I could use some input from people who have gone through a similar decision-making process on whether to go ahead with surgery. About a year ago while playing basketball I experienced trauma to my left big toe. A large person came down hard on my toe (wish I'd been wearing steel toe boots). It was very painful for a short period, but it didn't feel like it was broken, and I continued playing. Later that night I found I could not walk without a lot of pain. In the week that followed the pain diminished quite dramatically and I soon returned to running and playing basketball. However, I started feeling pain in the toe area in the morning that would gradually diminish throughout the day. It was not dramatically impacting my life at this point. I continued running and playing basketball. The blood circulation promoted by these activities seemed to loosen up the joint and the foot actually felt better following vigorous activity. During a regular checkup with my doctor, I told him about the toe issue, he said it looked like arthritis and gave me some Voltaren gel. That was last June. The pain seemed to intensify when the weather got colder in December, but it was still manageable--mainly pain in the morning and diminishing during the day. Still, I thought it best to see a podiatrist to make sure I wasn't doing damage by continuing to run and play basketball. I have now seen two podiatrists, both of whom say that the joint is badly arthritic with little range of motion. The x-rays show evidence of trauma, causing a bone spur, bone fragments, and damage to cartilage tissue. They both say that there is no remedy other than surgery, but this can be delayed as long as I can tolerate the pain. They both say that continuing to run and play basketball will not make any future surgery any more difficult, so encourage me to do whatever I'm able to do.
Naturally, I would like to get rid of the morning pain without drugs, but my main fear about surgery is the unintended consequence of making the problem worse. I have read a number of stories of people going through this type of surgery (cheilotomy?), not the fusion surgery, and some say they would never go through it again because the results were very minimal relief, no relief, or even having their condition worsen. I know there is always a risk with any surgery, but foot surgeries seem to be more unpredictable than other types of surgery and this makes the decision that much harder.
Any comments are appreciated.
The Following User Says Thank You to bruce587 For This Useful Post: bshorter30 (04-15-2013)
First of all, find a sports med ortho who is foot and ankle board certified and go see him/her. Find out who the Jags use - maybe one of Andrews' guys? Mark Ingram had this surgery last year and Shaquille O'Neal had it while he was with the Lakers. It's often called turf toe in athletes so it's a common injury and surgery. I've had two (both feet) and highly recommend it.
The Following User Says Thank You to Titchou For This Useful Post: bruce587 (03-09-2013)
I would see out an ortho(OS) who is well known with sports medicine and is certifed with foot/ankle. I would see what they have to say. If you do need surgery than I would go with an OS and not a pod but that is just my opinion. If need be I would see two different OS and see which one you like better and compare what they have to say. Plus I would ask around to find a well known one, or someone a lot of people recommend.
You are right that foot surgries are unpredictable but, most of the time if you follow what your OS says than you should be fine. Risk are there just like any other surgery and with feet there is more of a chance for rehurting the foot but, that comes with any surgery. I don't regert having any of the three that I have had on my foot. I feel like this last one is going to be my last and set me on the path to a heathly foot.
So that is my two cents. Feel free to ask any questions.
__________________ 1/24/11 accessory navicular bone removed
Thanks for the interesting input. Do you agree with the basic philosophy I've seen repeated on this site by numerous posters: don't do the surgery until the pain is bad enough to seriously affect your quality of life? It seems even many physicians encourage this approach, I assume because of the uncertain results of this kind of surgery.
I'm not sure 100% agree with that. I think sometimes it better to get in there and fix things early rather than wait it out and maybe have the risk for more work but that's up to the doctor and you. My first surgery happened because it was getting very diffcult to stand at work and I was a hostess at the time. I could still do it, its just the pain was always there.
I don't know much about the surgery you are thinking about having. I would read around these boards, maybe google a few things. Plus look for that OS as they might have a better understanding of what needs to happen and if its a good idea to have surgery or to put it off.
__________________ 1/24/11 accessory navicular bone removed
Thanks for info. I noticed in one of your other posts you mentioned that even after your surgeries you take 2 Aleve every day? One of my reasons for considering surgery is to avoid a daily drug requirement, but judging from many posts I've read you'r not alone in having to use anti-imflammatory medications even after surgery. You also said that your total recovery time was 9-10 months, which is considerably more than the eight weeks my podiatrist has cited for this type of surgery.
