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Medical Forum / Diseases and Disorders / Arthritis / April 2006Hallux Rigidus Surgery
I'm only 30 years old and have moderate/advanced Hallux Rigidus on my right foot. After seeing the orthopedic surgeon today he recommended surgery, otherwise it will get worse and the bone growth(spurs) will continue on top. I am pursuing a career that is physical in nature (military or firefighting) and am hoping for a positive pain free outcome that will allow me to continue with physical fitness, hopefully including running. He said there are basically 2 options. The Chielectomy or Fusion. He said that he doesn't really like the Chielectomy for long term pain relief and that my case is a little more advanced. He said I could try it, but possibly have to come back for a fusion, or he could do a judegement call at the time of operation. The fusion will result in long term pain relief. However i'm a little concerned with how i'll be able to function after. Has anyone had either of these procedures? What were the outcomes? Will I be able to run after the fusion? Will my toe/foot compensate for the lack of joint movement? Should I look for an alternate career that is less physical? Thank you. >I'm only 30 years old and have moderate/advanced Hallux Rigidus A shot of penicillin will clear that right up. I had this surgery in December, I didn't have the fusion. I left that decision to surgeon at the time of the surgery. I've been working out on an elliptical machine since three weeks after the surgery but it's much to early to know if I'll be able to run again. I have talked to several people who have been able to run and play basketball. I returned to my job as a railroad conductor seven weeks after and haven't had major problems with walking on rough surfaces. Watch this newsgroup instead of cross posting to several and Walt might be along to offer advice, he's the resident expert on foot problems. Cooly > I'm only 30 years old and have moderate/advanced Hallux Rigidus on my > right foot. After seeing the orthopedic surgeon today he recommended [quoted text clipped - 20 lines] > > Should I look for an alternate career that is less physical? Thank you. hey thanks for the replies. Hopefully Walt will be around! I don't understand, the pain isn't always there. I just went out for a brisk run and no pain during the run or now. I'm hoping that a simple chielectomy will be sufficient. I should hear back from the surgeon soon as to the result of the xrays. I am worrysome about a fusion as I want to be able to run! The artificial joint the surgeon said is not very promising due to the amount of force the joint takes on a daily basis. It's more geared for older folks I believe. My fingers are crossed. I have worked so hard and invested so much time (3 years) and money ($30k) into this career to be held back by something as small as a toe! Well, talked to the surgeon today re: xrays. He said it's pretty advanced arthritis and less than 50% cartilage so he recommends the fusion. I'm still a little skeptical because I know this surgeon pushes surgeries. Honestly, today (a day after my run) i don't have any pain...I don't understand why. So he said I could just leave it, but that it will get worse. Or I can choose cheilectomy, and if that isn't successful accept more downtime and do the fusion as a last resort. OR he said I could just leave it up to him at the time of surgery because he'll be able to see more when he opens it up. I'm not sure what i'm going to do yet. For now i'm not rushing anything because it's really not that sore and I want to research some more. Any advice is greatly appeciated. > Well, talked to the surgeon today re: xrays. He said it's pretty > advanced arthritis and less than 50% cartilage so he recommends the [quoted text clipped - 11 lines] > > Any advice is greatly appeciated. Hi,,,,, I think I would do the same as you. If it were your hip or your spine, sometimes a person can wait too long and cause too much bone loss or the fracture with pressure on the nerve truck. That is what happened with my mother's back and after the operation she wished he had it done 10 years before. Harv Thanks for your reply. I don't understand, the pain isn't that bad. I just came back from more fitness and light jogging. NO pain whatsoever during the run. Now I am moving my toe up and sure the flexibility isn't there completely but no pain. If anything, I think I might try the cheilectomy first because maybe it's not as bad as the doc says. Maybe they push these surgeries too much? I'm very apprehensive about the fusion still. > I'm only 30 years old and have moderate/advanced Hallux Rigidus on my > right foot. After seeing the orthopedic surgeon today he recommended [quoted text clipped - 20 lines] > > Should I look for an alternate career that is less physical? Thank you. This is a great link that explains hallux rigidus and treatment options: http://www.allaboutmydoc.com/surgeonweb/surgeonId.2729/clinicId.1432/theme.theme 3/country.US/language.en/page.article/docId.22009 It sounds like your doc didn't offer you joint replacement, maybe because he doesn't perform that surgery, or maybe because he thinks it's a bad idea for you. Scroll down in the link to read about it. There's a nice diagram that explains how the artificial joint works, how long it lasts, etc. Joint replacement would preserve function, but you'd probably have to have the surgery repeated because the artificial joint will wear out and need replacing. Good luck, --Patti Well, I'm scheduled for cheilectomy in a couple of months. The surgeon recommends fusion since he says my cartilege is in an advanced stage but i'm apprehensive about the fusion when I need to be very active for future career goals. Furthermore, i've been taking quality fish oil for about a month, working out pretty hard (running, stepper, weight lifting etc) and I don't really have any pain anymore! I guess it takes the inflamation down. So now i'm thinking about cancelling the surgery...but i'm not sure. The only limitation I have right now is range of motion. Any advice? >Well, I'm scheduled for cheilectomy in a couple of months. Since when do they schedule those? Aound here, they just shove a garden hose up your arse, turn it on, and when you can't hold it anymore that's it. Then you