Hi, James.
The fire is to the north of the park and the prevailing wind is carrying the smoke to the east away from the mountains and the park. It was very smoky around Fort Collins, but Loveland and Estes Park were totally clear. From the town of Loveland, you could see the huge clouds of smoke rising up from the fire.
No effect on Rocky Mountain National Park that I could tell. Your brother should be fine.
Originally Posted by Bob Peters 
I'm supposed to do pretty much as minimal a ski outing as I could. I promised to be as light on my feet/foot as possible.
All those one-footed ski drills will come in handy?
Have you put it into a boot yet?
Bob - Thanks so much for the update and all the details. Everything sounds absolutely wonderful! I am curious about the bone graft - was it a cadaver bone or was it from your iliac crest or rib? I am so glad he approved you to ski this month.
All those one-footed ski drills will come in handy?
Have you put it into a boot yet?
I have tried on my backcountry boot and it fits without any real problem. I'll use those boots because they're roomier and softer.
Bob - Thanks so much for the update and all the details. Everything sounds absolutely wonderful! I am curious about the bone graft - was it a cadaver bone or was it from your iliac crest or rib? I am so glad he approved you to ski this month.
There was no graft. On the big toe, they simply fused the bones of the main joint together. That's where the plate and all the screws are. He cleaned out whatever remnants of cartilage there might of been in the joint, roughed up the bone surfaces, stuck them together, and then put on the plate and anchored it with the screws.
On the second toe, he did what's called a Weil's osteotomy. The purpose of that one was to shorten the bone between the main joint and the second joint because that toe was trying to curl upward and inward over the top of the big toe. The osteotomy involves cutting the bone diagonally in two places (I think) in order to remove a few millimeters of bone and then screw the two bone ends back together.
No graft, just bone surfaces fused together.
See above. I'm using my backcountry boots for this outing (and any others this summer). I'm probably getting new alpine boots this fall, however, since I'm still skiing on Head boots and I'm supposed to be on Rossi gear. I'll be trying on boots come September.
Here's what the foot looks like at seven weeks:
Don't look at the messiness at the front of the big toe. I was splitting kindling for a bonfire along the river and managed to run a chunk of split wood directly through the open front of my walking boot. It scraped the skin next to the toenail but didn't do any damage to the plate and screws. I was embarrassed at how dumb a move that was. oops.
Bob, better get those steel toe boots on soon!
Curious, did you ever have recurring gout in your feet and could that have contributed to your problem?
Hi, James.
I've never had gout that I'm aware of. And from what I've heard about how painful gout can be, I think I would probably have been aware of it.
My problem is basically osteoarthritis. I have it in toes, fingers, knees, and back. So far, it's fairly manageable (I take diclofenac once a day), but all of these little sore spots are starting to add up.
The back is the one that's really going to get me one of these days. My local radiologist says my back MRI's are among the worst he's seen in anybody that hasn't had surgery. I do a lot of stretching and strengthening exercises for my back, but I'm fairly certain it's going to cause big problems sometime in the future.
Thanks.
Hi Bob - in the last picture of your foot - it looks like there is something under your big toe (on the bottom of your foot) - maybe like a morton's extension? I know you said you had been splitting kindling for a bonfire but just wondering if this was a shadow or what?
Do you go back to Vail for another postop visit?
Has you gait changed with the fused toe? When I had my cheilectomy and went through physical therapy, my therapist said that a fused toe can make you go forward.
In one of your posts you said you were wearing tennis shoes, sandals, and hiking shoes. Just wondering if they have to be a certain height (heel) with a fused toe. What kind of tennis shoes, sandals and hiking shoes do you wear?
Do you go up and down stairs like a kid would (putting 2 feet on one step) ? I know with my cheilectomy I had to take the stairs like a kid would at first but later I could walk up and down them normally.
