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My Excellent Toe Surgery Adventure - Hallux Rigidus, Plate/Screw Fusion, and Osteotomy - Page 58

post #1711 of 1750
post #1712 of 1750

I am starting to look like a lurker.....

 

Kittygal

post #1713 of 1750

Crumpcake - I'm sorry to hear that your recovery is taking so long. You had a MTP fusion - right?

Yes, my cheilectomy sounds similar to yours regarding pain, but I lost almost all ROM. I'm still doing exercises for it over the past year, and got some rom back, but it's not much and it still hurts more than before the surgery.

 

So this surgery in April will be:

1 - a TMT fusion with bone shortening.

2 - I think it's called an osteotomy? (bone graft?) portion of the top of the metatarsal that will be fused, to the bottom of that bone on the MTP joint side( because mine we shaved off during the Cheilectomy).

3 - Cartiva in the MTP joint to simulate cartilage (I don't have any left).

 

2 Weeks non-weight bearing , Then 10 weeks in a boot. It's my right foot so no driving!

 

Look forward to all updates.

Thank you all for posting.

post #1714 of 1750
Quote:
Originally Posted by KrisClimber View Post
 

Thanks so much for your post Mom2Boys!!!

 

ToeCutter - Just the one bone graft - the first one you mentioned.

 


I uploaded an xray with the doctors ink of the changes.

The metatarsal head was shaved away by the cheilectomy on the outside.


Thanks for showing the x-ray. I'm still not sure where the graft would be going but I hope whatever you guys are trying works out for you. Good luck with it!

 

Just curious -- where do you live?

 

Edit: I think I understand what you were describing now. Your surgeon is suggesting to remove some bone from the TMT joint then graft it to the medial first metatarsal head, in essence giving you a bunion, yes? I wonder how he plans to fixate the graft to the metatarsal head AND insert the Cartiva implant? If one were to run a screw through the graft it seems as if it would hit the implant. The entire metatarsal head risks collapse so hopefully your surgeon is supremely skilled. I have to say, this plan is pretty unconventional. Please let us know if it works.


Edited by Toecutter - 3/19/17 at 10:31am
post #1715 of 1750
Hi Crumpcake, Thankyou for your kind welcome, and hello to all the others in the Toe club!
I am now 3 days post-op with my left toe fusion. My right toe was fused 7 years ago with two opposing screws, this time my left has been done with a plate and screws by a different surgeon, so interesting to see what is the same, and if anything is different!
Both times I awoke with the Velcro boot/sandal over bandaging, and both times I have been allowed to weight bear on my heel on the day of surgery. The first time there was a hard half cast over the big toe side of my foot, this time there is just bandaging.
So far things seem to be following a pretty similar course to last time - the day of surgery I felt surprisingly comfortable afterwards, and was able to hobble heelwise when necessary with little discomfort. However ... the following day the anaesthetic wore off, pain set in until the tablets took effect, and I took to crutches because any weight on my foot was painful! A few days on it's now a little better and I've been able to ease up a little on the painkillers, and am using the crutches and a little weight on my heel for balance when I need to mobilise (as little as possible!) At all other times it is elevated on a couple of cushions.
I read with interest the comments and issues some of you have had with cheilectomies. At my first visit with my current surgeon he gave me the option of a cheilectomy, but also commented that I would be back for a fusion before too long. His recommendation was to go straight to the fusion, since my other toe was already fused. I decided one operation was better than two, and having already had a successful fusion, I knew what to expect. Having read the comments, I think I made the right choice for me!
post #1716 of 1750
Nevada Sue - sorry to hear about your DIP joint problem. (I'm guessing that is the one on the big toe itself?). That's a bummer.

I am now at week 12 and doing good. Still using a crutch to take light pressure off foot when walking, and trying to walk mindful of using the whole foot. The foot still swells after 30 min standing frown.gif
post #1717 of 1750
Quote:
Originally Posted by Toecutter View Post


Thanks for showing the x-ray. I'm still not sure where the graft would be going but I hope whatever you guys are trying works out for you. Good luck with it!

