The SPECIALIST'S OFFICE => Rheumatoid Arthritis (and its variants) => Topic started by: wofford99 on July 30, 2006, 02:46:47 AM

Title: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: wofford99 on July 30, 2006, 02:46:47 AM
Hi everyone-
I have severe arthritis in my knees which has required 15 knee surgeries including bilateral patella realignments.  I'm age 29 and now I have bone spurs that have developed around my 1st MTP joints (big toe joints).  This is formally called hallux rigidus. I'm not able to pull my big toes up due to spurs. The cartilage is now wearing off at the base of my big toes.  My foot surgeon has decided surgery can't wait any longer.  In a week, I'm having the spurs shaved off my left foot and my 1st MTP joint realigned and fused.  My big toe will be permanently pulled a little upwards.  By fusing the joint, it will save the cartilage that's left.  I'll be in a walking cast for a few weeks. 
  Have any of you had this surgery or have bone spurs in your feet? I'd appreciate any advice!! Thank you so much! Margaret
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: windbarb on October 03, 2006, 09:36:24 AM
Hi Margaret!

I see that this post is old, but I'm an old-timer on the board here who just returned and saw this.  I fell down the stairs in 1/04 and did some pretty significant damage to the 1st MTP (base of the big toe) joint.  My surgery in 11/04 smoothed out a bone spur, smoothed the edge of the articular cartilage that had torn away from the trauma of the fall, and did a microfracture in the cartilage hole to help it smooth out.  Should that fail, fusion is the next alternative.  So far, the surgery was definitely a help, but X-rays of my foot show arthritis in the joint (I'm in the process of being evaluated for RA).  I'm curious about how your surgery went, how the recovery has been, and what it feels like to have a fused joint there.  Thanks!

Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: wofford99 on October 04, 2006, 06:35:44 PM
Hey Barb-
thanks for the reply.  I just returned from the foot surgeon.  I've had a heck of time since my surgery on August 9.  The surgeon took bone spurs off the 1st MTP (big toe) joint then did a wedge osteotomy because I had no cartilage on the metatarsal head.  So, with the osteotomy, he moved the metatarsal head up slightly and put my big toe at a 15 degree angle to keep me from losing bone.  unfortunately, due to poor technique he broke the medial sesamoid bone that is critical for gait and foot alignment.  I switched surgeons last month and am now in PT and having weekly appts with my new surgeon who is wonderful.  He said the only way to salvage my foot now is to do a replacement.  Pt is very painful due to breaking up scar tissue.  the Foot and toes have many nerves.  I've been in a boot for 2 months and will be for 2 more months.  I just turned 30 and have also had 15 knee surgeries.  The doctors now think I have some aytpical form of rheumatoid arthritis. My advice to anyone having foot surgery is to ensure you understand all the risks and benefits of the surgery and you have a good surgeon.  Margaret
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: tjh on October 07, 2008, 06:14:45 PM
I had my big toe fused 2 years ago and I wish I had never done it!  I work in an office environment and must wear suits and dresses.  Do you know how hard it is to find a decent pair of shoes with no more than 1 inch heal that looks nice with suits?  I absolutely hate shopping for shoes!  I can't kneel down since my big toe won't bend.  Because of the toe being fused it has caused me to walk on the outside of my foot which caused the next problem.  I ended up having another surgery to remove the neuroma between my 3rd and 4th toe.  So now I don't have any feeling there without the nerve.  Makes cutting toe nails a little difficult!  I've cut my toe a couple of times because I have no feeling there.  It's now been a little over 2 years and my foot is hurting just like it did in the beginning.  I would never recommend toe fusion to anyone.  Anyone have similar problems - any suggestions?  I sure won't listen to my podiatrist anymore.
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: scl on May 28, 2009, 03:55:41 AM
I just found this site, and wasn't sure if anyone is responding to the question
about fusing the big toe joint.  I have seen 2 podiatrists, and have been told that
I'm headed for fusion.  Anyone out there care to respond?  Successful or not?
Would really appreciate hearing.
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Redtrek on April 05, 2010, 08:40:16 PM
Hi Wofford99,
I'm new to this site, but when I read your summary, I felt like there is someone else in this world going thru what I am going thru. Our situations aren't exactly the same, but there are a lot of similarities. I had my first surgery about 3 years ago and the quack-podiatrist took out the joint of my big toe and replaced it with a titanium one. My body rejected it and I got an infection in my foot. I had more problems after that than I did with the bunion I originally had.