Sorry I have so many questions but I may have to have my toe fused one day and want to be prepared for the good, bad, and ugly. I don't like surprises and the doctors don't go into lots of detail. For example, after my cheilectomy, I didn't realize that I would not have plantar flexion any more. I have dorisflexion and that is what I need to walk. I do have lots of benefits from the cheilectomy (very thankful), and I am glad I had it done but I know the joint will never be normal and the underlying disease (arthritis) is still there.
Glad you are in pain-free now.
Best wishes on your skiing on Saturday, 6/30. Let us know how it goes.
Hi, Lashes.
I think what you saw in the photo was a shadow. Nothing unusual under the big toe that I know of.
I went back to Vail on June 18, which was just short of 7 weeks-post-op.
As far as gait is concerned, I'm really not exactly out of the walking boot yet. I'm being weaned off it and I'll be out of it for good by the middle of next week, which would be 9 weeks post-op. I'm not wearing the boot while in the house but I'm "mostly" wearing it while outside doing stuff. When out of the boot, I think I still favor the "new" toe somewhat. I'm walking a little bit on my heel and the outside of the foot.
By 10 weeks post-op, I'm supposed to start consciously trying to do a "normal" gait with a higher portion of my weight on the big toe than I've done for years. I've experimented with that a little big in the house and it seems to feel pretty good. I won't know exactly how the gait is for probably about two to four more weeks. Pain is almost non-existent, but the foot is still somewhat swollen and tender. I'm still babying it to some extent but he told me that those bones haven't done their full healing thing until at least 12 weeks, so I have a few more weeks to go.
As far as the good/bad/ugly...
The good is that I seem to be able to tell that the pain underneath the second toe is no longer there. That was the aspect of all this that was preventing me from hiking in the mountains. That pain was apparently caused by the tearing of the plantar plate below the second-toe joint. That pain *seems* to be gone now. If it stays gone, that's a huge improvement for me and I'll be happy.
The bad is that I can definitely feel that the big toe is simply not going to flex much. From a functional standpoint, I'm not sure that's a big deal to me as I seem to be walking pretty well without it. Once the healing process is over, I'll be able to better tell if it causes me any longterm issues. For now, it doesn't affect me other than the fact that I can FEEL that the joint is much different and doesn't bend.
No ugly that I can tell so far. There were no infections, no adverse reactions, no debilitating pain from surgery, no screws that have come loose. While I tried to be a pretty good patient, I'm pretty sure that the lawnmowing, flyfishing, wood splitting, fence-walking, and softball (I only played catcher) were well beyond what I was supposed to do as a patient. I felt like even though I did a lot of that stuff, I was careful to use the walking boot and careful to listen to what my foot was telling me. So far, it all seems positive.
And yes, I did ski. On Thursday I drove to Beartooth Pass outside of Red Lodge, Montana, and skied for about an hour. Once I had my foot in the ski boot, everything felt really good. I ended up skiing much more aggressively than I imagined I might and I skied for quite a bit longer. No ill effects at all that I can tell. I iced and elevated when I finally got home that night, but it felt perfectly fine the next morning. I put a trip report in that section of EpicSki, but here are a couple of photos:
All things considered, it went great and it felt REALLY good to be back on skis.
I'm a happy camper.
I like your Good/Bad/Ugly descriptions.
It gives hope to those who are pondering this type of treatment.
Glad you felt good in a ski boot, and had your stamina.
Bob - great pictures. You look like you had a lot of fun! Your such an inspiration. It is amazing all the activities that you are doing in such a short postop period. You won't let anything keep you down long.
You are one amazing and positive guy. Take care.
Thanks so much for sharing your story, Bob!! I have a lot of things going on this year with my body - foot problems on both feet, AND a bad back problem which caused my left foot to "drop" two months ago (maybe I'll check other threads for that topic!). But since this thread is about toes, let me add that I just saw a new podiatrist yesterday after not having seen one since I had a cheilectomy on my left big toe in October 2009.