Just curious -- where do you live?

Edit: I think I understand what you were describing now. Your surgeon is suggesting to remove some bone from the TMT joint then graft it to the medial first metatarsal head, in essence giving you a bunion, yes? I wonder how he plans to fixate the graft to the metatarsal head AND insert the Cartiva implant? If one were to run a screw through the graft it seems as if it would hit the implant. The entire metatarsal head risks collapse so hopefully your surgeon is supremely skilled. I have to say, this plan is pretty unconventional. Please let us know if it works.

It's the #2 part that's confusing. He's fusing the tmt. That's the tic tac toe board on the right. Then he's doing the Cartiva for the mtp.

#2 looks like he's grafting a bump on the medial side of the met near the head? That's what has me confused.
post #1718 of 1750

Hello all! I've been reading this long thread for a few weeks now :) and am so happy that I found it! 

I had the 1st MTP joint on my right foot fused four days ago, fixated with two crossed screws. I have a plaster splint over the toe and am allowed to walk on my heel in a postoperative shoe with the help of crutches. 

 

My background story is that I had a very successful bunionectomy on my left foot in 2008, then went in to have one on my right foot in January 2016. Instead of putting a screw in the bone, as was done in my first surgery, this surgeon put a pin through the joint and bone which was removed after 5,5 weeks - it was supposed to stay in there for 6 but I had intense pain from the pin after five weeks so it was removed early. 

I waited for my foot to heal and stop hurting, but after a few months I realized that something was wrong as it was getting worse, not better. I was referred to an orthopedic specialist who performed a series of examinations including MRI and scintigraphy, and eventually he came to the conclusion that I had osteonecrosis in the joint. Basically a part of the metatarsal head had died and ceased to exist, leaving a cyst which caused pain each time I bent the toe. Standing was no problem, but walking was painful and running was out of the question. In 2014 I ran two marathons... 

I'm only 37 and the idea of living with constant pain and not being able to walk more than 3 km a day for the rest of my life was unappealing to say the least. I don't care about high heels, I just want to live a normal, active life. Fusion it is. 

 

Fast forward to last week. He performed the fusion operation last Thursday, and told me that the bone looked perfectly fine now except for that missing part, and that everything went well. He was pleased to have been able to use two screws instead of a plate, as he said that plates often need to be removed after a while. 

 

The first three days were very painful. I took strong pain meds and slept most of the time. Today I already feel better though; was able to stop taking the oxycodone which I believe is what made me so sleepy. 

 

Anyhow, thanks to this thread (and my excellent surgeon) I am feeling very hopeful about the future. I am dying to get out there and start running again... or even walking without pain! 

post #1719 of 1750
Quote:
Originally Posted by dbpaddler View Post


It's the #2 part that's confusing. He's fusing the tmt. That's the tic tac toe board on the right. Then he's doing the Cartiva for the mtp.

#2 looks like he's grafting a bump on the medial side of the met near the head? That's what has me confused.

 

I think he's saying that the first metatarsal head is a bit narrow for housing the Cartiva implant, so therefore he wants to graft bone onto the medial first metatarsal head to make it broader. Somehow at the same surgery he wants to install the Cartiva implant even though the graft isn't fused. It would be very unconventional. I'd just fuse the thing -- less likely to end up with a giant mess where the metatarsal head disintegrates. There's probably more to the case than we're privy to.


Edited by Toecutter - 3/20/17 at 4:38pm
post #1720 of 1750
Quote:
Originally Posted by Toecutter View Post

I think he's saying that the first metatarsal head is a bit narrow for housing the Cartiva implant, so therefore he wants to graft bone onto the medial first metatarsal head to make it broader. Somehow at the same surgery he wants to install the Cartiva implant even though the graft isn't fused. It would be very unconventional. I'd just fuse the thing -- less likely to end up with a giant mess where the metatarsal head disintegrates. 