After a year and 1/2, I went to 2 different orthapedic surgeons, and both couldn't believe what a mess my right foot was.† My second surgery the doctor removed what the pod and done, shaved bone from my hip and basically fused the bones together to give me a big toe. To be honest, I wish I had never even touched my foot.

Now my right foot is somewhat cosmetically ok, but I can't bend my toe (forget lunges, calf raises when I'm working out). It's been almost one year since the second surgery and I'm still in pain, foot is still somewhat swollen and if I'm in sneakers too long, or walk too much, I have to come home, take off the shoe and soak my foot in the tub. I use yoga toes, which make it feel better, but not by much.

I'm so unhappy with my right foot, the only way I would have anything done to the left would be is someone paid me a lot of money. Otherwise, forget it. I would give advice to anyone thinking about this surgery to think twice and PLEASE get a second opinion before you go under the knife. I wish I had gotten a second opinion myself, before I went to the pod. I actually looked into malpractice but it's a lot harder to prove than you think.

Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Elveerah on May 27, 2010, 11:49:52 AM
After suffering for the last 20 years with a slowly deteriorating left big toe joint (due to genetic elongated metatarsal bone) I have been advised to go for the fusion option. I still have mobility in my toe (though not upwards) and the biggest problem for me is the bone spur which makes buying shoes a nightmare.  I've been told that the joint is severely arthritic and there is little or no cartelidge left. I am very wary of this operation and am very reluctant to go for the surgery.  It has made me really very depressed as I have always been a very active person bu the thought of not being able to kneel down anymore fills me with horror.

From some of the kind replies here, I gather that anyone who has had this operation is in fact more disabled than before the surgery.  Can anyone let me know if they would have gone for the bone-shaving and then orthotics instead. Or no surgery whatsoever and just relying on orthotics?

I'd appreciate any suggestions including from the medical profession.

Thanks, Elveerah.

(I am in my mid-40's)
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Lottiefox on June 01, 2010, 11:49:06 AM
I can't comment on what it is like afterwards but big toe fusion has been suggested for my right foot too. I have a range of options from injection, chielectomy (debridement and removal of the dorsal bone growths) or straight to alignment of the joint and fusion. X-rays indicate some loss of joint space although not complete and lots of bone spurring. I have OKish ROM without weight, but on weight bearing my bend upwards is limited by the spurs. Pain fluctuates from nothing to someone drlling my toe joint open at night, and heels are out. My OS (a specialist in foot and ankle reconstructive surgery and lead in a big private practice) assures me that fusion brings good results if the toe is fused at the right angle (with some flexion to allow normal heel to toe movement when walking) and I will only be restricted from high heels and sprint starts. The latter is what puts me off - I am not a sprinter but in my fitness work i do activity such as push ups, planks, yoga positions....these all need some big toe flexibility.

So, I too am undecided. Logically - perhaps start with the lesser op, use the orthotics, do PT to help the ROM and pain and see how it goes. No turning back after a fusion....but if you've got severe pain then many people would say fusion is the way to go. No more bone on bone pain!

Lottie  :)
Title: Re: Hypermobile joints- Surgery to fuse all toes- anyone else had this?
Post by: Elisbetta on July 29, 2010, 07:07:13 PM
Would love to hear from anyone who's had more than one toe fused. I suffer with hypermobile joints and have wrists and thumbs fused already. I've now been told that I need all my toes fusing on both feet to allow me to continue to walk. They all dislocate every time I walk and are quite painful. the only comments I can see are from people who have had only there big toes fused.

Can anyone advise what there recovery times have been etc.


Elisbetta† † † † † †:D :D :D
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: mike55 on September 20, 2010, 03:04:41 AM
It's been 7 years since I had knee surgery. I don't really know how I had my ACL torn because I had three different accidents between 1993 and 2002. It was in 2002 when I was actually told that my ACL was torn by a hospital doctor. I went to see two more surgeons who had different opinions, one told me I needed no surgery just therapy, the second one said I needed surgery just to clean the cartilage or the knee. The hospital doctor had said that I needed to have my ACL repaired with one borrow from a cadaver. I was confused with the three opinions and I went for the one in between. Bad luck! The doctor messed up my knee. I could not walk right for three years, and when I went to see another doctor, a physicial medicine doctor, he said that nothing had been done to me knee and he confirmed that my ACL was torn ( which I had refused to believe). He explain the two options left : do the ACL repair or therapy. I chose to do therapy in my house with my own equipment since I had already been to the routine. This helped me walk more or less right but I could place all the weight of my body on my right knee ( the one with the problem). So I resulted with the big toe damaged. I now have a spur, almost no cartilage, tremendous pain when I walk, so much so that I develope a weird gait. I went to see three different podiatrists who again gave me three different opinions: fusion, replacing my cartilage with a plastic one, and I cannot remember the other opinion. I have been thinking about the surgery but I belive I will do neither because I see that I might end up losing my foot. None of the doctors were willing to provide names of patients for me to inquire about the results. So I am suspicious and I think that with your comments, now I am more than sure that I will not have my big toe touch by no doctor. I will bear the pain and continue with my weird gait because I see that I have no choice left.
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Lottiefox on September 20, 2010, 03:45:56 PM

