This is a nice review of current thoughts from the surgical standpoint on Hallux Rigidus. I am remiss at telling my patients what stage they have, and the article makes distinctions between Stage 1, 2, 3, and 4. I believe the conservative treatment in Stages 3 and 4, the so-called surgical stages could probably be better, with less going to surgery. I do not have a magic formula, but have so many patients in these phases who are trying to avoid surgery, especially if fusions is their only option offered. This article does give a valid argument towards joint replacement before fusion, which I am happy they considered this.
Showing posts with label Hallux Rigidus Surgical Options. Show all posts
Showing posts with label Hallux Rigidus Surgical Options. Show all posts
Friday, January 23, 2015
Sunday, September 29, 2013
Hallux Rigidus: Great Comments from patient after Joint Fusion
Male, early 40s and I take exception with opinions above steering people away from certain treatment. I started in orthotics for a while, then bilateral chielectomy in 1999 for Hallux Limitus, eventually progressed to minor Hallux Rigidus. Again, chielectomy got me by for 2 years before little was left for joint space, along with arthritic bone surfaces.
Tried arthroplasty on left instead of fusion. It failed due to quick return to arthritic bone surface that shredded the tissue. Fused shortly after, then once that was stable enough, fused the right at the end of 2012.
This year I've had a sesamoid removed in the right, opted to increase the angle of the fusion in left due to some hip/back pain and general discomfort of the toe in shoes. I'm weaning out of the walking boot now, but showing signs of sesamoiditis already. My guess is I'll just have that removed and not drag out the process any further.
I've had 9 surgeries, and I will state with extreme confidence that if you take the usual 7-10 initial days of recovery IN BED with foot up, you'll be far better off. Toughing it out or playing hero by going back to work in 3 days, slows healing and greatly increases risk of infection and injury of vulnerable foot... won't fool your doc at all either. They know when you push it.
I was a U.S. Marine... I can push myself physically and mentally. But I know enough NOT to push. What's the benefit of pushing? None... except maybe to your employer. It's NEVER acceptable for your health to be less than top priority for you and even your employer when you end up in surgery again... less productivity long-term, etc. Of the 7 my current surgeon has done, he called me out on #4. I went back to work at 6 days, 3 days sooner than any other and he knew it before I said a word.
I have no hesitation about surgery if needed. I have a fantastic surgeon, ask every question I can think of and accept answers I may not want to hear. Consider your situation honestly and do what is recommended by the doctors. The recommendations aren't guesswork.
I suggest the opposite of a gal above. DO consider fusion or other procedures, but only a good fit for your condition, your surgeon's preferred course and all post-op aspects of the process. Ask about what's next after surgery. What option are if something doesn't go as planned. It can and does happen, and having a plan you and your doc agree upon is vital. Don't focus on future problems, but do talk about the possibility. Non-union of a fusion after you went out golfing on day 4 is on you and if you have a plan for complications, everyone moves forward. My surgeon actually had such a patient. Next initial post-op visit, I walked in using a 3-iron as a mock cane. :)
Oh, and shoes are often a question here, as well. For me, hands-down, New Balance with plenty of width. Do not skimp on width! You'll get used to and treasure it very quickly. Even then, the exact same model/size can differ between pairs. Finding what works consistently does take time, and likely won't be a $29 pair of cheapo shoes. Pain relief is worth time and money for me, though.
The local New Balance store lets me mix and match from boxes of same size/model and gives me 7 days to walk in them because they know I'll be back next time. Even a 1/8" tilt difference due to slight tweak during manufacturing of two otherwise identical shoes makes all the difference in knee/hip/back soreness. As shoes age, they stretch in different places, as well. Do not discount this aspect of your treatment and recovery... you do so at your peril.
I'm a lurker, but a fan, Dr. Blake... keep up the great work, and your participation in discussions here is valued far more than you realize! Without it, the site is just a place for you to opine and others to talk about you, usually in the negative, benefiting nobody. Because of your willingness to be involved, I have sent two your way, one a happy cured patient, the other currnet and they are very pleased, as well.