He says that since I am only having worsening symptoms on that toe with the arthritic changes and not much space between the bones (so it is almost bone-on-bone at the joint) AND I am having lots of pain when I walk much, and heaven forbid I try to put on little high heels which thankfully aren't a priority anyway - I should probably go ahead and get a fusion of the toe. He doesn't think that it should be a problem with skiing, as long as I can get the foot into the boot. I am worried that I can't bend the toe enough to get the toe into the boot if it will be mostly straightened with just a little upward bend? I might have to look for a new boot, and they don't have a huge selection here in Ohio, so I might have to dabble online which is trickier for fitting. But since this surgery won't be for awhile, and maybe I WILL be able to get my toe into the boot okay, I shouldn't worry about it much yet.
My right foot will "just" need a bunionectomy for the long-developing monster bunion, but after awhile should be good as new, since so far, they said that that toe joint looks okay in terms of arthritic changes.
I have THREE potential surgeries out there to think about - two toes and a back - and don't know how the timing is going to work out with them. Right now concentrating on getting the left foot stronger (actually got it into my ski boot last night, which had been a problem due to the foot drop - YAY!). Wish I would have gotten the toes fixed before the back went out, if only I'd known!
Anyway, I was SO happy to see your ski photos and know that you got your boots and and got back out there, giving me hope!
Best of luck to your continued recovery and enjoyment of life!!
bob, any update on how the toe is feeling and progressing?
Bob, we're getting worried about you. . . no updates. . . .
(I know, you get your toes fixed, and forget about those of us left behind in pain. . . .)
I REALLY suspect that no news is good news, and you have gone on with enjoying the fun things in life and are not sitting behind a computer! Yay for you!!!
Kitty
bob, any update on how the toe is feeling and progressing?
Bob, we're getting worried about you. . . no updates. . . .
(I know, you get your toes fixed, and forget about those of us left behind in pain. . . .)
I REALLY suspect that no news is good news, and you have gone on with enjoying the fun things in life and are not sitting behind a computer! Yay for you!!!
Kitty
Hi, kids.
Thanks for the concern. It really is as simple as I've just been enjoying summer (and working a bit). I've been fishing, biking, gardening, cutting/splitting firewood, and hanging out on the river.
As to the foot, it seems to be doing great. I'm a bit over 16 weeks post-op now and I would assume I'm out of the woods now as far as doing any damage to the repairs.
The fused big toe joint feels just fine. I can't tell that it limits me in any way other than the fact that it still feels "weird" when I unconsciously try to flex the joint. The foot goes in a ski boot just as well as it did before the surgery, so I got that going for me. 
The question of gait is an interesting one. Because of the extreme arthritis in both big toe joints for such a long time, I don't think I've had a "normal" gait for years and years. I had gradually changed my gait such that I was walking on the outside of both feet as an unconscious means of dealing with the pain that would come from flexing the big toe joints. Now, I have a left big toe joint that simply doesn't flex and a right big toe joint that still flexes (sort of) but hurts when it does. So, now when I start to walk "normally" with most of my weight coming off the big toe area with each step, I've found that the left toe (the fused one) doesn't hurt at all while the right toe still does. So I'm actually able to walk normally on my repaired foot. I'm finding it a bit of a learning experience on walk on that left big toe again after all these years of trying to avoid putting much weight on it. In that sense, I think the surgery has been a big success.
The other part of my surgery was the osteotomy of the second toe. This was done to address the fact that the second-toe joint had been pushed sideways out of place by the growth of the bone spurs on the big toe joint. That displacement had resulted in damage to the plantar plate beneath the second toe joint and that was causing me a lot of pain when I walked. That pain is now essentially gone, but I occasionally feel little twinges in that same spot. That MIGHT be due to bone bruises on the bottom of the second-toe bones from when there was no plantar plate to protect that bone surface before the operation. Because of those little twinges, I've decided not to do any significant hiking for exercise between now and this coming ski season. I've been riding my bike a lot and getting my exercise that way. I guess the verdict won't be in on how successful the second-toe operation was until next summer when I want to start hiking again.
Overall, I'm very pleased with how the big toe has turned out. Here's a photo of the foot from about a week ago:
So, that's the story. Things feel good.