I'd definitely be deferring to the doc on that one. Maintaining the cortical rim is kind of key. I guess if there is enough of it and the graft is well fixed. That's why I'm on the outside looking in. smile.gif
post #1721 of 1750
Quote:
Originally Posted by dbpaddler View Post


I'd definitely be deferring to the doc on that one. Maintaining the cortical rim is kind of key. I guess if there is enough of it and the graft is well fixed. That's why I'm on the outside looking in. smile.gif


I wonder what the lateral view looks like?

post #1722 of 1750
Quote:
Originally Posted by Toecutter View Post

I wonder what the lateral view looks like?
Maybe he didn't have access to that view.
post #1723 of 1750

Kittygal, I was thinking about you the other day, wondering about the latest revision.  Glad it's good!

 

How did you find the surgeon who did your revisions?  I've tried googling, but am not coming up with anything.  There are only two orthopedic groups in my area, and each has one foot surgeon.  There are a couple of podiatrists, but I've not heard good things about them.  I'm at the end of my rope with the pain in my foot.  I can't sleep at night if I've been on my feet all day, especially if I'm up and down.  Did yard work yesterday and it still hurts like hell this morning. 

 

With all this political crap going on I'm afraid I will lose my insurance next year, so I'm feeling pressure to do SOMETHING.

 

Nevada Sue

post #1724 of 1750

Hi @NevadaSue and everyone!

 

I would recommend word of mouth to find a good revisionist. The professionals who will see the results of surgeries are the physical and occupational therapists, and the orthotists who make your orthotics. Those are probably the people most likely to have some input as to what they see, and how people are doing. But that is very tricky, as they don't like to say bad things about doctors. I think because I work in the medical field I am better able to gain access to the Inner Circle.

 

Bob and some others have lots of good things to say about the Steadman Clinic in Colorado. And I have read some literature written by Dr. William Fishco in Arizona who reportedly does revisions, but I don't really know anything about him.

 

The surgeon who did my thankfully very successful revision surgery was Dr. Jordan Grossman in Akron, Ohio, working out of Akron General/Cleveland Clinic. Not only a talented surgeon but one who listens.

 

Kitty

post #1725 of 1750
Hi crumpcake, Nevada sue et.al.
I see there is an interesting debate going on re alternate surgeries beyond just MTP fusion of which I cannot add anything of use. Wanted to check in at Week 13. Still not ready to run a marathon by far! But close to losing the crutch. Still getting swelling but less than before. Here's a pic:
post #1726 of 1750


BobbyCR -  Your foot looks good!  Glad to hear you are continuing to progress and heal.  Just returned from my 11 week checkup and doctor said it was essentially fused and I could lose the boot, which I had been trying in the past few days.  Still a lot of weakness and soreness in my ankle.  No PT prescribed, so curious to hear what your therapy involves.  He said best thing is just walking on whole foot from heel to toe.

 

I did have one issue I am curious if anyone else had this.  My toe sticks up quite a bit.  I knew he said he was going to do a slight angle, 10 sheets of paper, but honestly I could put 70 under now.  He actually said it wasn't fused at that angle and shouldn't be sticking up so much.  He had me bend my DP? joint, and I could definitely do that, and can push it down so it almost touches the floor.

 

He seems to think it a tendon being too tight, as a result of surgery.  He feels since I have good movement in the joint and its not stiff, if I keep moving it, it should relax down.  Has anyone else had this problem with their toe sticking up too much?

 

 He assured me that is not the angle it was fused at, so I am hoping if I keep working on it, it will go down.  NevadaSue -- didn't your toe stick up a lot ?  And if I remember correctly  you had hardware removed and it went down some?  Can you move that little joint under your toenail?

 

Emgee- Hope your recovery is progressing! Aren't you about 2 weeks?