I'm allergic to aleve and mortin so I don't take those. I can't. After surgery I take the pain meds that I was given. I just got vidodin called in and then I will slowly go to tylenol 3s. I did take a tylenol a lot leading up to surgery, that might be what your reading. As for daily drugs you will need them for a bit, I use them for the first 3 months but I slowly go down from oxy, to vicodin to T3s like I stated above but everyone is different. I was taking daily drugs aka tylenol leading up to my surgery.
I've never fully recovered form any of my surgries, I got into an accident at 7 months post op from my first one and we knew my second one failed at around 7 months . I am now 1 week and 2 days out of my FDL surgery and I hope its my last. I was told it can take up to a year to heal but most doctors can tell around 6 months if it looks like things are working.
Feel free to read posts that have been posted but keep in mind I haven't had what your looking at, I've had a few accidents that have hinder my recovery and I'm only 20, so my age sometimes plays a roll in my healing and how long they think it will take.
__________________ 1/24/11 accessory navicular bone removed
I'm not familiar with your surgery, but I can sympathize about agonizing over the decision making process. I'm 4 days post op from my surgery. It took me a few years to make this decision to have this surgery. Actually I injured myself again, and that was the last straw for me, I couldn't take it anymore!! I wish I had done this a few years ago. I tried everything else, suffered through several injuries, including severe sprains, fractures, dislocation....everything!! I was afraid that I would open up a whole other set of problems by having this surgery.
Finally I took everything into my own hands, I did a ton if research, I found a great suergon and I made sure I knew everything possible about the surgery, recovery and everything in between. I feel like I made the right decision and can't wait to get my life back!!
Good luck in your decision and do what is best for you and your quality of life.
__________________
Surgery 3/5/13 - Modified Brostrom Repair with allograft and removal of scar tissue from peroneal tendon, L Ankle
The Following User Says Thank You to IrishAD For This Useful Post: bruce587 (03-10-2013)
First, the medication issue. You have lost cartilege in that joint. You now have arthritis. There is nothing that can be done about that. True, they can drill holes in the remaining cartilege and hope it produces enough scar tissue to help, but it doesn't always work. So, most people are going to have to take something to help with the inflammation.
Second, if you wait too long, there will be no cartilege left and fusion will be your only option. I'd go for a clean up.
Third, yes, 8 weeks recovery is about right in order to be able to do whatever you want. Shaq had his in Sept and was back on the basketball court in November. But FULL recovery, where you never even know you had it done, can be up to a year. My last cheilectomy was done on June 15 and I was at a dance on August 5 and danced probably 75% of the songs. But it really wasn't fully healed at that point.
Hope this helps.
Last edited by Titchou; 03-10-2013 at 06:00 AM.
The Following User Says Thank You to Titchou For This Useful Post: bruce587 (03-10-2013)
Titchou, thanks for the additional information. There appear to be differences of opinion about the wearing down of cartilage tissue. The two doctors I've seen so far seem to think exercise is actually helpful to what cartilage remains. One of them said that putting off surgery would not make the surgery more difficult later on. There is another school of thought that too much exercise can be detrimental to the remaining cartilage. I have cut back a bit on my running in favor of biking, but otherwise I am going to play half-court basketball because it is a passion of mine. I realize this is a bit risky, as I could get crunched again, but I'm just not willing to give it up. Thanks again for your insight.
This is just my opinion based on my experiece (cheilectomies in both great toes - main causes wearing high heels all day and lots of dancing). The cartilege will deteriorate. Mine did. I waited too long for the second one (right toe) and there was more damage than we thought. That repair job isn't lasting as long as the other one (left foot done in 2003, right one done in 2011). The xrays of the right one will make your stomach churn. Luckily, I have a high pain threshold so am not doing the fusion yet but there is absolutely no visible cartilege left now. It is bone on bone.
But I'm vain too so don't want to give up my pretty shoes!
It may also be that you are seeing pods and I didn't. There is a definite different approach - in my experience. And it really doesn't have that much to do with "exercise." Your toe joint moves up and down more when you are walking than when jogging. The fact that I also jog has precious little to do with my joint damage. In fact, I can jog when my toe hurts more easily than I can walk. I strogly suggest you talk with a sports med ortho to gain more understanding. If it were true that waiting won't do any more damage then no one would ever need a fusion. Just my 2 cents worth.
Titchou, thanks again. I guess the reason to go ahead with fusion is the pain has become unbearable. One thing I'm not clear on is whether running and basketball would still be possible after fusion. I've heard different things about that, perhaps because it can vary from person to person.