Bob - great pictures. You look like you had a lot of fun! Your such an inspiration. It is amazing all the activities that you are doing in such a short postop period. You won't let anything keep you down long.
You are one amazing and positive guy. Take care.
Heh. The catcher thing just sort of happened. My friends needed a warm body behind the plate. I just sort of stood there, caught balls that the hitters didn't hit, threw them back to the pitcher, and then threatened anyone who might be foolish enough to try to slide into home with a baseball bat sandwich.
See above on my gait. I think it's excellent. Much better than before.
I skied in my backcountry (alpine touring) boots. They are roomier than my alpine boots, but I've since put on my alpine boot and there doesn't seem to be any problem at all.
The question of gait is an interesting one. Because of the extreme arthritis in both big toe joints for such a long time, I don't think I've had a "normal" gait for years and years. I had gradually changed my gait such that I was walking on the outside of both feet as an unconscious means of dealing with the pain that would come from flexing the big toe joints. Now, I have a left big toe joint that simply doesn't flex and a right big toe joint that still flexes (sort of) but hurts when it does. So, now when I start to walk "normally" with most of my weight coming off the big toe area with each step, I've found that the left toe (the fused one) doesn't hurt at all while the right toe still does. So I'm actually able to walk normally on my repaired foot. I'm finding it a bit of a learning experience on walk on that left big toe again after all these years of trying to avoid putting much weight on it. In that sense, I think the surgery has been a big success.
Bob I just read through this thread and its very encouraging, especially the part about your adaptation to gait and your lack of any real PT. My wife is now 4 weeks post op on her left foot. We saw the doctor again today and he took the stitches out of her foot. and put on a hard cast. She is totally non weight bearing until early November. She has Ehlers Danlos Syndrome (connective tissue disease) and with it comes permanently impared propriorception (knowing where your body is in proximity to other things). As a result crutches are out and a walker is only useful to transfer to a wheel chair. Your post gives a bright spot that there is light at the end of the tunnel.
At the Cleveland Clinic she had her achillies tendon lengthened plus all the bones in her heel fused to all the bones in her midfoot fused to the big toe. The only thing not fused is her four other toes. Surgery was 9 hours and 50 minutes. The surgeon said there was not much holding her foot together and said it was the longest and toughest he has ever done in his 25 years. We would rather not have had that distinction. The titanium hardware bill totals two pages and is over $35k. OR is $75k. We think we have seen all the hospital bills $155k but none of the doctor bills yet.
Since surgery 4 weeks ago we have been back for 5 post op visits. Thank god we get three weeks this time before the next one. Each visit takes all day. We think we are past the worst of it. No more bed side commode and we have managed a few showers so life is a lot better than it was.
At this point we just hope it is worth it and she is reasonably functional walking on her own before ski season in Ohio. In reallity you deal with the cards you have, not the one's you want and your thread is nice encouragement on that road to recovery.
Hi Folks:
Just happen to be passing by and saw these threads. There is an alternative to fusion that is too little known, but has been in use for 22 years. I am the inventor of the Total Toe System. Biomet, one of the worlds leading orthopedic companies makes the Total Toe. See greattoe.com. Movement and function can be restored just as it is in the hip and knee. But first, I would like to dis-spell some myths: you may or may not have had a trauma that caused Hallux Rigidus. Osteoarthritis in the great toe joint can be inherited via the shape of that joint. A certain shaped joint is destined to fail and will take the cartilage with it. A mal-alignment of the great toe joint can also be the etiology of Hallux Rigidus. Once again, a foot shape is inherited and that may lead to mal-alignment. Most often, however, a severe trauma (fracture) or repetitive minor injury can result in Osteoarthritis.
As you can well imagine, I am not a fan of arthrodesis (fusion) of the great toe joint. This is not to say that it isn't helpful in some cases, I just think that it is used as a first surgery way to often. And speaking of first surgeries, avoid chelectomies (clean -up procedures) as they just exacerbate the condition and hasten you to the arms of waiting joint surgeons who will replace or fuse the joint. Finally, some replacement joints simply do not work and should not be done. Make certain that the joint chosen for you comforms to the standards set by those historically who know, hip and knee replacement.
