Hi - I've been reading up on these boards and very surprised to see all who've been down this road. About 3-4 years ago I noticed stiffness (inflexiblity) in my left big toe. At the time I was running a good bit & figured I injured it & it would get better. After it got worse & the bump bigger on top of the joint, I saw 3 docs - 2 podiatrists & 1 orthopedic...all different opinions for treatment of course. I have late stage 3/stage 4 hallux rigidus. Pod 1 says do the osteotomy pretty soon to avoid fusion. Orthopedic says osteotomies are for bunions and won't work & to just wait until it's bad enough & do fusion. Pod 2 said it should be my decision - but there is high probability that osteotomy won't work because it's stage 4. I hate the idea of having a fusion (because of recovery time, stiff toe, no hi heels, etc) if I can prevent it - but at the same time don't want to have osteotomy & then fusion if it doesn't work. None of the doctors have mentioned a Keller bunionectomy, which I read about on this thread somewhere.....
To make matters worse, my other toe is heading the same direction. It's about stage 1 or 2, and both podiatrists say it's a good candidate for osteotomy. I'm 43 & pretty active...would love to get back to running which I don't do much because I'm working much. Thanks in advance!!
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Get away from the pods. You need a sports med ortho. You don't say where in NC you are but my standard recommendation is to call the nearest pro football or basketball team's front office or the nearest major college athletic department and ask who they use for "turf toe" - also known as runner's toe, tennis toe. That is what you have. Very common among runners. I had it in both great toes.
I had a cheilectomy with wedge osteotomy(clean out of bone chips,grind off spurs, wedge cut bump on top of toe, drill holes in existing cartilege to promote growth) 6 years ago. Great results. Jog, dance, wear heels, whatever and I am 62 years old. Do some research on Shaquille O'Neal. He had the same condition and had it repaired while he was with the Lakers.
Good luck and let me know if you have any questions.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
With all due respect to Tichou, not every hallux rigidus is "Turf toe", sports med othopods are not necessarily the way to go and not every foot needs the same procedure. I researched a lot over 2 years, saw 2 orthoped surgeons and a couple of Pods who all gave me different advice. It all depends upon exactly what is wrong with your foot and what you hope the function to be afterwards. Also with respect to the docs, no one knows what shape your foot is in until they open it up and see. I did not want a fusion because I wanted to dance and so I wanted even limited ROM. In the end, my podiatrist did a cheilectomy to repair the joint and also a kind of osteotomy (bone cut and reposition) different from Tichou's to try to prevent the hallux rigidus from coming back. The ortho guys were flippant and wanted to do more extreme and risky procedures. My surgery was 5 months ago and I couldn't be happier. I had about 50% of cartiledge left and went from 10% range of motion to 45%. Pod predicted I would get 25% so I am doing pretty good.
By the way, drilling does not promote cartiledge regrowth. (Cartiledge does not grow.) Healing from drilling causes scarring and it is the scar that then acts like cartilege. My Pod did not do that because he did not want to disturb the cartiledge I do have. Learn about your condition & ask a lot of questions. In my case, I also asked some PTs their opinion about the outcomes of various surgeons. It was very helpful because they often see the fall out. In the end, I was and am very happy with my surgery. Should have done it years ago. Sorry about the spelling.
In the end, you will have to go with someone who you trust and who respects your wishes. I told my pod No Fusion, no matter what he saw when he opened my foot and he agreed. I would have rather lived with even 10% ROM with pain. The ortho guy said he wanted to fuse it if HE saw fit. Simple choice. i love my Pod. He gave me my life back.
Last edited by dncergrl53; 11-22-2008 at 12:04 AM.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
In my case, repositioning was not necessary. My was a classic case of turf/runner's toe from years of running and wearing high heels every day. And the growth of the cartilege or scar tissue - whatever term you want to use - did occur with me as I now have more cushioning in that joint. Additionally, my experience with the best pod here was that he was flip about the whole thing and did not want to do the whole procedure. He wanted to leave out the osteotomy and told me to never run again or wear heels. (BTW, I still use him for podiatric things and he still complains about my jogging - calves too tight, etc) My sports med ortho, Dr. John Gould, wanted to do the whole procedure and told me I could run and wear heels again. Looks like he was right and I am glad I went with him instead of the other.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
The point here, is that it is important to find the best individual who will listen to you and meet your needs. Hallux rigidus only means the hallux (big toe joint) will not move (rigidus) or is limited (limitus). There are many different reasons for that and the solution should match the problem.
