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  • First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

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    Old 11-02-2005, 11:12 PM   #1
    Midwest-JD
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    First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    Hello -

    Newbie here. Used to come to HealthBoards about 5-6 years ago - forgot all about it! Was glad to find it tonight, as I'm facing surgery (this next Monday) and think I'm getting "cold feet"

    History: Had severe bunions by the time I was 17yo or so, had bunion surgery and osteotomies on both feet in 81 and 82 (each foot one year apart). Am now 42, and feet have been pretty good up until this last year or so. (Wish I could say the same for the rest of me! My back stinks - I've had 2 3-level fusions in lumbar spine, have 2 bulging discs above those, and more problems in neck... but that's another story for another board....)

    ANYway, my left foot started splaying way out again (had been partially corrected by osteotomy in 81), and now with additional problems (besides the big, painful bunion) of metatarsalgia, as my 1st metatarsal is no longer bearing weight - my 2nd and 3rd metatarsals are doing that now, and have become very painful. (I've done all the special shoes, custom orthotics, etc. - no help). SO, my podiatrist is going to do a first metatarsocuneiform joint (MCJ) arthrodesis - cut at the joint near ankle, put pins in there to straighten and stabilize, and then cut/shorten 2nd metatarsal (to decrease it's weight-bearing) and stabilize that with pins as well. He'll also remove the recurring bunion, and says it should stay gone this time. (that's what the ortho surgeon told me LAST time, when he did osteotomy) I'll be in non-weight-bearing cast for minimum of 6 weeks, on crutches (can't wait to see what that does to my back pain-levels)

    I had been keeping all this pretty much in the back of my mind, but tonight I started doing a bit of reading/research on this, and I am now TERRIFIED!! After doing some reading, I am really, really, dreading this, and worried about if I'll actually get good results or not. I think I read there is 10% non-union chance (?? Would that be as bad as a spinal fusion not fusing - that's happened to me already, and it's NOT good!) Has anyone here had something like this done, and how were your results? Are you able to walk normally? Did you need a lot of PT? How's the pain? How long were you on crutches, and how long limping/gimping around afterwards? (I remember with my previous foot surgeries I had walking casts - wish this one was like that! And I was limpy/gimpy for about a month after the casts came off...

    I would really appreciate input from anyone who has had something similar.... before I really chicken out and call and cancel this surgery...

    Thank you!
    JD

     
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    Old 11-03-2005, 09:42 AM   #2
    sorefootsophie
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    Midwest-JD, I have something of a similar problem and am currently waiting for a surgery date. I had bunion surgery back in '91 for what they called metatarsus primus varus. My feet were really splayed as well. During those surgeries, they shortened the first metatarsal. Now my second met is more than 1.5 cm longer than 1st and 3rd. My problem is not so much at the head (by toes) of the 2nd met but at the base or the tarsometatarsal joint. There is inflammation there more so than at the head. So I will have a 2nd metatarsal shortening osteotomy and possible fusion of the tmt joint. There is arthritis there and the doc says he will either clean it out or fuse it. I am looking forward to getting this done so I can get on with life. The doc also warned me about the high chance of non union of a fusion. I have been in and out of a boot for 5 months now. Just kind of weird that the problem is only occurring in one foot. With just the 2nd met osteotomy and cleaning out of joint, I should be 4 weeks nwb. If the joint is fused, it will be 6 weeks. Please let me know about your progress as I think what we are having done is quite similar. Thanks and Good Luck!

     
    Old 11-03-2005, 11:14 AM   #3
    Midwest-JD
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    ***************************
    (Quote) I had bunion surgery back in '91 for what they called metatarsus primus varus. My feet were really splayed as well. During those surgeries, they shortened the first metatarsal. Now my second met is more than 1.5 cm longer than 1st and 3rd. My problem is not so much at the head (by toes) of the 2nd met but at the base or the tarsometatarsal joint. There is inflammation there more so than at the head. So I will have a 2nd metatarsal shortening osteotomy and possible fusion of the tmt joint. There is arthritis there and the doc says he will either clean it out or fuse it.
    *************************


    Wow! Yes, that does sound like we have very, very similar things going on. I had the metatarsus primus varus as well as bunions. I had what was called a "Chevron osteotomy" and was apparently "experimental" at the time (I don't remember that part, but my mom, who went with me to pre-surgical appointments, says that's what the doc said - This doc lost his medical license now about 3 years ago, for performing "Unapproved" surgical procedures! Guess that's what happend to me ) My podiatrist said I "probably" had short 1st metatarsal to begin with, but the type of osteotomies that were done (also with bunionectomies) that I had at ages 18 and 19 probably shortened them even more, so the 1st metatarsal is "very short" and 2nd metatarsal is "much too long" and as a result is now bearing most of my weight, rather than the 1st metatarsal, which is supposed to be the main weight-bearer. When you look at the X-ray, you can see that the 2nd metatarsal has thickened so much (from accumulated stress fractures, and from weight-bearing) that it is now thicker than the 1st metatarsal! You can also tell because I don't have any callus or thickened skin under the ball of my foot - it's under the 2nd and 3rd metatarsals instead.