Thank you Dr. Koenig. I hope you will stay tuned to this thread for our members that may have more questions...meanwhile:
Dr. Koenig - any idea of practitioners who do this in your old stomping grounds (northeastern Ohio)?
BOB - how IS that toe?? How much activity have you been able to do - most particularly, walking in shoes which don't have heavy/firm soles, or walking barefoot? I am guessing that hiking might be okay (or at least I am hoping that it is) due to the supportive soles? What type of shoes do you wear for cycling - regular cycling shoes with clips (and stiffer bottoms)?
Thanks!
Kitty, ten days post-bunionectomy (not on the foot "needing" toe fusion)
Hi Bob,
Thanks so much for this thread.
I am 51 years old and no stranger to arthrits--have had both hips replaced; left at age 45 and right at age 48. I am now in the process of preparing for great toe joint fusion on both feet. The joints will not be done at the same time but consecutively.
My question is, do you think recovery from the first surgery will be sufficient to do the second surgery at six weeks?
Great appreciation in advance if you're still out there!!
Bob--
thanks for your story. I am wondering if I would be able to hike in a shoe or hiking boot and cross-country ski in a flexible touring boot with a fused toe?
Thanks for any thoughts you or anyone else has!
Linda
Hi, all.
Hopefully this email will answer the last three posts above...
It's now been just over 5 months since my surgery and I got back a little over a week ago from my final follow-up appointment with the surgeon. I wasn't expecting there to be any problems and there weren't. He said everything looks good and the bone tissue has pretty much fully sealed in across the fused area. It's as strong now as it needs to be and I'm fully cleared to do whatever I want.
The toe feels fine and I'm gradually finding that I'm no longer consciously (or unconsciously) trying to flex that joint. I think my body is adjusting to the fact that the joint doesn't move and I honestly have not found any movement or activity that causes any pain.
As to activity:
In the middle of September, my wife and I joined several friends for a one-week biking trip to Tuscany and then a one-week hiking trip in Sardinia. While neither trip was SUPER demanding, the biking consisted of about 45-50 miles per day of very hilly biking and the hiking was 10-15 miles per day of occasionally very rough terrain. I had no issues with the toe during any of that. I used light, soft-flexing tennis shoes for the biking because I wanted to use bike cages rather than clips. That was mostly because I was afraid if I klutzed-out trying to disengage from clips that I might come down the wrong way on the toe. Wearing very flexible tennis shoes proved not to be an issue at all, even when we were walking around exploring those beautiful hilltop towns in Tuscany.
For the hiking, I used my old, medium-sole hiking shoes. I was planning to get heavier-sole hiking boots before the trip but never got around to it. At times, we did some fairly significant bouldering in Sardinia and my toe(s) didn't bother me one single bit. Here are a couple of photos of some scrambling we did in the Gola Su Gorropu (also known as the Grand Canyon of Sardinia):
Another thing I did that tested the toe was flyfishing from the shore along the coast of Sardinia. I did a lot of scrambling around on wet, sharp, slippery, rocks and boulders while just wearing sandals. That was a real test, I think, of whether walking around on rough surfaces with very little support would work out. The foot did fine with that, too.
I think my gait is becoming pretty normal and I can definitely tell that walking "normally" by rolling off the big toe does not hurt with the fused left toe but DOES hurt on the right toe that still suffers from hallux rigidus and has not been fused. From that standpoint, I think the operation was a major success.
As to other activities, I've been flyfishing here in Wyoming which involves walking around on slippery underwater boulders. I've had no problems. I've also started hiking - I did eventually get those heavier-sole hiking boots. No problem. I've also skied several times in both my alpine boots and my randonee boots. No problems at all. I haven't been cross-country skiing yet (no snow in the valley yet 
) but I can't imagine why that motion would be any more difficult for the toe than anything else I've been doing.
