- 349 Posts. Joined 6/2001
- Location: Ct
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Hallux Rigidus, Anyone? - Page 3
I'm one year and one month post-op. Things are going very, very well.
I still have some pain in that toe, particularly while rock climbing or while walking downhill in steep, rocky terrain. My doc is an orthopedist. She pretty much told me going in that the surgery would "alleviate" pain, not "eliminate" it. There's no getting around the fact that I've still got an extremely arthritic toe joint.
Still, I'm very glad I did the surgery as the pain I have now is nothing compared to what it had become. I've got far more range of motion and I can do *almost* anything I want on that toe.
As evidence of that, here are some photos from a climbing trip we did in the Dolomites of Italy last September. At that point, I was three months and two weeks post-op.
This is a peak called the Civetta, just outside a small town near Cortina called Alleghe.
This was the biggest day of our trip. We hiked and climbed UP over 6,000 vertical feet and then back down about 6,500 vertical feet. Most of it was on very rough and rocky terrain and my toe felt fine (the rest of me was sore as hell).
We did a form of climbing called Via Ferrata, where you wear climbing harnesses and safety carabiners but you don't have to carry ropes or protection gear. We went with an IMGA guide. It's incredibly fun and there are climbs all over Italy, Austria, Switzerland, France, and Slovenia.
Here, I've marked out the ferrata route we took up the Civetta.
We climbed for seven days straight and my toe survived with very little problem. Here's a fun shot of some of the terrain we were on:
The only bad news in all this is that my *other* toe is starting to show all the same early symptoms. I'm sure it's arthritic as well. It's actually reached the point where that toe is more painful (although no osteophytes to speak of yet) than the toe I had "fixed".
All in all, I'm a very satisfied customer.
Good luck with yours.
Okay, old doctor jokes aside, this sounds pretty good. I know there can always be complications, but the more good results I hear about the surgery, the better I feel about the decision to do it.
Will let you know how things progress ...
Update -- I got home earlier today from my surgery, which turned into a joint replacement mid-operation. I knew it was a possibility, but we didn't really think it was that far gone. Apparently the articular cartilage was completely trashed, and I was bone on bone. And now I have a titanium cap in there. (Hmmm, I wonder if I will beep at the airport? I need to ask about that.)
Will let you know how things progress ...
It may well be that the full replacement is the much better strategy down the road. I suspect I'll be doing that one of these days.
Good luck and keep us posted.
I have two titanium screws in my left knee from an acl operation years ago. The screws are each about as big as my little finger, but I've never set off the alarms. I bet you'll be fine.
Which does bring up the question...
If titanium doesn't set off alarms, what's to stop the terrorists from making ___________ out of titanium?
Inquiring minds want to know.
I went into the surgery center, signed the release forms (which allowed them to perform the osteotomy/cheilectomy OR the replacement, although I didn't worry too much about that b/c I didn't think it would be necessary. duh.). They just gave me a local anesthetic, although I was sedated pretty good at first so I don't remember the beginning of the surgery. But I became more and more aware as things progressed, and I heard the surgeons discussing the fact that they needed to replace the joint. They were trying to figure out how I had injured it, because this is pretty rare for someone of my age who hasn't had major joint trauma. (I've never seriously injured it, though -- just years of soccer and tennis and bad genes, I'm afraid. That's also my leg that's a little shorter than the other, plus I, like my dad and brother, walk up on my toes. Must be cumulative.)
So, I was sort of in a haze, until they started sawing and drilling. That was an experience! It didn't hurt, of course, which is kind of weird, but you certainly hear it and feel the vibrations.
They took off the spurs, did microfracture in the toe side of the joint, and installed the titanium cap in the foot side of the joint.
By the end of the procedure, I was fully alert, so when they wheeled me into recovery, I was ready to go after not too long. They had to check vitals for 15 min or so, and take out the IV and all that, but I was outta there pretty fast. If you can stand the noise, I highly recommend not going under general. I never had a lot of trouble with anesthesia to begin with, but this was really nice.
So ... I got a little velcro shoe, no crutches, no cast. "Take it easy for a few days -- elevate and ice for about 48 hr." They had me put the ice on my ankle instead of trying to keep it on my actual foot/toe. That worked just fine. Weight bearing was okay, but I didn't push it. Just got up when absolutely necessary for the first two days (I did notice that it would start hurting and oozing when I walked around, so I just didn't do that).
It was pretty numb for the first couple of days, so the pain was minimal. It was achy, and the incision got a little sore. I did take my vicodin for about 3 days.
By the fourth day, I was up and around a lot more, no more pain medication; I drove on the fifth day, and saw the doctor on the sixth. They redressed it and took an xray -- all looks good and straight.
Yesterday (day 12) I had the stitches removed. All is still well. The incision and the ball of my foot under that toe are tender, and I don't have full range of motion yet, but it's still pretty early.
I was a little surprised by reading that others were treated a little more conservatively as far as a cast! and crutches and elevation for a week! Wow ... I was walking around a soccer field in a week. I do get a little more tender if I overdo it, but the doctor said just not to push through pain quite yet. But I can do whatever I am able to ... walking the dog, but not hiking; biking, but not uphill ... etc.
I was initially a bit concerned about the life of the joint, but the doctor said it should last forever. If it doesn't, the toe will have to be fused, but that's not a huge problem. You can do a fusion after a replacement, but once you fuse it, that's the end. You can't go the other direction.
The good news for me is that I am now pain free,after years of suffering.Eventually I will do the other foot but not until I have to.
Hope your healing keeps on going well!
Then after about 45 minutes, I pulled a muscle in my back/ribs ... not surprising, since I haven't swung a racquet in a month ... so I quit. Duh. I can hardly take a deep breath at this point.:
Still need to work on my ROM ... I need to overcome about 5 years of favoring that foot, which I didn't think about.
