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sorefootsophie 05-31-2006 09:08 PM

MTP Fusion...and the EHL tendon
I know there are a lot of people lately who are about to have a 1st mtp fusion....Add me to the list. :wave: My surgery is scheduled for July 5th. I will have 2 screws (no graft) and have a surgical splint for a week followed by a nwb cast for 6-8 weeks the rest to be determined later...whether more casting or the boot!! Does anyone know or did anyone ask what happens to the EHL tendon (the one going down the top of the foot to the big toe) that helps to lift the big toe. Since it will not move after the fusion...does it atrophy?? I have heard that some doctors just cut it!! This will be my second surgery in less than a year as I also had a 2nd met shortening with plate and 4 screws and arthritis cleaned out from the TMT joint in Nov. and had a nwb cast for 18 WEEKS!!! (in the same foot). There is only 10 degrees of motion in my MTP joint and my doc says there is no saving it!! That's what I get for trying to walk on the outside of my foot for so long (to avoid the pain of that joint). Also had a stress fracture last spring from walking weird!! Some of you are having surgery sooner than me so I will follow your progress. I wish all of you the best! I am SOOOO nervous to have this done and have another surgery so soon but I really appreciate all the support on these boards. They are my life line. If any of you remember me...please chime in...I would love to hear from you! we go again...thanks for being there!! Sophie :angel:

lizzy21 06-01-2006 08:23 AM

Re: MTP Fusion...and the EHL tendon
Hi Sophie!
I had the MTP fused on my big toe on Dec. 19, 2005 (having it redone in 4 days, with a screw b/c it failed...which is rare!) and I still am not really able to move by big toe down, b/c that tendon is so tight now. I can point w/ my toe and move it up, but not down. I am not sure if I am the best example, b/c mine failed though ;)
Anyway, good luck with your surgery and I will follow your progress on here.


sorefootsophie 06-01-2006 08:42 AM

Re: MTP Fusion...and the EHL tendon
Lizzy, Thanks for the reply. I think the reason you can move your toe at all is because it failed. IF it is the 1st mtp joint being fused...the first metatarsal and the phalange (toe) will become one bone and will not move AT ALL! That is why it really takes some getting used to and why there is so much emphasis placed on NO weight...nwb for such a long time so the joint actually fuses in the proper position.

The tight tendon you are talking about is probably the EHL tendon. This is the one I am concerned about. I wonder if it atrophies from disuse after the fusion. Some doctors will cut it! My big toe has only 10 degrees of motion upward now and nothing down so the doctor says the lack of movement caused by the fusion should not be TOO MUCH of a concern. There is just a lot of arthritis and no joint's bone on bone!

(((Some people have the joint within the toe (the IP joint) fused and not the mtp...that would still allow for up and down movement. )))

I'll look forward to chatting with you. So sorry your first fusion failed...did they say why? Did you have the original surgery because of hallux rigidus? Do you know what Stage you were? Did you try anything else before the fusion? My doctor said I would continue to have more fractures on the outside of my foot and that the MTP joint was basically a train wreck at this point! So there is really no other choice! Sophie :angel:

eko 06-01-2006 09:46 AM

Re: MTP Fusion...and the EHL tendon
You will still be able to move your IP joint after the fusion of the MTP, so I believe that is still controled by the EHL tendon, but I could be wrong. It is important that even though the MTP is fused that you keep working the flexibilty of the other toes and the IP joint after your fusion heals. After my fusion (2 years ago), I work on the flexibility to my toes, including scrunching exercises, and can pick up things with the lesser toes. And actually with the big toe raised, I rely on the lesser toes for balance when standing on one foot, so give those other toes credit and work them too after the initial period of healing.

Wishing you well. -eko

sorefootsophie 06-01-2006 09:59 AM

Re: MTP Fusion...and the EHL tendon
Hi Eko, Thank you so much for your reply. My IP joint on the big toe has no active motion. I can passively move it but not actively. I have been trying with PT for the last 20 sessions (since my last surgery). :eek: Also when I had my 2nd met shortened back in November, the doc did a flexor tendon transfer on the 2nd toe (phalange) so I can move it slightly up and down at the base but it will not bend mid toe and he told me it never would. This was supposed to stop a "floating" toe. However, to this day, that toe is still not right. It is on an angle toward the big toe and still swollen. So I am just going to give it more time. But as far as the picking up marbles'll only ever be with the outside three toes from here on in. I guess balancing on that foot will take some getting used to. I am panicked to say the least about this upcoming surgery! Sophie :angel:

lizzy21 06-02-2006 08:43 AM

Re: MTP Fusion...and the EHL tendon
Hi! My EHL tendon is so tight that I am not able to move it either. I worked on it for awhile in PT and it really did not do much. As for why the fusion failed....aparently, it was a non-union, which occurs about 10-30% of the time (of course I had to be in that group :rolleyes: ). I had a level 3 (I think that is the highest level) bunion, so the only option my os thought would be adequate was the fusion. He said there were tons of other procedures he could do but I would end up back in his office in about year b/c it would go back to its original position.
When is your surgery and what are you getting done?


