Hi, Wondering if anyone has some advice having a surgical repair on both feet at the same time. I am a very active (compete at a national level in my sport) and cannot take a ton of time off work. I have a supportive family who can look after me during any down time. Am I crazy to do both feet at once? Is it better to stagger slightly (have 1 foot done, in 4 weeks do the other)?
As to the procedure, I am not sure yet. I have been to three physicians and haven't been satisfied with the discussions. I have two more appointments with two different surgeons and will figure out what's what after those meetings. The discussions to date have mostly revolved around "cleaning up the joint". No one has suggested implants or fusions.
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There are pros and cons for doing it either way. I assume that as you are an athlete looking to return to sports, you would want to stay away from a fusion procedure. The procedure that you seem to suggest is called a cheilectomy, and you should know that although this type of procedure is often helpful for mild to moderate hallux limitus where the main difficulty is blocking of the full range of joint motion by osteoarthritic proliferations and ossicles, rather than full blown joint cartilage destruction, it does not stop the osteoarthritic process from continuing, and you may need additional and more radical surgery in the future. I trust you used the term hallux rigidus incorrectly, as that is generally the end stage condition of hallux limitus and as such, would not generally be appropriate for a cheilectomy. In most cases, it comes down to a patient choice as to whether to do both at the same time or one, but, in my experience as a surgeon, all other factors being equal, I prefer to do both at the same time. Generally, the healing time is no where near doubled if increased at all, and it has been my experience that, as surgery is always some amount of aggravation . . in this case, a period of ambulatory disability. it is often difficult to get a patient to undergo the second procedure immediately after the first . . not because the procedure is so bad, but because it's just human nature not to voluntarily return to disability once rehabilitated.
__________________ Foot Doc
Last edited by FootDoc; 11th July 2009 at 08:28 PM.
I am a nurse with no podiatry training, so I don't claim to know alot about treating hallus rigidis, but I have had it for 13 years and I had a joint replacement in 2003 that has now "failed" that I am trying to figure out what to do with. I just want to caution you about having either the joint fusion or joint replacement surgeries. Both are "joint destructive." With a total joint replacement, the ends of both the metatarsal end of the joint and proximal phalangeal end of the joint are sawed off to accomodate the hardware for the joint. If this fails there is not much else that can be done except a fusion or (new and experimental) a bone graft replacement. With a fusion, large screws are place in the metatarsal and phalangeal bones to fuse them together. There is no going back from this. I read that you are an athelete. Try to go with the least destructive surgery possible. Think of the fusion as the last resort. Even though they fuse the toe at a slight bend, it is not at all the same as a functional joint. I hope that you can go with a less radical surgery.
I don't seem able to start a new post of my own, so I hope that someone reads this post about my own problem:
I had a total joint replacement for hallux rigidus in 2003 that is now failing. The metal in the toe is apparently lose and has led to significant bone loss in the proximal phalange. The hardware in the toe will have to be removed. But there won't be enough bone left to put another metal prosthesis in. The hardware in the metatarsal seems fine at this time. I am athletic and I love to dance (recreational). I don't want to give up my active life (I can't even imagine it, to be frank), so a fusion looks very unpalatable. I came across some references to new surgeries that involve full joint replacements with autonomous bone grafts. Could my short toe be grafted with my own bone and some sort of joint surface created so that I could maintain a functioning MPJ?
Here's another question that has been bugging me: Why do podiatrists insist that a joint fusion is better than a toe amputation? I mentioned this to my podiatrist and he said that I would have to go to South America to have an amputation done. Why? I have read that people who have amputated toes learn to balance and they can walk, run, and dance. I think that that is more believable than the claim that you can do those things when you've had a joint fusion. An amputation seems much more functional than a fusion. Have you ever heard of having an amputation for end-stage MPJ arthritis?
My podiatrist hasn't mentioned the allograph replacement, nor has he answered my many other questions. I feel like I am supposed to just give up on an active life and succumb to a fusion. I am seeking a second opinion in a few weeks.
Any information about this would be so appreciated.
I have just been to the hospital to get on the list to have fusion surgery on my left big toe. Although I still have a little movement left, it is very painful. I had my right big toe fused over 3 years ago, and it has been marvellous. Being free of pain after 10 years of suffering was brilliant. I was a bit concerned about losing some of the length on my big toe, but that is a small price to pay. With hallux rigidus I had a restricted lifestyle, not being able to wear high heeled shoes and suffering a swollen foot after too much walking or dancing. I still have to wear "sensible" shoes with low heels because of the fusion, but I can walk, run, dance for as long as I like. Not so much lately, however, because of my other toe, and I feel I must get it done otherwise it was a waste of time having the right one done! If both toes had been as severe as my right one at the time I had the last surgery, I think I would have had them done at the same time. It means 6 weeks of sitting with your feet up, but it's worth it for a lifetime of freedom to get about without pain. However, I am not a runner so cannot really comment on how the surgery would impact on speed, but a good quality trainer should make it possible to still get up a good speed. I can't wait to be totally pain free.