Tichou, I really wish you did not tell me at first to search out doctors who treat turf toe and to go see a sports medicine doctor. Turf Toe is slang and does not apply to everyone. You confused me for months at first when I was deciding what to do. I had hallux limitus but did NOT have turf toe. The damage in my toe joint and the biomechanics of my foot was much more complicated than that.
The other thing is that if people ask if their doctor drills to grow the cartiledge and the doc says no, that does not mean the doc is missing something. Our poor doctors had to cope with patients having partial and erroneous information.
Last edited by dncergrl53; 11-22-2008 at 12:48 PM.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Thanks all. Your info is all very helpful & confirms that I still have some homework to do and should not just settle on the fusion down the road when it gets unbearable. I just find it hard to believe that there's no other options except fusion, especially since I'm not in a whole lot of pain. We live in Charlotte so it may be worth my while to see the Panthers doc.
I'd be interested to know what "stage" your limitus/rigidus was when you each had surgery. One pod says mine is a late 3 or 4.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
bigtoe:
I was stage 2-3 when I had my surgery. My other great toe is still at stage 1 so I'm not doing anything to it yet. It would certainly behoove you to get a second opinion from the panther's doc.
Dncergrl:
I never said that a doc who doesn't drill is missing something. I said mine did it and it helped me. I can only speak from my experience.
Additionally, when someone says they have hallux limitus/rigidus and do not go on to say they have other underlying structural issues, I take them at their word. I had no other issues - a straight, old fashioned, everyday version of runner's toe - too many miles over the years in the wrong shoes with too many miles on them...in addition to wearing 3" heels 5 days a week. Nothing needed to be stabilized, straightened, etc. It was a straight forward clean up job. Obviously if there are other issues that compounds the situation - such as yours. But it doesn;t make me wrong - and I resent your implication. I have never dissed your experience - nor would I because I didn't experience it - and I expect the same in return. Thank you very much.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Tichou On Nov 21 you wrote:
"but my standard recommendation is to call the nearest pro football or basketball team's front office or the nearest major college athletic department and ask who they use for "turf toe" - also known as runner's toe, tennis toe. That is what you have. Very common among runners. I had it in both great toes.:
Tell me how you know this writer has "turf toe"?
Last edited by dncergrl53; 11-23-2008 at 09:28 AM.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Look, I'm an athlete. I belong to a track club. Everyone in the track club knows what turf toe, runner's toe, tennis toe, etc is. Athletes understand the terms. They are catchall phrases. Just because you don't know that doesn't mean it's wrong. It just means you haven't been exposed to the term. I have no idea what ballet dancers call it as I am sure they have some other term. But it generally means a deterioration of the great toe joint due to some repetitive action. Period. End of story. And yes, there can be other contributing factors to the deterioration. But for the common, everyday one, turf toe suffices. In fact, when my doctor told me I had "classic hallux limitus", I asked what that was because I had never heard the term. He said most people call it turf toe, etc. He went on to explain the basic condition and some of the ones that have underlying structural conditions. He even drew pictures of them for me so that I would understand exactly what mine was and exactly what he would do to correct it. So, if one of the foremost sports med foot orthos in the US called my condition "turf toe", I don't have a problem using the term.
I told him to use that term when calling the front office because that is the commonly known term in those arenas. If he asked for who they used for hallux limitus/rigidus, the person would have had no idea what he was talking about. And if he just asked for their foot doctor, he may have gotten the one they use for ingrown toenails.
All I did was try to help him - and you - find the most qualified doctor. It's up to you, him, everyone to listen to that doctor and go from there. I'm not a doctor so I can't anyone which procedure is best for their condition. I can only state what was best for mine....and how I came to that conclusion. Because you hung your hat on my situation when evaluating yours does not constitute a shortcoming on my part.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Tichou,
Your doctor used the term "turf toe" to describe your condition because he was SIMPLIFYING it to you.
