The SPECIALIST'S OFFICE => Rheumatoid Arthritis (and its variants) => Topic started by: huntingandmoon on January 13, 2011, 09:00:49 PM

Title: Kellers Bunionectomy vs Toe Fusion
Post by: huntingandmoon on January 13, 2011, 09:00:49 PM

I've been suffering with terrible pain in my left foot, especially the first few steps.  I went to a DPM who did an injection into the area and told me to use Voltren gel 3x a day.  I went for my follow-up appt. and told him the injection didn't do anything to relieve the pain.  He took new x-rays and said since the injection didn't help I probably have Hallux Rigidus.  Surgery is the only option and suggested a Keller Bunionectomy. He said the joint implants for toes don't last very long and he's not a big fan of fusion so the Keller procedure is what he would do.

I'm concerned because I've had both knees replaced with less than an optimal outcome.  I worry that any "fiddling around" with my toe would through off my gait but the toe pain isn't helping my gait either.  Have any of you had the Keller procedure done?  Are you glad you had it done?  What was the recovery like?

Thanks for your time - stay well!

Title: Re: Kellers Bunionectomy vs Toe Fusion
Post by: Lottiefox on January 16, 2011, 10:19:58 AM
Hi there

I too have Hallux Rigidus (both toes affected but the right one is the most troublesome, it has more pain on flexion). The left foot has a larger "bunion" but little actual arthritis in it. The right has a small hallux valgus deformity but pretty bad arthritis around the joint (dorsal spur). I saw a foot and ankle consultant who suggested a big toe fusion, or else a scope to clean out the joint, try and restore motion but leave the bunion deformity as it is.

Its a tough call. Is the Keller op the one where the toe joint is left "floppy"? With a space between the joint surfaces? I have heard fairly mixed reports of that although if you are not overly active/fond of walking/sporty it can be a decent option. I'm a part time fitness instructor and my foot man said he wouldn't do it for me. He said fusion would not affect anything apart from sprint starts (ha ha ha I can't run for a bus due to my kneecaps so thats not an issue!). He gave me details of two younger people he'd done fusions on to chat with but my foot settled and I haven't done it yet. I am sure it does affect gait slightly, but if your joint is really sore and not flexing fully anyway you are adjusting your gait anyway, probably with more damage.

Anecdotally I know of someone who has a fusion on their big toe, through injury rrather than choice. As I see it, they do EVERYTHING and more us people with bendy toes do! VERY active and sporty.

I think, to be honest when my time comes I'll go for fusion and hope it works. I don't want multiple foot surgeries and if I get anything done, I finally want a straight foot with no chance of the bunion coming back and the arthritis back!

Honestly, joints. Who'd have them!!

Good luck and keep us posted

Title: Re: Kellers Bunionectomy vs Toe Fusion
Post by: huntingandmoon on January 17, 2011, 12:24:37 AM
Hello Lottie,

Thank you for your reply.  I am 62 years old and fairly active, although not as much as I would like because of the darn pain in my foot/toe and an instability problem with my right knee.  I'll be seeing my DPM tomorrow afternoon for a follow-up on the x-rays he took last week.  I have a list of questions for him, one of which is my concern about that floppy toe I read so much about.  I have also heard there is less of a push-off force with the Keller procedure, more to worry about.  I will make sure he is absolutely aware that I am active and have no intention of spending the rest of my life in front of the TV all day and night!
I really to be sure that the Keller procedure is the best for me and my life.

I'll post after the visit....

Title: Re: Kellers Bunionectomy vs Toe Fusion
Post by: Lottiefox on January 17, 2011, 10:03:34 PM
Hi Diana

Why is he so against fusion? One other thing to ask about the Keller - it apparently can shift too much stress and force onto the second toe. O had a new client referred today (I'm a rehab psychologist) and interestingly he had a Keller some years back and now has a severe hammer toe on the second metatarsal. (That isn't why he has been referred to me!! Thats an incidental!). I would certaibly ask about that possibility too.

From my OS's viewpoint the fusion preserves activity, does take 5-6 weeks to fuse and of course, if it doesn't fuse can cause problems along the way. But, with decent shoes on (not high heels!) it shouldn't make too much difference. I do wonder about activity such as walking on sand - but I find that painful now, so I'd have to just strap it up!

Good luck and keep us posted

Title: Re: Kellers Bunionectomy vs Toe Fusion
Post by: huntingandmoon on January 19, 2011, 02:27:22 AM
Hi Lottie,

My doctor walks in the room and says "here's my mystery patient".  He put up the x-rays and shows me my big toe has plenty of cartilage and no decrease of bone.  There is a spur and I have a bone anomaly (where there should be one bone there are two separate small ones) that I was probably born with.  So, no Kellers bunionectomy, fusion or joint replacement instead he will do a simple chielectomy (sp).  He will also address a lumpy bone on the top of my foot - will  take it down a bit and smooth it out.  I have an issue with my pinky toe and the guy next to him that he will take care of.  He also said my biggest problem will be with swelling. I'm looking into getting hot/cold therapy booties.  I'll have to wear those rocker shoes for 2 weeks then go into a sneaker. 

So, I'll be having four issues taken care of in one trip to the OR, thankfully it will be done on an out-patient basis with a local and sedation.  I don't have the date as yet but I'm hoping it's not to far away.

Take care of yourself and I'll let you know how things turn out!

Title: Re: Kellers Bunionectomy vs Toe Fusion
Post by: La Paz on June 28, 2011, 09:26:07 PM
Hi Diana, I have read some of your posts and would like to ask you a few questions.  I am struggling right now with a similar problem like you.  I had bilaterals done in Feb 2010 and now 16 months later the right did not heal correctly and is unstable due to soft tissue balancing and possibly the spacer is not thick enough.  I too like you was knocked knee.  My original surgeon kept telling me to give the knee more time but I knew something was not right as it was not getting strong and I would have pain when doing any activity.  I went for a second opinion and the doctor ordered a bone scan and blood tests.  The bone scan just completed shows a little possible loosening that the doctor feels is only secondary to the looseness in my knee.  Did your knee feel like spaghetti?  Where you in constant pain?  When did you start having the problem?

I read here that the thicker spacer did not correct the pain.  Did it correct the looseness?  How was that surgery?  My doctor says it is a short surgery that has a quick recovery.  Is that so?

I plan to get a third opinion but for now I am waiting for my doctor to make his final evaluation.  I live in Mexico and don't have USA insurance so I went to India to have the surgery.  Now I have found a doctor from Tijuana I am using.

I too have had a numbing in the bottom of my right big toe and sometimes it travels through my foot.  I have read it is a nerve in my spine which may be pinching and then I read about the nerves on the outside of the knee that can be damaged during knee replacement.  In the meantime I am doing more stomach and back exercises to help my spine.

Hope you can answer my questions, Nancy