 

Oh, here's a pic of my cocked up toe:)

 

post #1727 of 1750
Crumbcake
Don't know if you are getting formal PT or not, but I also had much calf pain after my fusion. My therapist had a doctorate in PT and helped tremendously. One simple observation ended my calf pain quickly. I was not aware I was externally rotating my lower leg and bearing more weight on the lateral edge of my foot, to avoid putting weight on the fusion. This was all subconscious on my part. I was healing well so there was no reason not to put full weight on the fusion site. She had me walk on a balance beam heel to toe several times a day. By retraining me to keep the foot straight and flat, the calf pain stopped.
For 6 months I could not wear any of my old shoes. They were just too tight. Slip on shoes were the worst as they bridge too tight over the fusion site. I am most comfortable in lace up Skechers that are relaxed width and have a woven upper sole with no strap of material on the sides that would run over the fusion site. They have an air foam insole and the woven material breathes so my foot isnt hot. By sticking to lace ups, I can make it more loose around my forefoot. As I approach my 9 month recovery, I am finding I can start to wear some of my old shoes.
My peroneal nerve injury is slightly better but I still wear silicone toe caps on toes 2 and 3. The tibial nerve is much better so the foot slap is gone.
post #1728 of 1750

BobbieCR - looks great!

 

Crumpcake, that's EXACTLY what I have.  The tip of my toe went down a little bit after hardware removal, but my toe is still very far off the ground.  I've been manipulating that joint, but there isn't any change and the joint is pretty "crunchy".  The part of my foot that touches the ground is getting a beating and I know I'm not walking correctly because I'm subconsciously trying to avoid that pain.

 

Do you know what angle your fusion was set at?  Mine was 25 degrees.  I've read elsewhere that people have had as low as 15 degrees.

 

I'm seeing my Dr. next week and we're going to have a "come to jesus" meeting.  I want a revision.

post #1729 of 1750
Quote:
Originally Posted by Crumpcake View Post
 

I did have one issue I am curious if anyone else had this.  My toe sticks up quite a bit.  I knew he said he was going to do a slight angle, 10 sheets of paper, but honestly I could put 70 under now.  He actually said it wasn't fused at that angle and shouldn't be sticking up so much.  He had me bend my DP? joint, and I could definitely do that, and can push it down so it almost touches the floor.

 

He seems to think it a tendon being too tight, as a result of surgery.  He feels since I have good movement in the joint and its not stiff, if I keep moving it, it should relax down.  Has anyone else had this problem with their toe sticking up too much?

 

 

 

Without having seen the x-ray or your actual foot, your 1st MTPJ joint angle looks pretty reasonable. Your toe is sticking up at the interphalangeal joint (IPJ). Did you have a plate and screws put in? If the plate is pulling up on the tendon then it could make the IPJ extend like that. Removal of the plate will remove tension from the tendon and the tip of the toe won't want to stick up any more. Extending up at the IPJ isn't necessarily bad though; Your toe would be rockered and will roll through when you push off the floor.

post #1730 of 1750
Hi All, and thanks to Crumpcake for the special mention!
Yes, I am now two weeks post-op for my left toe fusion, and had the stitches removed this morning at my first follow-up appointment. All is looking good, and doing what's supposed to at this point. A few funny twinges here and there, and it swells and aches if it's down to long, but that's to be expected. The bandages are now off and I can get it wet (yay, normal showers!). I will continue to wear the black Darco sandal for the next two weeks (except in bed - yay!) and then I'm allowed to try my own shoes. Walking on heel only for the next four weeks until I have the follow-up X-ray just before I return to work - I teach young children, so need to be mobile and able to be on my feet most of the time! Dr will give me extra time if necessary.
Comparing this to my last surgery - toe fusion on my right toe seven years ago (which had two crossed screws, this time I have a plate and five screws), I would say this time is easier and my recovery seems to be quicker. Last time I had to wear the sandal for about three months! Perhaps the increased hardware means it is more stable? My foot also has considerably less swelling this time, I'll try and post a photo.
The more I read, I notice there seems to be a very wide range of protocols for recovery. My op was a simple toe fusion, no other work involved.
I hope everyone continues on with a good recovery.🙂
post #1731 of 1750

Thanks, Toecutter.  The OS thought it might be sticking up  a little higher than the angle he fused at do to a tendon, also.  Too hard to tell if it will give me problems down the road.  Im only at 11 weeks, so still have a ways to go for things to calm down. And Im sure plate remove wont be discussed for many months down the road. Biggest problem now is pain walking barefoot with ball of foot taking most of my weight and is painful, so I just keep shoes or slippers by my bedside! And definitely working on that joint, too.