My toe is still a little sore some days, but in a different place than it was before. It's been less than a year, so I'm not surprised.
But even if the toe continues to hurt, it was worth it for the good it did my other joints. And I'm just as active as I want to be. I'm not a runner, and I'm not sure I could run (distances) on the days that the toe is sore, but I can sprint short distances. Three seconds of pain is much easier to deal with than 30 minutes, I guess. :-)
Hi ... my replacement was somewhere around $10,000. I was supposed to have insurance, but there is a dispute, so then they charged me $6000 (still disputing). But if you don't have insurance, you won't have insurance issues! I don't know if that's good or bad. I think you can negotiate downward if you don't have insurance, and if you do both at once, I would guess it would be cheaper than $10,000 x 2.
I don't know if you want the replacement or the osteotomy. I still have pain in my toe, just in a different place. It's still sore where the thing is screwed into my foot. But the top is much much better, no pain there. Range of motion was very difficult to get back (it's definitely better than before the surgery, though), and still isn't 100%. I was almost there last fall, and then I took a very strange fall where I landed on my toe and bent it straight under my foot. It turned black and blue and I babied it for a while, and it got a little stiff again. I probably needed an xray, honestly, but I'm tired of dealing with it.
However, as I described before, my knee and hip on that side have been in much better shape since I had the surgery, so for all the ambivalence I might have, I am glad I did it. I still wish I had the osteotomy, I think, but I guess I'll never know.
Thanks for the info - Im definitley hoping for the osteotomy but I gues they wont know how much cartalige i have left until they open it up just like in your case... My right knee is starting to take its toll so I guess I have no choice...
Although I went to a phisiotherapist today who claims that I can fix it dramatically with manual therapy but im not sure how that can make the osteophytes disappear... Every doctor I go to has a different opinion - I
dont know what to belive anymore...
Anyway, thanx for the update!!
- 847 Posts. Joined 3/2008
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With all due respect to your physio... good luck. The only treatment for osteophytes that are blocking joint movement is a rongeur .
The treatment choices for hallux rigidus are pretty straightforward, in no particular order:
1) formal fusion (not a great choice for active people)
2) suck it up and carry on with a rocker soled shoe (ditto above)
4) joint resurfacing/replacement
5) debridement (remove osteophytes and usually release soft tissue/joint capsule to gain ROM)
6) combination of 3-5
Don't get too many opinions. Talk to a surgeon that you have a good rapport with and discuss the options. Good luck!
Edited by jdistefa - 2/20/2009 at 05:26 pm
Saw that this was bumped, and decided to update again ...
The past year kind of sucked. My feet (now the left one hurts too) were really painful. I had returned to my podiatrist in May 2009 to check on things, since after initial relief, things were hurting even more, but not exactly the same place. After xrays he said apparently I was one of the few who just didn't heal right, and he could take out the artificial joint and fuse the toe. I wasn't ready for that, so I went to find second opinions. I did get a cortisone shot, which helped, but only briefly.
Next doctor (May 2010) showed me that the joint space in my toe had closed back up, even after the surgery, which is what was causing the occasional nauseating pain. But what I didn't know was that the sesamoids on both feet were craptastically arthritic as well. Long story short, new orthotics to deal with this, which have been helpful. But mostly, I started taking systemic enzymes. Holy crap, I feel SO much better. These things are miracle pills, for me at least. I'll have to make another post somewhere. My pain level is down to where it was maybe 7 or 8 years ago. Pain isn't 100% gone, but it's close.
Also, my doctor told me that he recently resurfaced a big toe joint with the patient's own non-articular knee cartilage, and to that point it had been a success. So there might be another option for treatment. But first, get the spurs removed, then try Wobenzym N.
I have to say...this is the best I've read yet online! Thankyou, I feel so much better about my soon and upcoming Cheilectomy surgery now. There was definitely confusion between bunion and an osteoarthritic joint in my case! I feel confident in my surgeon, Dr. Heard with Banff Sport Med that he will do the right thing for me. I was feeling that this surgery may be a bit premature...but after reading your segment....maybe it's not. Better to take care of it sooner than later. Even with the nerves....I just don't want to miss out on this skiing season! But recovery time does sound pretty nominal. Thankyou, I feel better reading this
I have to say...this is the best I've read yet online! Thankyou, I feel so much better about my upcoming Cheilectomy surgery now. There was definitely confusion between bunion and an osteoarthritic joint inmy case! I feel confident in my surgeon, Dr. Heard with Banff Sport Med that he will do the right thing for me. I was feeling that this surgery may be a bit premature...but after reading your segment....maybe it's not. Thankyou.
- 1 Post. Joined 8/2011
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I am interested in an update on your hallux rigidus situation. I live in Idaho Falls, ID and would like to know what surgeon you used. Is your surgeon in Jackson Hole? My podiatrist here wants to perform surgery using the HemiCAP (trademark) arthrosurfacing procedure. This was approved by the FDA for the toe in 2006, but not covered by many insurances until 2009. According to my doctor it is very new. Was yours a cheilectomy or a replacement?
I too spent many years climbing (maybe the cause) and your Dolomite pictures attracted me to this site. Thanks.
I'm bumping this again in case anyone out there sees it and has any experience with this ...
My toe was resurfaced with a hemicap that looks like this:
I am still having trouble with the joint when I push off -- the space has closed up again, and it's like constant turf toe. My doctor told me yesterday that they don't use the above cap anymore; now it wraps over a little farther, like this:
So he wants to go in there and just replace just the cap, not the implanted part; he says it will be minimally invasive, only the 2 weeks for stitches to heal, etc. (Hmmm, I've heard that before...) Anyone out there done anything like this before, or heard of it??