dianelev 06-02-2006 10:09 AM

Re: MTP Fusion...and the EHL tendon
I know how nervous you are and it is a horrible feeling! I am 8 weeks out from surgery for my non union and I am really nervous waiting for the next xrays!!! Are you wearing a boot now? Are you able to walk? Try to stay distracted- I know it is hard!

sorefootsophie 06-02-2006 08:36 PM

Re: MTP Fusion...and the EHL tendon
Diane, Thank you so much! When is your next appointment date for xrays? I am not wearing a boot. I am just wearing running shoes but my foot is aching all the time. It even aches (sometimes worse) when I sit down after walking!! I really am looking forward to getting this fusion over with scared at the same time!! The post op pain is still SO fresh in my mind. The nwb time is not something I am looking forward to either but having a cast on all summer isn't the end of the world. At least I won't have to contend with ice and snow this time!! One of the hardest things for me is comments from people about..."Isn't that foot better yet?....You should get another opinion!" etc......if only they walked in my shoes!!

I'll follow your progress! Thanks for your support! Sophie :angel:

dianelev 06-04-2006 03:22 PM

Re: MTP Fusion...and the EHL tendon
I know your summer is not going to be fun- especially having a cast in hot whether is a big pain! Make sure you have air conditioning where you sleep! It feels like a year ago when I had my last surgery. Its hard to believe it was only 2 months ago! I have the next xrays a week from Friday!!! Wow. I am soooo nervous. It seems the more I tell myself not to think about it, the more I do! I hope these next few weeks go by quickly for you. Just think about walking without pain again!

sorefootsophie 06-04-2006 07:42 PM

Re: MTP Fusion...and the EHL tendon
Diane...Do you mean a week from last Friday? At nine weeks??? I do not have air conditioning but I don't think the Pacific northwest is too bad in the summer. It will be my second summer here and I had a cast on all last August for the start of all these problems..a cuboid stress fracture (actually that was a result of walking on the side of my foot because of the current problem). So I feel like I have been in a cast more than out of one for the whole time I have lived here. My crutches are totalled from so much use last time and I will get new ones for this surgery. I wish I could find out where people get those soft lambswool covers for the hand grips and underarms (I know there is not supposed to be any weight on the underarms but sometimes you just can't help resting that way). I'll watch for how your appointment goes! Thanks SO MUCH for your support.....getting more anxious by the day!! Sophie :angel:

dianelev 06-05-2006 01:03 PM

Re: MTP Fusion...and the EHL tendon
I wish I never knew what a cuboid, navicular, etc. was in the first place!
I also did that walking on the side of the foot thing for months because of the non union in my midfoot. My os said it was bad to do that but I really couldnt walk any other way! My xrays are actually a few days before my next os appt. (a week from next Friday) because he wants me to go to the main hospital for a more extensive set of xrays. Usually, he just does them in his office and I see the results on his monitor. Everyone asks me how my foot feels and I feel so frustrated because I have no idea!!! It doesnt hurt because I am pwb and put very little weight on it. The fact that it doesnt hurt is good but I know from experience that only the xrays will give me the answer as to if the bones have fused.
Did your os tell you what the chances are with this surgery of a good result? I am just wondering because I was sooo suprised when I got the diagnosis of a non union. My os barely mentioned that possibility because I think it is very unusual. I hope you are not going crazy with all the waiting.

I will send good thoughts your way!


kimann 06-05-2006 01:50 PM

Re: MTP Fusion...and the EHL tendon
I'm praying for you today, and watching for your post-op post! You know the first few days are bad, but hang in there, and it will get better. For the crutch pads, search "crutch pads" in your web browser. You will find jersey knit and some "dressier" ones on the less medically oriented hits, and the lambswool ones on the medically oriented hits. They are quite high, I got frustrated and made my own... tore up an old pair of sweats, took awhile to figure it out, then got some furry pink material from Momma and made a nice set. If you're interested, I'll type out the directions and post them for you. :) You probably could do them by hand if you don't have a machine, but it might take awhile. Take good care of yourself! Kim

kimann 06-05-2006 02:15 PM

Re: MTP Fusion...and the EHL tendon
I'm with you! I've learned a lot about the anatomy of the foot this last year, and remember the good old days when it worked without my knowing or caring how it worked, LOL.
I'll keep you in prayer, that you will have a vigorous amount of bone growth! Because you had a previous, non-union, did your surgeon do a bone graft this time? I'm curious about what factors (age, diet, supplements, exercise, pre-op bone mass, etc.) really affect the likelyhood of non-union, and if there are any ways to help prevent it? How long were you NWB after this surgery? I'm surprised that he has you pwb if there is any question in his mind at all. I'm not a fusion, just an osteotomy, and my OS has kept me NWB, will reconsider at next visit. On 21st June, which will be 11 weeks, he hopes to put me in a cam-walker and let me do pwb awhile. Take care, and, yes, try to relax! ;) Kim

sorefootsophie 06-05-2006 03:43 PM

Re: MTP Fusion...and the EHL tendon
Kim...Thank you so much but it's July 5th (not today). I have exactly one month to wait and worry!! Sophie :angel:

kimann 06-05-2006 04:55 PM

Re: MTP Fusion...and the EHL tendon
awww... shucks! :o Sorry I misread somewhere. Poor lady, that is a long waiting period. Take it easy, and [COLOR=Navy]try[/COLOR] not to worry so much! Kim :p

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