If you have pain with every step then I would not be dismissing surgery, especially if you are an active type. My big toe has little remaining cartilage and a spur but after a  big flare up it has settled down, so long as I wear the right kind of shoe. At some stage it will need sorting out though, and that will likely be a fusion. It sounds like you've been given options of fusion, replacement joint (these are not highly regarded for the big toe as they wear out very fast and can affect future options) and possibly a chilectomy which is cleaning up the joint and reshaping the bone heads. This can be OK, it depends on the level of damage you have. It won't get rid of the arthritis though, only fusion will do that.

It is highly unlilely you'd lose your foot after a surgery. Obviously your health impacts on something like a fusion - if you're fit, don't smoke, eat well and do the rehab then you stand a better chance of a successful fusion and recovery. Choose your surgeon wisely, I would got for an ortho doc not a podiatrist. The angle of fusion is critical for future success. My surgeon has provided details on previous patients who have had success, and there is another member on here who's partner has a fused big toe as a result of an accident and pinning. They are extremely active and fit. Every surgery is a risk but I am sure with the right surgeon and the right rehab which you follow to the letter, a big toe op can be very successful. Pain on every step is depressing and when mine got to that stage I was ready for the op..

Good luck with your choices.
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Todtotty on September 28, 2010, 03:58:51 PM
Hi everybody, this is a success story about a big toe fusion.  I admit to having far fewer problems than some of you, having suffered only with osteoarthritis in my right big toe for years, but by the time I had my op I could hardly do any exercise longer than 20 minutes without dosing myself up.

Iím 58, weigh 10 stone and love cycling, modern jiving and walking but early this year I was finally having to take painkillers and anti-inflammatory meds just to do half of what I had been able to do previously (and desperately wanted to do again) so I did an internet search to find an osteo and trauma surgeon with a good reputation who specialised in foot surgery.  You can now ask your GP to refer you to the hospital where the surgeon of your choice works.  (Just for the record, contrary to the course of action some people have taken, I wouldnít dream of letting anybody but a fully qualified surgeon anywhere near my foot!)

Itís now six weeks since I had the op.  Iím back at work today, started driving two weeks ago, have been for a couple of dances, albeit doing only about a quarter of what Iím used to doing.  I could cycle at three weeks after the op (foot doesnít move on pedal so not a problem), I can walk nearly a mile and yesterday I ran for about 50 yards.  I canít kneel down and donít really expect to be able to, but hey, who cares?  Iím very pleased with my result and the only problem I have now is that my foot is still swollen and all my shoes rub the wound, so Iím in sandals and my cycling shoes for the time being. 

I was very careful to follow instructions and spent the first two weeks after the op sat with my foot up and as soon as my foot gets tired now I put it up.  I went to see my surgeon to be signed off two days ago and he said the swelling takes some time to go down, but thatís the nature of feet, isnít it.  I have no pain now at all and am looking forward to when I can get back to my previous active lifestyle.

I was dubious about the op, having read so many bad reports, but I couldnít go on the way I was and Iím so glad I had it done. 

All the best to everybody and I hope you can get your problems sorted out.

Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Lottiefox on September 28, 2010, 07:38:34 PM

Great story. Thank you for posting. I am sure when my time comes for fusion I will make the best of it. You sound like you did everything right - those first two weeks of elevation and rest are essential, as is being a good weight and fit beforehand. I too have sought a specialist foot and ankle consultant as this operation depends on the skill and expertise of the surgeon. Can I ask where you had your op? How bad was the pain immediately after? Did you have a significant sized dorsal spur/spurring on the joint? Thats awesome driving after 4 weeks, were you in a special shoe thing (Podalux will be my footwear of choice!!). Is the lack of kneeling because of the lack of flexion in the toe? that is something that worries me a bit - I am a fitness instructor part time and need to be able to do things like push ups/kneeling. But hey - I am sure it can be worked around when its necessary!

My foot doc said swelling could take up to 12 months to fully resolve, the nature of feet as you say. Elevation and ice will be my friends too.

