I have noticed that I have a little trouble walking down steps if I leave my right foot behind and step first with the left. However, I step first with the right and do the bending with the left foot, and it's not a big deal.
Maybe a smaller implant would have been better for me, I don't know. None of the three pod's I went to though felt that anything was wrong, I just seemed to have swelling that went nowhere for years. In fact, when the ortho opened me up, he said it was pretty gross what he saw; there was a lot of old fluid and bone dust from the implant grinding on my foot. It's a little late in the game since you are scheduled for Wednesday, but then again, it's your body. If you are having doubts and want another opinion, by all means go get it. I'm sure you remember that once you are cut open, there's no going back to the way it was before, for better or worse.
There are no guarantees in the world of medicine, sometimes a doctor is negligent, but I think in most cases when things don't work out the way you want, it's not because of physician error. Most doctors I think take great joy in helping their patients to a full recovery from what is bothering them, and I think they feel very much for us when things aren't going well. Maybe I am naive, but that's the impression I have gotten from the guy I am seeing now, and the docs I have seen in the past. Anyway, if you want my opinion, and it may not fit everyone's situation, but I would say go with the fusion. Go to an ortho and get a lot of information, ask a lot of questions, do some research. I have had tremendous success with my fusion and look forward to doing some running this spring. (there is a post on this board with questions to ask before surgery, it's pretty good)
Good luck, and please let me know how you make out.
The Following User Says Thank You to dbgoalie For This Useful Post: danny1957 (01-27-2011)
Dbgoalie, thanks so much for your response. I'm glad your bone fusuion is working for you. I did give the bone fusion serious thought. I went to an Orthopedic surgeon in NYC. His recommendation was that if I wanted to have only one more surgery, I should go with the bone fusion. The one main reason I was apprehensive about doing it is the fact that, unlike you - 37 years old, I am a 60 year old woman. I am very concerned about invading another part of my body in order to get the bone needed for the fusion. I am very active, in pretty good health, but I am worried that I might stir up a problem in another area of my body given my age. I was also told that there was no guarantee that the bone fusion would work in which case they would have to try again. I also want to be able to wear a heel now and then which, up to now, I have not been able to do because of the inclination of the shoe and the swelling in my toe (which by the way never seems to go away - as you stated, also). I work in the Corporate world and it has been very depressing for me not to be able to dress like I used to because I have to wear low wide shoes and am unable to wear a dress for special occasions because I would look pretty silly in shoes with a velcro strap.
The Podiatrist seems to believe he can take care of my problem without having to do the fusion. I do think he wants to see me walk without pain and be restored to normal physical activity. I truly believe he is very sincere, and he is a well-respected doctor as I did my homework before choosing him. Today, I was having second thoughts; thinking that, at least I am able to walk even if it's in sneakers or the like. What if after this surgery, I am worse off? However, I must think positive and leave it in God's hands. I guess the worse thing that can happen is that I will end of having the bone fusion. However, at this point, I feel I need to exhaust all other options, first. I am trying to prepare myself mentally for the long road ahead as it is still very fresh in my mind what I went through with the last surgery.
I pray I'm making the right decision. Right now, my doctor has me taking Celebrex (an anti-inflamatory) prior to my surgery and for 3 days after. I must say my stomach isn't handling it too well and was unable to sleep last night. I'm a little concerned about taking too many meds especially since he has prescribed that I take 2 percocets every 3 hours after the surgery. (The last time, nothing helped the pain. I had taken 3 Vicoden and 3 Percocets within a 16-hour period before I began to get the slightest bit of relief and I had packs of ice on my foot 'round the clock.) Not looking forward to this. I keep saying "this time it won't be as bad." After surgery, I will post as soon as I am able.
For what it's worth, I think you are making the right decision on trying other avenue's before the fusion. My ortho only wanted to use bone from my hip; he says that in the ortho world, there is a saying 'there is no bone like you own.' The reason I asked about synthetic substitutes or bone from a cadaver was because I have a friend who had a bone graft off the hip for his neck vertebrae, and he told me it was extremely painful. He wasn't lying; I felt like I had been hit by a car on my right side when it was done, but I'm fortunate to say that I am probably 80 to 90 percent now with the hip, it is close to being painfree for me. I had some apprehension about the bone graft because like you said, that opens up another area on your body, another area that might develop infection, and worse case, what if it hurts and never goes away?
My thoughts are with you. Isn't it funny how people with foot pain are sympathetic with each other? I think it's because so many people don't go through major surgeries like this and just think it's a toe, how bad can it be? But we know, so please keep posting here, I want to know how things turn out for you. One piece of advice with the pain killer medication, try to drink lots of water. I find them to be very dehydrating. I was NWB for almost 8 weeks, but my wonderful wife always got up to get me some water when I asked, and was filling it for me when I wasn't asking, so drink your water. Good luck.
i think the fusion is the answer. i also went through the same exact stories. the implants have a low rate of working. my fusion was over a year ago. i can do everything i did before. i play tennis, work out and ski. believe it or not i am actually wearing 2 in. heels and some higher. i cant walk long distances in high heels, but i am able to keep them on foe a long time. i have done so much research in terms of shoes. i know what brands look and feel good and i know what the shoemaker can do and sometimes it is miracles. i had this done when i was 50. i did give away my 3-4 inch heels and now i look back and say what was i thinking? i am 99lbs, i like to dresss well and wear great shoes. the only thing is, i dont want to be in pain. i am my active self and i feel great. yes, i wish this never had to happen, but it did. i would not even consider walking around in sneakers and flats. i am saying this to only help with your decision. it can be done. if you want more answers on anything, just post. debbie g
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