 

Footman, thanks for the PT advice. I'm definitely working on the heel to toe and trying not to walk on outside of foot.  Not easy after walking that way for the past couple of years.  Im lucky my swelling is not bad at all so I can fit into most tennis shoes.  Other shoes I can fit into, but are not that comfortable walking in yet.

 

NevadaSue--Not sure what degree, thought he said 10 sheets of paper or 10 degrees?  I don't think the angle is wrong though, as I can push that joint down so it touches the ground.  Seems more like something is pulling it up, like a tendon.  When I am barefoot, the joint almost involuntary pulls itself up when the ball of my foot touches the ground.  I am a little concerned because I have arthritis of my sesamoids and they were a majority of my pain prior to surgery.  Don't seem as painful now, but I still can feel them.  As Im only 11 weeks post op, I feel I need to give it more time.  I go back for an appt the end of May and feel like it can be better evaluated at that point.

post #1732 of 1750

For anyone that wants to maintain motion of the first MTP joint, the Cartiva Synthetic Cartilage Replacement Implant is a great option.  FDA approved last year, with a pre-market approval.  This is the most stringent regulatory pathway the FDA has.  Cartiva is the only PMA approved implant for this joint.  The data from the UK and Canada that was used for the approval is the most extensive study ever conducted on an implant like this.  In addition to 5 year published, peer reviewed data, the first patients implanted with the device is over 10 years out.  This is revolutionizing treatment of arthritis of this joint.  Wearing boots or high heels are still an option after this procedure.  Most surgeons allow patients to drive and walk immediately after surgery.  This is a much less destructive procedure than a fusion and does not compromise outcomes of subsequent fusion if required.  The company website is very informative.   Hope this helps.

post #1733 of 1750
Quote:
Originally Posted by Jeff Golden View Post
 

For anyone that wants to maintain motion of the first MTP joint, the Cartiva Synthetic Cartilage Replacement Implant is a great option.  

 

TBD.

post #1734 of 1750

After spending an hour with the lead author of the study discussing his surgical protocol, and patient satisfaction, not much that is left to be determined.  The foot and ankle orthopedic surgeons, who are extremely pro fusion and anti implant arthroplasty have been following the data as it has been presented at their annual meetings for the past 3 years.  They are extremely evidence based, scientifically oriented thinkers...not much left to be determined in their minds.   The authors of the 2 year and subsequent 5 year data are extremely well respected for their unbiased research...might be the reason why the acceptance of Cartiva in the US (at least among foot and ankle MDs) has been so high.  Orthopedic surgeons generally do not readily change treatment protocol unless there is science supporting the change.  

post #1735 of 1750
Even if it's promising, we're still looking at relatively low patient numbers. Everyone seems to be referencing only one study. Anyone considering having this surgery should be aware of that. Still, someone has to go first.

Do you have any relationship to the company? In what capacity did you spend an hour with the lead author?
post #1736 of 1750


My team and I work with Cartiva providing localized the surgical support.  We are in surgery every day working with surgeons throughout the state providing technical support for this and multiple other surgical implant companies.   Dr. Daniels was in-state for an invite only dinner meeting with a select group of orthopedic surgeons to discuss.   In my 20 year career in this industry, I have never had a product with the clinical data to support a product prior to Cartiva.  Remember that this implant was FDA approved last year, but has an extensive history in the UK and Canada.   

post #1737 of 1750
You're a Cartiva sales representative then. That needed to be disclosed.

I'm excited about the preliminary results for sure but I've seen the same excitement about myriad other surgical methods and products. We need patients who are early adopters and as long as they're aware of that fact then thumbs up.
post #1738 of 1750

Yikes, 12 weeks out and struggling. Released to shoes, but difficult. Pain is not in joint but ankle, side of foot, ball of foot.  Im really hoping as I have read this thread, that 16 weeks is a magic number.

post #1739 of 1750

Hang in there, Crumpcake!