Tried arthroplasty on left instead of fusion. It failed due to quick return to arthritic bone surface that shredded the tissue. Fused shortly after, then once that was stable enough, fused the right at the end of 2012.
This year I've had a sesamoid removed in the right, opted to increase the angle of the fusion in left due to some hip/back pain and general discomfort of the toe in shoes. I'm weaning out of the walking boot now, but showing signs of sesamoiditis already. My guess is I'll just have that removed and not drag out the process any further.
I've had 9 surgeries, and I will state with extreme confidence that if you take the usual 7-10 initial days of recovery IN BED with foot up, you'll be far better off. Toughing it out or playing hero by going back to work in 3 days, slows healing and greatly increases risk of infection and injury of vulnerable foot... won't fool your doc at all either. They know when you push it.
I was a U.S. Marine... I can push myself physically and mentally. But I know enough NOT to push. What's the benefit of pushing? None... except maybe to your employer. It's NEVER acceptable for your health to be less than top priority for you and even your employer when you end up in surgery again... less productivity long-term, etc. Of the 7 my current surgeon has done, he called me out on #4. I went back to work at 6 days, 3 days sooner than any other and he knew it before I said a word.
I have no hesitation about surgery if needed. I have a fantastic surgeon, ask every question I can think of and accept answers I may not want to hear. Consider your situation honestly and do what is recommended by the doctors. The recommendations aren't guesswork.
I suggest the opposite of a gal above. DO consider fusion or other procedures, but only a good fit for your condition, your surgeon's preferred course and all post-op aspects of the process. Ask about what's next after surgery. What option are if something doesn't go as planned. It can and does happen, and having a plan you and your doc agree upon is vital. Don't focus on future problems, but do talk about the possibility. Non-union of a fusion after you went out golfing on day 4 is on you and if you have a plan for complications, everyone moves forward. My surgeon actually had such a patient. Next initial post-op visit, I walked in using a 3-iron as a mock cane. :)
Oh, and shoes are often a question here, as well. For me, hands-down, New Balance with plenty of width. Do not skimp on width! You'll get used to and treasure it very quickly. Even then, the exact same model/size can differ between pairs. Finding what works consistently does take time, and likely won't be a $29 pair of cheapo shoes. Pain relief is worth time and money for me, though.
The local New Balance store lets me mix and match from boxes of same size/model and gives me 7 days to walk in them because they know I'll be back next time. Even a 1/8" tilt difference due to slight tweak during manufacturing of two otherwise identical shoes makes all the difference in knee/hip/back soreness. As shoes age, they stretch in different places, as well. Do not discount this aspect of your treatment and recovery... you do so at your peril.
I'm a lurker, but a fan, Dr. Blake... keep up the great work, and your participation in discussions here is valued far more than you realize! Without it, the site is just a place for you to opine and others to talk about you, usually in the negative, benefiting nobody. Because of your willingness to be involved, I have sent two your way, one a happy cured patient, the other currnet and they are very pleased, as well.
Sunday, March 10, 2013
Hallux Rigidus: Wonderful Review of Surgical Options
I practice in an area where many of the top surgeons prefer fusing an arthritic big toe joint called Hallux Rigidus. But, there are options out there that I hope these 2 links give you some reference point. I am not a surgeon, but in the hundreds and hundreds of Hallux Rigidus cases I have seen, most patients are avoiding surgery. Those who need surgery have to look for a recommended 3 surgeons to honestly discuss cheilectomy (joint clean out), shortening osteotomy of the first metatarsal, joint replacement, intra-positional arthroplasty, and joint fusion (arthrodesis). There are definite camps of preferences. You need a surgeon who is skilled in all of these and knows the subtle differences and where your joint fits into this schema. You don't want to hear "I always do it this way". I do try to live in that ideal world. Fantasy???
http://lowerextremityreview.com/article/assessing-alternatives-to-first-mtp-joint-fusion
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=1958
http://lowerextremityreview.com/article/assessing-alternatives-to-first-mtp-joint-fusion
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=1958
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