    My doc will also be shortening my 2nd metatarsal and putting pins in there, but the fusion thing is for sure (at the base, near ankle, same as yours - maybe I used the wrong term - I was going from memory - I know it's the part of the foot where the 1st metatarsal has it's first joint - way back by ankle, behind/above arch) is for sure, as that is splayed out nearly 45 angle Now I know why I can never find shoes that fit!! (And why I've been gimping around for the last several months)

    I'm hoping someone will pipe in that has had this procedure done (the 1st metatarsal joint fusion with pins, and the 2nd metatarsal shortening and fixing with pins). I'm turning into a huge chicken after having 2 very bad experiences with back surgery - I'm actually going to call my family doc this afternoon and ask him if he can Rx some kind of sleeping pill to take the night before surgery (and maybe the couple nights before that!), as I'm very anxious right now.

    Thanks for your reply. I will let you know how it goes.
    JD

     
    Old 11-03-2005, 11:46 AM   #4
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    I had bunions as well, but the bigger problem was the angle apparently. I had a Mitchell's osteotomy which I don't think is used any more either as it shortens the 1st met too much. I have arthritis there too (at the mtp joint)but up til now that hasn't bothered me yet. My 1st met was short to begin with so now it's even shorter. I think the thing that is different is that my agony is in the lisfrank joint. That is at the base of the 2nd met not the first. I also don't put any weight on the first and have been walking on the outside of my foot for some time now. The doctor says he is not sure if he will fuse or clean up this joint because it is so complex. Normally people with this problem (extra long 2nd met) have more pain at the head (by the toes). Mine is at the base with less at the head. Good luck again!

     
    Old 11-04-2005, 04:59 PM   #5
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    Midwest-JD, So are you going through with it on Monday or have you cancelled. Mine is set for the 18th. Please let me know and Good Luck.

     
    Old 11-05-2005, 07:57 AM   #6
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    Yep. Monday at 8:30. I'm glad it's early in the day so I can GET IT OVER WITH!!!

    I did find out that part of what the doc will be doing is called the "Lapidus procedure". (He also will be doing an osteotomy and fusion of the 2nd metatarsal.)

    I found a website with a cool little movie of the Lapidus:

    http://www.physicianwebpages.com/lapidus.html (Not sure if that'll be a clickable link - might have to copy/paste).

    Now I'm off to post with the more specific name, hoping I'll get some ideas of how recovery will be.

    Good luck on your surgery! I'll post as soon as I'm up to it and let you know how it went.

    JD

     
    Old 11-07-2005, 04:23 AM   #7
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion su

    Hi there,

    I just had an austin bunionectomy on my left foot done 7 months ago along with the 2nd metatarsal bone shortened, and had the same procedure on the left foot 5 months ago. I had the 2nd met. shortened because it was taking all the weight, causing a great deal of "ball of the foot pain". I also developed hard calluses which I always had to shave. They put 2 permanent screws in each big toe, and one permanent pin in the 2nd metatarsal bone. After the my right foot (first surgery) I continued to experience pain and ended up having to have the pin removed from the 2nd metatarsal bone. My right foot is still not right (pain in big toe joint, clicking sound, and pain under head of 2nd metatarsal) but I am thinking the doctor goofed, because my left foot is doing really good, no pain. I do however experience pain first thing when getting up out of bed, my whole forefront of both feet hurt for about 5 minutes but than all is fine. As long as you have a good surgeon, I think I would feel comfortable. I thought my doctor was good, but now I am having very mixed feelings as he appears clueless to why I still have pain. Since I had 2 feet done, I can compare and I know that one is not right, and worse than before surgery. If I can answer anything else, please let me know.

     
    Old 11-07-2005, 04:55 AM   #8
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    Good Morning! Thank you for your reply! That's the same thing that's going on with my 2nd metatarsal - it's bearing all the weight and shouldn't be. On X-ray the 2nd met. is at least as thick as the first! I also have the callous beneath my 2nd/3rd metatarsals rather than on the ball of my foot, which is soft as a baby's but! I hadn't even noticed the callous till my pod pointed it out to me.

    Thanks for sharing your story - It makes it easier to go through this stuff when you can "talk" with others who have had simliar. I hope you continue to see improvement in you latest surgical foot.

    Have a great day! I'm off to see the butch- ER, I mean WIZARD!

    JD

     
    Old 11-08-2005, 04:08 PM   #9
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    JD I hope your surgery went very well. I hope you feel better soon. By the way, I noticed that you said you were from UP NORTH. I have several relatives in Northern MN. What a small world.

     
    Old 11-08-2005, 04:46 PM   #10
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    Hi W - Thanks for your reply. Unfortunately, my surgeon did not show up!! (Unbelieveable, huh??) I guess he's human like the rest of us, and somehow got some dates mixed up, somewhere between him and his nurse, who does the scheduling. He called me this morning, apologizing sincerely, and I am now re-scheduled for Friday at 1:00pm. I wish it could be first thing in the morning, but 1:00 is better than several weeks from now!

    I'll post again afterwards, hopefully on my way to pain-free foot!

    JD

     
    Old 11-08-2005, 07:27 PM   #11
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    I have also had my first met fused. Actually, it helped a lot with the pain that I was having in that area. I cannot believe that he did not show up. WOW. I can picture you sitting there in that warm gown. Waiting and Waiting and Waiting. I am sorry that happened to you.

     
    Old 11-17-2005, 05:33 AM   #12
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    Re: First metatarsocuneiform joint (MCJ) arthrodesis, anyone? Also previous bunion surger

    I had a 1st metatarsal joint fusion on Sept. 30, the joint on the top of my foot, two screws put in. Tomorrow is my 7 week check-up. I am supposed to be able to bear weight. I have quite a bit of "nerve waking-up" and some burning at the incision site. It swells alot if I have it down to long.

     
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