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Consider a Lapidus rather than big toe fusion for hallux rigidis

post #1 of 16
Thread Starter 

Hi Folks,

 

Sorry, but I am not much of a poster but I wanted to share an alternative with folks who may be considering a big toe fusion.  I had stage 3 arthritis and the space between my joint is quite good post op.  I will include pics from my 2 week appt below.  The bruising is so much less just one week later.

 

I am only 3 weeks post op now but I already have no pain in my big toe except for sensitivity in my incision and achiness/hotness where the plate and screws were placed when I do too much upright/walking in the boot.  My big toe has quite a bit of movement but I expect full movement once I start PT in 3 weeks when I can start weaning off the boot.

 

The Lapidus procedure is a type of fusion of the first TMT joint that decreases the movement of that joint and straightens out the first metatarsal and toe. Rather than fusing this joint, my big toe joint is now in the right position so it doesn't bang the big toe joint.

 

Dr. Eric Masternick, a podiatrist, in Reston, VA, did the surgery and I cannot recommend him enough.  I had seen 4 doctors prior to him that all recommended the big toe fusion.  Until meeting Dr. Masternick, I thought that was my only option for pain relief.

 

Btw, the odd triangle of weird looking flesh to the right of my incision is a skin graft from this past summer.  Long story but suffice it to say, a doctor messed up my aftercare after stitching a blister which led to 3 surgeries including a skin graft and flap (which Dr. Masternick fixed a portion).

 

Hope this helps others!

 

Best of luck on your recoveries!  I am more than happy to answer questions and keep folks posted, if there's an interest.

 

Active Ann

 

 

post #2 of 16

Would you have your pre-op x-rays? I wouldn't mind seeing them.

post #3 of 16

I m no expert but that looks like a serious surgery.

Half of your foot was cut open.

How does this cure your rigid big toe?

The surgeon made your foot wider butwhat did he do to your first big toe joint that was originally the problem?

Cu ron

post #4 of 16

Sorry meant your second bigtoe joint.

post #5 of 16
Thread Starter 

That's a great idea.  This xray was taken by a different doc so they may not be 100% comparable but you can definitely see the lack of space in my big toe joint.

post #6 of 16
Thread Starter 

Ron,

 

Yes, the lapidus surgery does require a larger incision.  Part of the incision is needed to fuse the TMT (mid-foot) joint and the remainder of the incision is needed to clean up the arthritic big toe joint and drill holes in big toe bones to create pseudo cartilage (forgot the technical term for that).

 

I don't have a pre-op side X-ray of my foot, but my metatarsal sat high in big toe joint rather than 'nestled' in the joint properly.  So when I would walk or run, my metatarsal would bang against my big-toe joint which caused the arthritis and pain over time.  By fusing the TMT (mid-foot joint), the metatarsal was shortened which allowed Dr. Masternick to properly align my big toe joint and create space in the joint which returns the joint mobility that was lost due to Hallus Rigidus.  So that's the 'cure'.

 

Dr. Masternick performs a lapidus 95% of the time over a big-toe fusion because he believes a patient gains way better results by maintaining mobility in the major bending joint (the big toe) and fusing the TMT (mid-foot joint).  I wish more doctors offered this option, particularly to patients that want to remain active.  I plan to do the second foot ASAP but due to finances, I may need to wait until next year.  

 

I wish I had known about the lapidus in 2007 when I had a chilectomy which did nothing for my pain and limited mobility because the misalignment was still there.

 

I talked with a patient of Dr. Masternick who had a lapidus done on both of her feet, 4 months apart.  After physical therapy for the second foot was complete, she did the 'couch to 5K' to return to running and she is super active and completely thrilled with the results.

 

Hope this helps!  Feel free to ask more questions.