pay them $40. > Well, I'm scheduled for cheilectomy in a couple of months. The surgeon > recommends fusion since he says my cartilege is in an advanced stage [quoted text clipped - 10 lines] > > Any advice? I don't think advanced cartilage breakdown would prevent you from getting a joint replacement. They remove all the cartilage and both of the bony surfaces in the joint replacement surgery. Did your doc tell you joint replacement was the wrong choice for you because of the stage of your cartilage? No, he said it was the wrong choice because he doesn't do it (or recommend it anyway) due to the fact that they are not durable/reliable and need to be replaced after an extremely short time. Apparently they are designed for more sedentary or older individuals. Have you had one implanted? > No, he said it was the wrong choice because he doesn't do it (or > recommend it anyway) due to the fact that they are not durable/reliable > and need to be replaced after an extremely short time. Apparently they > are designed for more sedentary or older individuals. > > Have you had one implanted? Nope. I found another link that agrees with your doc. You'd think if they can make an artificial knee that lasts around 20 years, they could do better with a toe, but I guess that shows what I know. http://www.blackburnfeet.org.uk/hyperbook/conditions/hallux%20rigidus_backgr.htm Well, I don't know what's up but I don't have any pain whatsoever. I've been taking about 5g of quality fish oil per day in addition to other sources of quality Omega 3 EFA's from fish and nuts. I eat extremely clean and strict. I'm curious if I actually have more cartilege left and a better joint than the doctor is leading me to believe (afterall surgery is his livelihood). I suppose my symptoms have been less and less until they have no disappeared since I stubbed my toe real bad last Sept. I guess the body has a remarkable sense to heal itself and the only problem are the bone spurs which don't hard but limit the range of motion which doesn't seem to bother me. At this point i'm thinking of cancelling the surgery and going on with my life and moving forward with my career. If the pain comes back then i'll have to deal with it at that time. This almost feels like a miracle! I highly recommend fish oil for arthritis and joints...give it a few weeks and you'll see for yourself. > Well, I don't know what's up but I don't have any pain whatsoever. > I've been taking about 5g of quality fish oil per day in addition to [quoted text clipped - 13 lines] > This almost feels like a miracle! I highly recommend fish oil for > arthritis and joints...give it a few weeks and you'll see for yourself. If it hurts again... A cheilectomy and joint distraction with extrenal fixation is also a great option. All damaged cartilage / raw bone can also be made to bleed with a K-wire, which will cause a pseudo-joint to form while the joint is distracted. Once the external fixator is removed, the joint appears narrower on X-rays, but the function of the joint is improved. If the joint is really bad... the new KMI hemi implants are promising. The older implants popped out, or became useless in one way or another.... The gold standard for a bad rigidus is still fusion. And with fusion, will I really be able to be active, do sports, and have normal gait. I have heard mixed things on this...some say running is no problem, other says I will need a rocker type shoe to walk normal! Plus i'm guessing much more strain on other joints in the toe. This is a tough decision for me...but the pain is pretty much gone. I can only occassionally feel something (and it's not even really PAIN per se) on the bottom of the joint when I walk with a specific shoe. And it seems exercise is ok and even helps loosen things up. Could the xrays not be as accurate as the doctor thinks? Sure I don't have the flexion but it doesn't seem to be a big deal to me. >And with fusion, will I really be able to be active, do sports, and >have normal gait. I have heard mixed things on this.. Do NOT let them cut you. It is a major mistake. Really? WHY?? Please elaborate. >Really? WHY?? Please elaborate. Common sense. Do not let them cut you. well I wish you could explain more, but I do understand that surgery is a last resort. I have been meaning to get my weight down some (i'm 210 presently, and want to get down to 200), so i'll do more cardio and circuit training instead of bodybuilding (weight lifting). It's weird...sometimes it feels great, but also at times when I walk I can feel it in the bottom of the joint, which leads me to believe that cheilectomy would do absolutely nothing since the pain isn't in the bone spurs (bunion). Even with the fusion, I think it hurts just if I put weight on it with the joint not even moving so the fusion might not do squat. Right now i'm heavily leaning toward no surgery and just keep taking the fish oil with a clean diet (fruits/veggies) and rehab it naturally. But then I think about my future career goals and want this out of my mind permanently. Today the pain while walking returned. Coincidence that I ran out of fish oil on the weekend? Or maybe due to doing some wind sprints yesterday. I am now starting to think that surgery is the only option. I have to get rid of this problem as it's holding back my life. I'm thinking i'll let the surgeon decide what surgery to do depending on the cartilage remaining - but leaning toward the Fusion as I don't want to have anymore discomfort. I'm also starting to pronate alot (my foot rolls in) and ball of foot is hurting more. This sucks! Furthermore, i've been taking quality fish oil for about a month, working out pretty hard (running, stepper, weight lifting etc) and I don't really have any pain anymore! I guess it takes the inflamation down. So now i'm thinking about cancelling the surgery...but i'm not sure. The only limitation I have right now is range of motion. Any advice? ~ msamson11975 Keep it up! Delay surgery. For range, try some light yoga, the sunrise sequence of 7 or so positions is good. 20 min worth, check out yoga.com for some good tips. Keep the weights light so you don't add weight on your bod, that x-training is good. Fresh fruit and veggies also reduces inflammation, eg, Mediterranean Diet, lowering C-reative protein. |
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