Thanks again for sharing this, I hope things go from strength to strength for you. No more arthritis pain in that big toe!! Woohoooo!!!

Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Todtotty on October 05, 2010, 02:24:02 PM
Hi Lottie,

I would definitely recommend getting your toe done.† My surgeon was Mr Mark Farndon based at Harrogate Royal Infirmary.† If you're in the south there's a chap called Mr James Calder working at a London Hospital but I can't remember which one.† If you get onto Google and input "orthopaedic surgeon + (where you live)" you should come up with someone.† From there you can get onto and look up the surgeon's experience.

I was surprised to find that I had virtually no pain immediately after the op, but I think this depends a lot on following doctor's orders and keeping your foot up.† (This wasn't a problem, actually, because I felt half dead from the op anyway!)† The wound itself is very tender but the repaired joint has not bothered me since it was done.† The only ongoing problem I have is finding shoes that don't rub the wound, but that will resolve itself when the swelling goes down.†

I had an enormous bump on the top of my foot before it was done, it that's what you mean, and it's been removed.† I was given what I call an ortho-boot, which is a backwards sloping foot support to keep your weight off the toe, for three weeks afterwards.† And actually, when I kneel now I can put more weight on the toe than when I wrote my first post.† As a fitness instructor I think you'll find if you wear a trainer (or in my case, my cycling shoes) with a stiff sole it will support your weight when doing your excercise on your toes.† Also, as I'm doing more I'm finding that my big toe is rubbing on the second toe because one moves and the other doesn't, so this moring I applied some talcum powder between them.† If this doesn't work when I'm fitter I'll probably try a very small plaster on the side of one of the toes - or both.† But, whatever, the pain's gone and that's what counts!

Good luck Lottie, I hope everything works out for you.

Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Andy4 on October 06, 2010, 10:36:06 AM
Hi there everyone,

I'm about to go in hospital November for foot surgery.
I've had R. Arthritis since I was a child. I'm 52 now and its getting really bad. I've worked hard all my life but knew one day I would break down and I suppose its happening now.
I've already had replacement joints in my hand and wrist, fused etc but now its my feet.
I've waited as long as I could before going ahead with the surgery due to work commitments etc (Self Employed for 30 years).
The pain now after a day on my feet is just unbearable.
All toes are affected and badly damaged. I've even got to have bone from my pelvis taken off and grafted onto my toes so there is something to fasten the metal too!
Its as though I'm walking on sharp pebbles constantly.
They are doing both feet together so I'm wheelchair bound for several weeks.
Just wondered if anyone else has been through this extensive surgery and what happened afterwards?
Thanks everyone,
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Lottiefox on October 06, 2010, 01:56:30 PM
Hi Andy and welcome

Sorry to hear about your impending op. RA is no fun, and you've been through it from the sound of it. I can't give personal foot op experience (yet) but my cousin has RA (had it all his life too) and a few years back he had all his toes operated on, one foot involved removing the joints and leaving them kind of floppy and on the oher fot I know he had some graft work done. He was driving in his ortho shoes in 2 weeks!! (This was probably not recommended but he is a subborn one!). I know the recovey was painful but he has NO regrets, his job involves international travel and he now deals with life far better than the constant foot pain he had prior. I think the key with foot surgery is to do things right in those first weeks. Elevate, ice if required and rest. The more you can keep the feet up at first the faster the healing progresses and the less the swelling gets a hold.

Tod - thanks for the info. I have a good specialist foot and ankle OS in Birmingham; he runs the Birmingham foot and ankle clinic after many years heading up the foot and ankle service a the RNOH in Birmingham. he's done the necessary X-rays etc and I trust his judgement and skill. Decent bloke - didn't sugar wrap things but told me honestly what he'd recommend for the path of fewest surgeries. I think Im just scared of never wiggling that big toe again - despite it hurting to wiggle it anyway! I'm curently in a bad flare of the foot pain, so I may be scheduling it for later this year after our hols in November. I bottled it in July and of course, things settled for while. Ive now got real bad pain from the spur on the top of the joint, I think its impinging a nerve so soner or will be chop chop pin...

Good luck Andy - keep us posted on how things go,

Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: coonsanders on October 24, 2010, 10:15:10 PM
hi gang
when i was a kid in camp this stupid horse stepped on my foot...he just put the hoof on my big toe joint for a second and lifed it up...but the damage was done.
im thinking of a fuse.i basically know what to expect except i heard from a lady
who has this toe fuse and she said they dint give any pain pills,,she had to end
-ure all that that true?

Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: marns on November 01, 2010, 09:08:33 AM
Hi,  I had a big toe fusion 5 weeks ago, it has been very much more painful than I anticipated. 