 

I'm on a HR forum on Facebook and all they can talk about is Cartiva.  I can't stand that people are ignoring the fact that 1 - all of the studies so far are funded by Cartiva, 2 - there are VERY few people in those studies, 3 - the only difference in outcomes (after two years) is  +26% improvement in range of motion.  A 26% improvement does not even mean the joint has 26% percent mobility.  All other outcomes are statistically insignificant.

 

What's really pissing me off is that if you question someone's statement, you are immediately attacked.  "I'm 2 weeks post Cartiva and feeling great!"  "All the studies show positive outcomes."

 

Then there's the FACT that very few surgeons in the US have performed the procedure.  I sure don't want to be a guinea pig, but people looking for a quick fix don't seem to care. 

 

Hell, my fusion has sucked, but I'm not going to jump on some bandwagon!

 

Thank you for listening to my rant!

 

On another note, I saw my surgeon again today.  He thinks revision surgery is a bad idea.  I got a cortisone injection today in the IP(?) joint.  Funny - he told me to manipulate the hell out of the joint when I got home, before the numbing agent wore off.  Turns out I'd locked my keys in the car and had to walk 3 miles home.  I don't think that was the kind of manipulation he meant, lol!  Glad the joint was numb for that walk, tho!


Edited by NevadaSue - 4/25/17 at 4:36pm
post #1740 of 1750
Quote:
Originally Posted by lilaryan View Post
 

Hi there. My husband was dx with HR about a year ago after repeat breaking of his metatrsals and a difficult 2 years with being NWB for months. After a second opintion, it turns out it was the HR in his big toe causing all of the problems, or so they think. So, he had big toe fusion surgery to correct this issue. He's been recovery from that surgery for about 4 months and has started to get back into some exercise. He was an avid exerciser and runner and is really depressed about how this past two years has taken such a toll on his 36 year old body! Anyway, I'd love to hear your recovery experience. He says he still has discomfort while spinning. He wants to do more but he's afraid he will do more damage or have additional breaks?! How was it getting back into exercise for you? The only shoes he says he can wear are the Altra sneakers but he's so bored of wearing the same pairs of shoes, we'd also love additional reccs there as well. Hoping this thread will be a helpful resource as we navigate recovery and hoping we are soon at the end of this very difficult 2 year ordeal. Thanks.

 

I used to follow this thread daily as I felt like I was in dire straits from the sheer pain of walking a few blocks each day. Sounds dramatic but it's true. I was pretty depressed about it. I had a bunion surgery on my right foot that went mostly okay (it still gets sore but it's not bad). Then decided to get a bunionectomy on my left foot a little over a year later just to get it over with. That didn't go well, I lost all my cartilage and had necrosis in my big toe (my bones basically turned to mush) so I had my toe fusion surgery in 2014 at the age of 28. It took me a long time to muster the courage to get that surgery because I was terrified of the pain and of possibly having another failed foot surgery, but I have to say it's been great ever since I fully recovered (I was sure to go to a great private hospital that specialized in athletes). I also used to be a marathon runner and quite active (loved hiking, skiing, dancing, and any activity that's not a good idea with bunions/bad feet!). It took me about a year to recover for the most part but then another year to really feel better. I would say it just takes time. It wasn't until at least a year that I even bothered with trying to run because I didn't want to mess anything up. While waiting I focused on lifting and diet to give me goals. Now my fused toe doesn't hurt when I run. I do get some pains here and there every once in a while but I think it's because I need inserts or to have the plate removed. And, after being in so much pain in the past, a little bit of pain or soreness in my feet isn't a big deal! I can pretty much do everything I could do before. I would say it really just takes time, and with a toe fusion he should be able to run again. Someone in this thread mentioned a runner who had fusion of both his big toes and adjusted his running stride to accommodate his 'new' feet and is a distance runner. He has videos online that you can view. Sorry I can't remember his name (you can search through the thread...I looked quick but didn't see it) - anyway my point is that there are people out there who run just fine with a toe fusion. Your husband WILL run again. With a good toe fusion he should be able to do everything he was able to do in the past. Although I'm sorry to say the shoe situation will never be the same, but it's a small price to pay :D

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