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Foot & Ankle Problems Message Board


Foot & Ankle Problems Board Index


Hello,
I have certainly learned alot from reading other posts on this board, but I would also like to get feedback on my question of whether to have big toe fusion or the implant.

Both of my big toes have degenerative arthritis, but the left toe is by far the worst. It really got worse when I got a new job (big box retail) two years ago. I saw a podiatrist then and he gave me a note for work and recommended surgery, but the health insurance through work wouldn't cover it. Ten months ago I had to quit that job because I could no longer work on my feet all day and the manager refused to move me to a different, less strenuous department. I am fighting UI for a 'medical quit' determination; I figured my future ability to walk was worth more than minimum wage.

Anyway, that's beside the point of this post. I have been unemployed for ten months and am now so destitute that I qualify for a state program, so I signed up. The first orthopedic surgeon I saw two months ago discussed my options as either a joint replacement or a fusion. She thought I'd be a good candidate for the joint replacement because I am in general good health, am 61 and very active, and I have a high expectation of post-surgery mobility. I told her I would like the surgery in early summer because I felt getting around post-op would be easier. When I saw her again earlier this week to schedule and discuss the surgery in more detail, she told me she was moving to a new city and wasn't taking any new surgery patients. :eek:

She referred me to another orthopedic surgeon at the same hospital and I was able to see him the next day. I thought I was just going to meet a different surgeon who would do the surgery that the first DR recommended. But he was skeptical about the implant and ordered additional x-rays. When he looked at them, he said the two small bones underneath the big toe joint were also arthritic and he felt the implant wouldn't have a high success rate and his recommendation was fusion. He said if he did the joint and [B]it later failed[/B], there wouldn't be enough bone left for a fusion and he would have to go into my hip to get a bone graft for the fusion, which would be a much more complicated surgery and longer recovery. Argh!

I was pretty upset. Why hadn't the first DR told me all this? I had already got my head around the joint replacement, which for someone who doesn't doctor much was no small thing. I also liked the shorter recovery of the implant vs. fusion, since you are not waiting for bone to grow (fuse) and you can do minor weight-bearing exercises right away after the implant.

As I said, I'm pretty active and I'm going back to school this fall so I don't have to work for minimum wage any more. But I'm in constant pain and cannot do many of the things I love to do (like walk my dog) or need to do (like go to school or work.) Even minor house work leaves me in such pain I'm popping Tylenol like mints. I live alone and am generally pretty independent. The prospect of eight to ten weeks of immobility (and not driving!) after the fusion scares me. I am totally confused. :confused:

The second DR recommended I get a third opinion, because I kept pushing him on the implant and he was holding fast for the fusion. He gave me a referral and I agreed, but now I'm not so sure. If DR #3 says implant, who will do it? And do I want to go against DR #2's advice? If DR #3 says yep, fusion, well, there you have it, and I've wasted everyone's time. It feels hard to get straight answers and lay out the pro's and con's of each option.

Re: Fusion vs. implant. Why did you choose one or the other? Did you have a choice? What did your DR say w ere the advantages/disadvantages? Are you happy with your decision? Ay input on the relative recovery rates of the two options?

Thanks and love,
coffeegal377
[QUOTE=coffeegal377;4774822]Hello,
I have certainly learned alot from reading other posts on this board, but I would also like to get feedback on my question of whether to have big toe fusion or the implant.

Both of my big toes have degenerative arthritis, but the left toe is by far the worst. It really got worse when I got a new job (big box retail) two years ago. I saw a podiatrist then and he gave me a note for work and recommended surgery, but the health insurance through work wouldn't cover it. Ten months ago I had to quit that job because I could no longer work on my feet all day and the manager refused to move me to a different, less strenuous department. I am fighting UI for a 'medical quit' determination; I figured my future ability to walk was worth more than minimum wage.