The medical name for TURF TOE is metatarsaphalangeal joint sprain, which is a sprain of the ligaments of the MTP. It is usually caused by jamming the joint. There are 4 stages of turf toe which correspond to how damaged the ligaments are: from stretched to completely torn. Turf toe can be treated conservatively and resolve, depending upon how bad it is.
Turf toe can also progress into hallux limitus and into hallux rigidus. There are also 4 stages of hallux limitus/rigidus. Hallus ridigus/ limitus can also arise without the MTP sprain (turf toe) precipitating it.
The office of any garden variety podiatrist or orthopedic surgeon would know what hallux rigidus is if someone called to make an appointment.
I still stand by my opinion that you are wrong to tell people with great assuredness, they have turf toe. In fact, you are not licensed to diagnosis anything as far as I can tell, especially without looking at x-rays and examining the foot.
So quit writing "You have turf toe" and change your "standard advice" to "Maybe you have turf toe?". Please?
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
This is my last reply to you on this topic - whether in this thread or a subsequent one.
I have never said to tell the doctor's office that one has "turf toe." I say to use that with the sports team's front office. In fact, I wouldn't say anything beyond "my big toe hurts" lest I establish a preconceived idea with the doc. It's just the best way - from my experience - to get the name of a good foot doc who doesn't butcher people. Why? Because a pro sports team is not going to send a multi million dollar asset (that's all a player is to them) to some hack. They have an investment to protect. End of story.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Hi Bigtoe..LOL love the name,
Each person is different and their recovery can be different. Ask questions when you see the doc. I had an osteotomy with a wedge for hallux rigidus. My pod felt that I would have better range of motion after I recover and felt that someone my age would do better with the osteotomy rather than a fusion. I am still active at 57 so I did not want a fusion. The recover has been long and sometimes frustrating. I am working on ROM and it improves every week. I went from 10 degree bend to a 35 in 6 weeks. I am told that it will improve even more in the next 3 months. I still have some swelling but that agonizing pain that I had pre surgery is gone. Good luck!
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
My doc said that full recovery can take up to a year but that it is, at least, linear. In other words, each day is improvement rather than back and forth like some surgeries (I had a Morton's Neuroma removed and it was definitely not a linear recovery!) I feel I am as good as it was at the end of the first year - 5 years later. And none of that horrid pain - even when I'm bad and dance for 2-3 hours solid!
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Dear Titchou,
i have just posted my diagnosis Hallux rigidus stage III. I am 60, love (and still do barre) dancing and will die without at least 2 inches heel. He said i need a fusion, or a new invention - one side implant. I am so desperate, upset, just don't know what to do. I have a mild pain while walking but no pain at the morning barre. I walk 40 min. per day to my office from Metra and back. Any advice? i don't see any other docs yet but plan to do. I hate fusion, it will kill my life.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Hi, I am going to have surgery soon. I have seen 2 docs. The one I just saw said they have to break my big toe or cut to realign shave or cut off the bunion and then take the knuckle out of my second toe and pin it. I have another appt Tuesday with another md. How long were you out of work. and How long before you can walk and then drive. Mine is my right foot.
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Dear Cat,
I entered this board in August with the same diagnosis. I also saw two docs the same as you. I also was forced to schedule an immediate surgery, a fusion or any other... I don't want to go into all details of my long journey but I just want to tell you to consider ALL other options before you say "yes" to your surgeon even if he is a genius and operated on all the best sports celebrities who continued to win their Olympic prizes after their surgeries. Sure, it depends on your age and your lifestyle and goals. My message is for those who are after 50 plus, not heavy or obese, and who want to continue their normal lives without running, jogging, or jumping (there are other ways of staying fit). You just need to find a doc who believes that hallux rigidus is no more than another sore and will treat you accordingly. The only thing is to be extremely patient, disciplined, believe in it and trust your doc. Please, remember- it is YOUR body and you are the only person who can decide what to do with it. This diagnosis is not a danger for your life, you won't die from it. It will change your shoes in some way, your life style and attitude but your bones will be left untouched, and this is the biggest investment you can do in your life no matter how bad your "stocks" are. If you are not a young person who wants to run hunderds of miles, then think twice before you give your bones to be touched, let alone to be cut off. Keep what you have no matter how bad it is. You can take your pain off with the right doc.