I'm pretty much able to forget about that toe now and do whatever I feel like doing. That is a very big change from what was going on before the surgery.
So far, so good.
Dr. Koenig - any idea of practitioners who do this in your old stomping grounds (northeastern Ohio)?
BOB - how IS that toe?? How much activity have you been able to do - most particularly, walking in shoes which don't have heavy/firm soles, or walking barefoot? I am guessing that hiking might be okay (or at least I am hoping that it is) due to the supportive soles? What type of shoes do you wear for cycling - regular cycling shoes with clips (and stiffer bottoms)?
Thanks!
Kitty, ten days post-bunionectomy (not on the foot "needing" toe fusion)
Hi, Kitty.
See the post above. I'm fairly active and I would say that I'm pretty much back to doing whatever activities I was doing before this toe started really bothering me about 18 months ago. Without being TOO upbeat about it, I think the fusion has really solved the problems I was having. I have been very active over the years and I feel like I'm getting very close to being able to do what I could two years ago.
I hope the healing process on the bunionectomy is going well.
Hi Bob,
Thanks so much for this thread.
I am 51 years old and no stranger to arthrits--have had both hips replaced; left at age 45 and right at age 48. I am now in the process of preparing for great toe joint fusion on both feet. The joints will not be done at the same time but consecutively.
My question is, do you think recovery from the first surgery will be sufficient to do the second surgery at six weeks?
Great appreciation in advance if you're still out there!!
Hi, Elizabeth.
Thanks for the nice comments. Six weeks was just about the time that I was allowed to get off the one crutch. I was getting along well but I *did* have to spend two more weeks in the walking boot. I'm honestly not sure if I would want to do the second surgery that soon after the first. I think that knowing how it went for me, if I were making that decision I would probably wait until 8-10 weeks post-surgery to do the second one. I know that delays the final I'm-done-with-it-all time, but I think you might find it pretty difficult to get around if you went for 6 weeks after the first surgery.
Bob--
thanks for your story. I am wondering if I would be able to hike in a shoe or hiking boot and cross-country ski in a flexible touring boot with a fused toe?
Thanks for any thoughts you or anyone else has!
Linda
Hi, Linda.
See my comments above. I don't think you'd have any trouble doing those things once you were about 12 to 16 weeks post-surgery. I've actually been contemplating (haven't done it yet) doing some low-level rock climbing now that the left toe is fused and feeling good. That's something I wouldn't have dreamed of doing a year ago.
Thanks for your reply, Bob. It's helpful and hopeful!
Did you like the Steadman clinic and Dr. Clanton? We live near Denver and it would be easy to make the trip. Worth it? I've had an unsuccessful surgery in my hometown and need some ideas from a thoughtful surgeon.
Thanks for your reply, Bob. It's helpful and hopeful!
Did you like the Steadman clinic and Dr. Clanton? We live near Denver and it would be easy to make the trip. Worth it? I've had an unsuccessful surgery in my hometown and need some ideas from a thoughtful surgeon.
I was extremely impressed with both the clinic and with Dr. Clanton. In addition to some very, very impressive credentials, he seems down to earth, takes time to answer your questions and tell you what to expect, and it's also very easy to tell that the staff there likes and respects him.
One little semi-intangible that really impressed me on the morning of the surgery was that there must have been six different staff people who came by before surgery. Each one introduced themselves, told me what their role was and what to expect. EVERY one of them asked me what procedure I was there for. I answered each one with "Left big toe fusion, left second toe osteotomy".
That might seem like overkill, but I think it demonstrates that they do everything possible to; a) make the patient feel as comfortable as possible and b) make sure the right thing was being done to the right body part. I think that's a great practice.
Also, while I didn't have any need for it, the Steadman clinic has a world-class physical therapy center.
Good luck if you decide to go. And say "hi" to Dr. Clanton for me.
While that toe hurts somewhat, it's not keeping me from doing anything - yet. The bone spurs are definitely coming back and I'll probably have to have something done in the future. For now, though, that foot it just an annoyance.