 

Active Ann

post #7 of 16
Thread Starter 

PS.  My foot isn't wider.  That may just be a result of the angle of the X-rays.  However, my big toe used to be longer than my second toe but now it's shorter.

post #8 of 16

Thanks for posting the pre-op films. I hope you'll update this thread as time goes on. I'd like to hear how you're doing in a year and beyond.

post #9 of 16
Thread Starter 

You're welcome.  I definitely will!  Honestly, I wish there was a better way to post my experience but I am not a blogger.

 

I truly hope I can have my other foot done at the 4 month point so I can deal with all the associated limitations at one time.  

 

Furthermore, I am determined to run again, not marathons but 3-4 miles 1-2x per week.  And once I set my mind to something, I have the determination to make that happen.  Plus I have the best physical therapists to help me. For example, after I had my ACL replaced, I couldn't fully bend my knee (like for a child's pose when you sit on your heels).  The surgeon said I probably never would.  Well I kept working on stretching my knee using that pose.  It took 2 years, but I finally gained the mobility needed to fully do a child's post.

 

It will be a long road, but hopefully worth it in the end...

post #10 of 16

Thanks Ann for the info. I have HR too. My x-ray looks like yours.

I had a Cheilectomy, but it didn't work. It's been 5 months and it's more painful now then ever.

Like you I am very active and particularly a rock climber. I need the range of motion in my toe, and this is the first post I've seen anywhere that has given me hope.

I'm going to look into this and see if it will be something that might work for me (and if I can find anyone that has done it and will do it).

I hope you're recovery is going well.

Thanks again.

Kris

post #11 of 16
Thread Starter 

Hi Kris,

 

I had the same results after a Cheilectomy - lots of recovery with no improvement in my pain or motion.  Where do you live?  Dr. Masternick works in Reston, VA which is super close to Dulles airport (IAD) fwiw.  

 

I don't know why more doctors don't offer a Lapidus as an option.  For me, the big toe fusion would have been too limiting for my desire to be active including some running.

 

I have done indoor rock climbing when my kids were into it.  Awesome sport!  HR is super painful and limiting when climbing.  However, maybe a fused, pain-free big toe might help you.  For me, there were certain things that I just couldn't do because of the pain while climbing.  So I feel your pain!

 

It just seems that fusing the big toe for active people means you have that much more stress on the other joints in the foot as you compensate.  I will say the recovery is long but I think it might be comparable to a big toe fusion recovery.  I am 4 weeks out and hate the wearing the boot.  Best of luck your search and finding a solution!

 

I will post more about my ability to be active.  As soon as my physical therapist gives me permission, I plan to do the 'couch to 5k' app to ease back into running.  I may decide to do my other foot in 3 months, the earliest my doc will allow, if my progress continues.  Another patient of Dr. Masternick did her right foot followed by her left and is back to running.  So that's promising!

 

Ann

post #12 of 16

Hi Ann,

So you had 2 surgeries to fix this. They tried the Cheilectomy first, and then you had the Lapidus?

Is the pre-surgery xray from before the Cheilectomy or after?

Below are my post (black background)-1 picture(Feb-2016), and PRE-Cheilectomy (Grey background)(2 pics)-Nov-2014

As you can see, I have LESS space than before. The report of the POST surgery x-ray says I have severe arthritis and that there is STILL A PIECE of bone floating around in there! The Cheilectomy was 'supposed' to clean that up!. Definitely not going back to this surgeon. Yes, I did my research as much as I could find out...he got great reviews and was recommended by my GP that has sent him other people with the same problem and all have had good results....or so she says.

I'm in Canada so healthcare here sucks most of the time. I have no problem getting this fixed in the US if I can get ROM in my big toe joints (yes both joints of the Right big toe, as they both have arthritis), no pain and can go back to being active.

My left toe looks bad but it works fine, no issues.

 

This site let me select the pictures and make them smaller, I hope that anyone who wishes to look closer can select them and make them bigger to see the details better. I imported here them quite large and high quality.