Good luck, and if you go for a surgery which is the best solution for you then I wish you the best success and the best result. Be brave and optimistic!
The Following User Says Thank You to Plie For This Useful Post: catcoffey (10-25-2010)
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Wow, this is quite the thread. Is the original poster still around? I'd be interested to hear an update.
I had a fusion of my big toe on October 28, 2009. As I approach my first anniversary, I am happy with the results. My joint was severely damaged. The surgeon said I had two choices, cheilectomy and fusion. He did not think the cheilectomy would work for me and if it did, it would only likely last a year. I did some research and realized that I was headed for a fusion. I decided on that and I am glad I did.
My recovery has been good. I did have a couple of scares when the radiologist suggested there might be a bone infection. Fortunately, that turned out not to be the case. I suspect he was confusing healing with signs of infection. At any rate, now that it is a year later, I have pretty much no pain. I am walking every day, usually at least a mile or two each morning. Sometimes I walk up to five or seven miles in one walk. My foot is up for the task. I have started curling for the season now, and my foot is great. The last time I curled, my foot was very sore (pre-surgery). It was so nice to curl without pain! Also, with all my walking, I am in better shape than before, so I curled amazingly well. Scary.
There is some misinformation about fusions I'd like to address:
Your gait will be altered with a fusion - my gait was altered by the sore foot and limited range of motion from the arthritis. Now my gait is normal, I toe off the big toe again. That means that now my hip feels better.
You won't be able to run or be active - fusion is actually recommended for people who wish to remain active. At least if the foot is damaged beyond a certain point. I am more able to run now than I was pre-surgery because I have a stable foot that does not hurt.
Surgery is painful - yes, I had about four days of pain that required medication. After that, as long as I had my foot elevated, I was fine. I think bunion surgery is much more painful
Fusion is certainly a drastic procedure that probably should not be considered lightly. At the same time, if it is the right procedure it is fabulous.
__________________
Life is too short to wear tight shoes. ~ May you have happy feet in 2012.
The Following User Says Thank You to Northwind For This Useful Post: catcoffey (10-25-2010)
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Hi to all, well today back at the Dr. This is what I am in store for in 2 weeks. Four procedures on my right foot. Lapidus bunionectomy, weil osteomoty, toe fusion and flexor tendon transer. I am a hurting puppy. He said I have almost waited too long for correction. I no longer have the plantar plate under my 2nd toe, it is torn there for my toe can twist and turn and do just about a back flip. lol. I also have dorsal and medial deviation. He was very good at explaining everything to me. I have just checked on the computer and all of what he said he is going to do is on google. I will be in surgery for 2 1/2 hours. Put in a cast after that. I have the option of haveing a catheter in my leg for 3 days to deliver pain med and go back 3 days later to have it removed. Any one ever had this done. It is a very long ride to the hospital for me 2 1/2 hours so i don't know about taking a long ride that soon. Oh yes, pins in all of my toes except my baby one. Thank god, they will leave the poor little thing alone. After 4 - 5 weeks in cast non weight bearing a soft boot, still non weight bearing. Then in a harder boot and can start to put pressure on my foot as well as go to pt. Yikes, this seems like so much. Any have any input let me know. Thanks and will write after Nov 12th.
The following user gives a hug of support to catcoffey: Northwind (10-27-2010)
Re: Osteotomy or fusion for hallux rigidus?? HELP!!
Wow, catcoffey you will be a bionic woman! That sounds like quite an ordeal. Hopefully the end result will be worth it. You will be a long time healing, but then you will have your foot back. I don't know what to say about the catheter. On the one hand, it will probably be great to have a steady supply on the pain med. On the other hand, the drive! I live an hour from the hospital where I had my surgery. I am not sure I would have wanted to go back so soon.......but I would have if the pain medication done that way was superior to the other. I would have the option, I think, of going to our local hospital in town to have the catheter removed. Would that be an option for you? Or would your doctor be able to remove it?
Good luck.
__________________
Life is too short to wear tight shoes. ~ May you have happy feet in 2012.