Anyway, that's beside the point of this post. I have been unemployed for ten months and am now so destitute that I qualify for a state program, so I signed up. The first orthopedic surgeon I saw two months ago discussed my options as either a joint replacement or a fusion. She thought I'd be a good candidate for the joint replacement because I am in general good health, am 61 and very active, and I have a high expectation of post-surgery mobility. I told her I would like the surgery in early summer because I felt getting around post-op would be easier. When I saw her again earlier this week to schedule and discuss the surgery in more detail, she told me she was moving to a new city and wasn't taking any new surgery patients. :eek:

She referred me to another orthopedic surgeon at the same hospital and I was able to see him the next day. I thought I was just going to meet a different surgeon who would do the surgery that the first DR recommended. But he was skeptical about the implant and ordered additional x-rays. When he looked at them, he said the two small bones underneath the big toe joint were also arthritic and he felt the implant wouldn't have a high success rate and his recommendation was fusion. He said if he did the joint and [B]it later failed[/B], there wouldn't be enough bone left for a fusion and he would have to go into my hip to get a bone graft for the fusion, which would be a much more complicated surgery and longer recovery. Argh!

I was pretty upset. Why hadn't the first DR told me all this? I had already got my head around the joint replacement, which for someone who doesn't doctor much was no small thing. I also liked the shorter recovery of the implant vs. fusion, since you are not waiting for bone to grow (fuse) and you can do minor weight-bearing exercises right away after the implant.

As I said, I'm pretty active and I'm going back to school this fall so I don't have to work for minimum wage any more. But I'm in constant pain and cannot do many of the things I love to do (like walk my dog) or need to do (like go to school or work.) Even minor house work leaves me in such pain I'm popping Tylenol like mints. I live alone and am generally pretty independent. The prospect of eight to ten weeks of immobility (and not driving!) after the fusion scares me. I am totally confused. :confused:

The second DR recommended I get a third opinion, because I kept pushing him on the implant and he was holding fast for the fusion. He gave me a referral and I agreed, but now I'm not so sure. If DR #3 says implant, who will do it? And do I want to go against DR #2's advice? If DR #3 says yep, fusion, well, there you have it, and I've wasted everyone's time. It feels hard to get straight answers and lay out the pro's and con's of each option.

Re: Fusion vs. implant. Why did you choose one or the other? Did you have a choice? What did your DR say w ere the advantages/disadvantages? Are you happy with your decision? Ay input on the relative recovery rates of the two options?

Thanks and love,
coffeegal377[/QUOTE]
I would also tell you not to do the replacement implant, they have a very high failure rate and a lot of doctors will not even do them because of the high failure rate.

I'm telling you this firsthand--I had an implant done in Dec 2009 and in March 2011 I had the implant removed and had my MTP joint fused, with a bone graft. FYI--I'm 47 yrs old, very active.

I had problems with the implant from day one--the swelling never went down (requiring more cortisone shots 5 months post op!), constant pain, even worse than before the surgery.

Went for 2 more opinions, both said fuse it, and I had one of them do just that. I've had virtually no pain since surgery, didnt need pain meds past 3 days post op, and even though I am not yet fused, the swelling is a bare minimum.

Yes, the immobility for the first 6-8 weeks is tough to go through, and you will need help at home for the first 2-3 weeks most definitely. Not driving is also a big deal. But I can tell this will work out in the long term. And I was never a stiletto wearer anyway, so not being able to wear a 2 inch + heel isn't a big deal to me.

Save yourself a second surgery and just fuse it.

Hope this helps....
I had a hemi implant done in May of 2010...podiatrist recommended this instead of fusion because I was active and would have more movement in the joint... BIG MISTAKE! It has given me nothing but trouble since I got it. I now have bone loss from implant and don't know if it can be taken out successfully because it is the screw type that has little barbs on the sides to anchor it into the bone better. Having it removed could shatter the toe bone... I now limp and my second toe has drifted over to the big toe to take its place. My big toe does not lay flat it is elevated... I'm in a lot of pain. I am 63 and very active like to go to the gym and like taking long walks. I'm unable to do any of this any more....PLEASE anyone thinking of joint replacement go to orthopedic surgeon M.D. that specializes in foot and ankles problems. Wish I had!
I am so sorry I had a joint replacement. I have had nothing but trouble since I had mine May of 2010. F





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