Certainly you can run and play basketball after fusion. You could even wear heels if you wanted! They fuse the toe at an angle so that rolling off it is normal. I have been in discussions about one and have elected to put it off because it doesn't hurt that bad and only at certain times (dancing is really a problem). I was honest with my surgeon about not wanting to get rid of my pretty heels. He explained that he could fuse it at more of an angle than normal so I oculd wear a higher heel, The trade off is that it will stick up more when my foot is flat in sandals, etc. If I can accept that, he's willing to increase the angle.
Hi Bruce587, did you decide to have the fusion? I'm a frustrated runner, deep in decision mode, having dealt with HR for a decade now. 2 sugeries (one hemicap-bad idea, then osteotomy and cartilage placed in the joint), and I'm faced with the last resort. Are there any runners out there who have had a MTP fusion and can still run, run better, or can't run anymore? There's a lot of anecdotal stuff, but I'm still not convinced. Any help appreciated.
Hi Bruce587, did you decide to have the fusion? I'm a frustrated runner, deep in decision mode, having dealt with HR for a decade now. 2 sugeries (one hemicap-bad idea, then osteotomy and cartilage placed in the joint), and I'm faced with the last resort. Are there any runners out there who have had a MTP fusion and can still run, run better, or can't run anymore? There's a lot of anecdotal stuff, but I'm still not convinced. Any help appreciated.
Bruce587,
I would very much like to know as well if you had the fusion. I'm in a similar situation as you.
This is a reply to SMJ7123 and MATTY. No, I haven't done the fusion. I continue to deal with the pain, which makes it difficult to run and is almost always painful in the morning. It tends to loosen up in the afternoon. I have found some encouraging information on this site, however, such as a very good posting by MARK27606 sometime last year, in which he did research on the results of fusion surgery. He found a study that claimed that 75% of fusion patients were able to run after surgery. Something like half were able to play tennis. There are certainly no guarantees, but if you are in constant pain, there may be no other choice than to try surgery and hope for the best. I am not yet at the point where the pain is bad enough to go to fusion or some other type of surgery, but I have a feeling it is inevitable. Sorry you guys are having to deal with this like me, but it would appear that there is a good chance surgery can improve your situation.
Thanks, Bruce587. I've found an orthopedic surgeon at one of the best places around. He lists HR as a specialty plus he's a marathoner/triathlete. I'm seeing him week after next. Will let you all know what he says.
One other symptom I'm wondering if anyone else has--horrible cramping--like charley horse cramping--in the foot. Any time of day, lots of times at night. One doc said it was because I'm constantly holding the foot funny, the muscles are just overworked. And, my toe is more painful in the am as well. I guess that's typical with arthritis. Ice helps.
Are you taking any anti-inflammatories live Aleve, meloxicam, etc? They really can help. Not as good as Vioxx was but that's not an option since it's off the market.
Also, I too have the foot cramps. Mine is mostly due to having worn heels for so long and now wearing flats more. I've had a couple of foot massages by a professional and it really helps. Also, roll a frozen water bottle or golf balls with your foot. That will help - and calf raises. You need to keep the fascia stretched out.
To SMJ7123, yes I've been having cramping and other types of pain in the foot that I assume comes from changing my normal step to avoid pressure on the joint. In particular, the bone over my arch often hurts, as well as my other toes that aren't used to bearing my weight so much. I will be interested to hear what your new doc says. I am trying to limit the use of pain meds, but for whatever reason Aleve doesn't work at all for me, while ibuprofen is very effective. One final note: I talked to a physician who I play basketball with and he said that surgical options may get a lot better in a few years with the expanded use of stem cell technology. He recommends delaying surgery as long as possible until these new methods are available. Obviously, some of us may not have the luxury of waiting.
Certainly you can run and play basketball after fusion. You could even wear heels if you wanted! They fuse the toe at an angle so that rolling off it is normal. I have been in discussions about one and have elected to put it off because it doesn't hurt that bad and only at certain times (dancing is really a problem). I was honest with my surgeon about not wanting to get rid of my pretty heels. He explained that he could fuse it at more of an angle than normal so I oculd wear a higher heel, The trade off is that it will stick up more when my foot is flat in sandals, etc. If I can accept that, he's willing to increase the angle.
Hi Tichou.
I will be meeting with doctors soon for consultations. Would you please share the name of your surgeon. You seem to have had positive results and I'm not ready to give up my heels.
hallux rigidus surgery 