 

Kris

post #13 of 16
Thread Starter 

Hi Kris,

 

I had the Cheilectomy in 2007 and then the lapidus 4.5 weeks ago (4/2016).  I am shocked that your surgeon didn't get that bone chip out of there as mine was removed in 2007.  I agree with you as I would have expected that to be cleaned up.  Totally lame!  Definitely find a new doc!  I was told back in 2007 that the Cheilectomy would get rid of the pain and would last 15 years.  It didn't do much for the pain and I was back up to the same level of pain within a couple of years.  Total waste of time!  

 

With HR, a cheilectomy doesn't fix the problem.  So the bone on bone banging continues and the arthritis comes right back.  And IMO a big toe fusion may get rid of the pain but is very too limiting and irreversible.  

 

ROM = Range of Motion?  I doubt I will gain full range of motion but my hope is that I not only have more range of motion than before with no pain.

 

Ann

post #14 of 16

@Active Ann How about an update? I think you're about 9 or 10 weeks post-op now, yes? Going well?

post #15 of 16
Thread Starter 

Hey there!

 

Thanks for asking!

 

Yes, I will be 10 weeks post-op on Wednesday.  I really turned a corner at about 8 weeks in terms of the inflammation calming way down.  Prior to the 8 week point, I had to continually ice my foot because it would get so warm.  I borrowed a Polar Cube from an office mate and that thing ROCKED!  Anytime I feel pain in my arch or heat, I just ice and it goes away always instantly.  My PT wants me to continue icing through out the day.

 

My doc said my joint is fully fused so I can resume all activities.  My physical therapist doesn't agree to my bike riding.  She doesn't like me riding my bike outside as she worries that it will increase the inflammation.  I decided to follow my doctor's advice and now I bike commute two days a week (16 miles round trip) and go to the gym for weights 2-3 days per week and I haven't noticed any ill effects.  I can even walk my dog around the block which feels GREAT.  However, I cannot fit my foot in my bike shoes so I bought flat pedals so I can wear my sneakers which are the only shoes that I can wear right now (including to work).  The first week I was super sore because even though I did mat work with a trainer and then on my own, apparently it wasn't comparable and my muscles are really out of shape.  It feels awesome to ride outside again and the motion never bothers my foot and helps loosen up my ankle.

 

My ankle and arch muscles continually want to tighten, apparently the after math of being in a boot for 6 weeks.  My gait is back to normal except when my ankle tightens up.  I stretch through out the day by doing the ABCs with my toes.  I am not sure about my range of motion but it's WAY improved.  I'll ask my PT to measure at my next appt and will post more info.

 

My foot swells and aches more without a compression sock so I wear that everyday and take it off at night.  It helps tremendously!  I tried walking barefoot in my sailboat over the weekend and it's not comfortable.  My foot prefers the support and cushioning of my running shoes.  I also still have nerves 'coming alive' that zing in my foot every so often (especially when walking barefoot).  My PT says when I go to the beach at the end of July, I may want to wear a compression sock in the sand because my foot muscles are weak and will get really tired when walking in the sand.  I don't know if others use a compression sock but I love it and cannot recommend it enough.

 

I should mention that in my post op pics that I posted earlier, that other area in the middle of my foot is NOT from my Lapidus.  I had to have a skin graft there last summer because a surgeon messed up my after care from a blister from backpacking.  (long story!)

 

Bottom line is I am thrilled with the results so far.  It is a tough surgery to recover from but I am glad that I did it.  I have ZERO HR pain now yet I have way better range of motion.  I will probably wait a few years before doing the other foot which I plan to time after xmas when it's too cold to sail and to icy to bike outside.

 

Toecutter - where are you in the process?  Did you end up having a toe fusion or a lapidus?

 

Best,

Active Ann

post #16 of 16

Thanks for the detailed update. I'm glad you like the results. It's great when things work out like they're supposed to. I hope you check in again further down the line.

 

I'm not having surgery myself. I just have an interest in hallux rigidus.

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