I had hallux rigidus which has been a problem since my early twenties (I'm now 43) and caused knee disalignment, hip bursa, torn tendons and stress fractures.  Most of the damage was caused because I was very active and refused to listen to the GP and consultant when they advised me to moderate my activities.

I'm now in a cast which is due to come off on Friday when I have an xray to see if the toe has fused.  The cast has pretty much fallen off anyway and there is a large hole in the heel area - it's now very uncomfortable and I have a sock inside it instead of the wadding (I'll find that very hard to explain when they come to take if off).

I think that the tendon on my missing toe joint is causing the pain whenver I move my foot, hopefully that will settle down soon.  I'm signed off work for 8 weeks although the consultant said he will extend this, I can't imagine going back soon as I have to wear uniform shoes, drive some distances and walk and kneel a lot (I'm a district nurse).

Wish me luck and I would love to hear any other post op stories I especially liked Todtottys but how on earth can she run and walk so far - I'm still on crutches and can only weight bear minimally on my heel???
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Andy4 on January 31, 2011, 01:19:14 PM
Hi everyone,
I've had the surgery now, it was postponed in November so it was Dec 2010 when it was done. (see my post earlier on this thread). Just up to my 7th week now. All going well apart from irritating tornique wound caused by the hospital.
Pelvic bone graft, to fasten the metal work to, then all new toes fitted, with the big toes plated. Its all gone well really. Looking forward to having my pots off and pins removed this coming Thursday. I then have to start learning to walk properly again... should be fun.
Good luck all,
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Bendy1 on July 12, 2011, 01:43:26 PM
Hi im new to this site but just read your post.
I had surgery 3 years ago to trim spurs off big toe on left foot and second toe on right foot.
I had both feet done at the same time BIG MISTAKE!  It was so so pain full i did say never again
but here i am sat at home 4 weeks post opp after haveing my big toe on left foot foot.
Befor the opp i walked on the outside of my left foot as could'nt put pressure on big toe.
My surgen said the best way was toe joint replacement but when i went in to have opp the joint was too bad so they fused it.
I have a 5 year old so i hope this wiil not stop me running , jumping and having fun with her.
I hope you find your opp  helpfull and do you or any one else have any tips post opp for me.
I am 52yrs young and had childhood arthritis in most joints ,knees mostly.

Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Pugsley on September 10, 2011, 09:41:35 PM
Hello All

Back in February of this year I had a replacement toe joint in my left big toe which went very well hardly any pain after a couple of days and the wound healed nicely.  However after 6 weeks of wearing a surgical boot and back in normal shoes (well flat wide things) I was in a lot of pain each time any pressure was applied to my toe.   After 3 months I had a check up with my consultant advising him of the pain I was still having.  Upon investigation he noticed that I have 2 accessory sesamoid bones in my big toe which were causing the pain.  Even though these bones have been there all my life they have reacted to the replacement toe joint.  I have now had a CT scan and awaiting another appointment to see my consultant as he is not sure of the next step.  Meanwhile the pain is increasing and the left side of my body is out of alignment as I limp when walking and have to make regular visits to my osteopath.  I have put on 1/2 stone in weight and emotionally I am very low as unable to walk at all without severe pain. 

Wondered if anyone was out there who has had the same problems and have now had a fix.

My advice if you are thinking of having a MTP toe joint replacement - DON'T if you have accessory sesamoid bones in your toe.  I was in less pain prior to the surgery. :-[
Title: Re: Arthritis in feet- Surgery to fuse big toe joint- anyone else had this?
Post by: Lottiefox on September 14, 2011, 11:22:18 AM
Is your doc SURE it is the sesamoids causing the problem, not the replacement? I have to say my foot doc won't do replacement big toe joints if you want to be active. He says they are simply not robust enough to cope with the stress they get placed under and quickly fail. I had a 1st MTP fusion in April. I am 42 and fit and active. I have had some complications that have had nothing to do with the fusion itself, and I could not be happier with the fusion results. I don't limp, the toe is fused at a perfect angle for me to toe off and even to wear a low heel, and I cannot feel the hardware. You must get a surgeon who does a lot of these, understands your foot inside and out and can deal with complications should they happen. I can even stand on kind of tip toe, do push ups with weight through the big toe, and walk fast. None of my difficulties now come from the actual fusion!

I'd be seeking a second opinion. I can see why accessory sesamoids may cause issues but I have also read a huge amount about replacement big toe joints causing more pain than they solve....

Good luck. Foot pain sucks, I feel for you,