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Foot & Ankle Problems Message Board

Foot & Ankle Problems Board Index

I was diagnosed with Hallux Limitus 1.5 years ago. Aside from the arthritis, I have 3+ cysts in the bone. Contributing issues are that I have a long first metatarsal and my joint is elevated. Much of the pain also comes from my sesamoids.

I have seen 4 doctors (podiatrists, orthopedic surgeons) thus far regarding opinions regarding treatment and surgery. The consensus is that my left toe joint is in REALLY bad shape, especially considering my age. I have been told by every doctor that they "haven't seen a case as bad as mine" for being 30; rather, the deterioration in my joint is something that would be found in the feet of a geriatric patient.

I have a lot of daily pain: walking or sedentary with feet elevated, and am becoming increasingly frustrated at the fact that nothing that has been done has helped a bit. I'm in even more pain than I was a year and a half ago when a bone spur was removed to decrease pain and increase range of motion.

[B]Conservative treatment: orthodics[/B]
I am now on my second pair of orthodics: the first was done by Dr. Z. and was weight-bearing (molded while I was standing). They were designed to be put into dress shoes (don't/can't fit), but even in athletic shoes haven't done anything to provide support and alleviate my pain.

The second pair of orthodics were created non weight-bearing (they were molded when I was sitting) by Dr. C., and I received them a few weeks ago. I am having adjusted Monday since they seem to be causing my big toe to just remain elevated (with air underneath) in my shoe, rather than supporting it. It's very uncomfortable. They also have a very thick sole, which means there is really only one type of shoe they will fit into (Dr. Scholl's).

[B]Frustrations with the orthodics and gym shoes:[/B]
Dr. C. told me that it might take up to 6 months for my orthodics to be adjusted perfectly. He also told me to begin wearing them only 10 minutes per day.

The shoes he suggested I wear with them: Asics, New Balance, and a number of others all come with THIN inner soles. This means that when I take out the "stock" thin soles and replace them with the thick orthodics he made, the shoe doesn't fit properly and my heel comes out of the shoe. It's so frustrating to go into a shoe store to be fitted for shoes, to be told that there are only two styles of shoes they might have for me, and then nothing they do have fits properly.

I'm a little aggravated he was so intent on plugging these certain shoes, but an hour in the Sear's shoe section with help from my wonderful boyfriend resulted in locating the Dr. Scholl's. Knowing how thick he made my orthodics, I really feel like Dr. C. should have given me better recommendations.

[B]Conservative treatment: cortisone injection[/B]
Dr. Z (who was my primary until I sought out additional opinions) injected me with a cortisone shot and, 4 hours later, I got cortisone flare. Excruciatingly painful lesson to learn that cortisone injections are NOT for me.
Conservative treatment: anti-inflammatory[/B]
Dr. Z prescribed an anti-inflammatory oftentimes used for treatment of gout, and I took it for 2+ months. There is no consensus that it worked or not to help alleviate some of the "puffiness" at the top of my joint, but it was discontinued due to possible GI upsets I was having.

[B]Conservative treatment: physical therapy[/B]
Dr. C. prescribed lots of physical therapy. The first focus was on the top of my toe joint, which has scar tissue (from the bone spur removal) and was swollen. PT definitely decreased some swelling, but there was no improvement in the pain. Dr. C. squeezed my sesamoid, which resulted in pain so excruciating that I could not put weight on that part of my foot for days (then making my shin muscles hurt. When I told this to Dr. C., he told me that shouldn't have happened: as if I shouldn't have had THAT much pain, causing me to walk funny, and then I shouldn't have had pain in my shin from walking funny, which really bothered me: how can he tell me what pain I should or shouldn't have?! I'M the one experiencing it!). So, PT focused on the bottom of my sesamoid and still did nothing.

BTW, "PT" in this case was the usage of electrodes to stimulate the joint and muscles/tendons around the joint.
Conservative treatment: fluid injection[/B]
Dr. C. referred me to Dr. V. (an orthopedic surgeon) to get a fluid injection in my big toe joint to see if that will help cushion the joint. Apparently fluid injections can be successful for up to 1 year. Dr. V. did an x-ray and looked at my MRI and told me he would never inject my joint due to how deteriorated it is. He said it wouldn't do anything for me, isn't covered by insurance, and would cost me $600 a pop.

[B]Conservative treatment: gym shoes[/B]
Both Dr. C. and Dr. V. said I need to wear athletic shoes. Dr. C. says they need to be running/walking shoes. Dr. V. says I would benefit from "very sturdy" shoes with "half rocker soles" as a first step before surgery. Both have suggested New Balance, so I bought New Balance Rock and Tone. We'll see how those work when they arrive.

[B]Surgery[/B] (in the order of doctors I've seen):
[B][COLOR="Red"]Dr. Z[/COLOR][/B]., the first podiatrist I've seen for this issue and who did my first surgery to remove my bone spur, says that I have a large elbavatis (joint), contributing to the elevation and thereby putting pressure on the joint.

Dr. Z. recommends a [B]Sagittal Z[/B] surgery: that my first metatarcal needs to be shortened by a few millimeters (4-6) in a "cut and drop" form, and that I might need a joint implant in the future. Drastic surgery is the only thing that is going to work for me: everything else is "trying to pour a thimble full of water on a forest fire."

[B][COLOR="SeaGreen"]Dr. S[/COLOR][/B]. recommended an Austin Bunionectomy, which is similar to a Sagittal Z. Dr. Z. says that this will not have enough impact (too conservative of a cut/drop).

[B][COLOR="RoyalBlue"]Dr. C[/COLOR][/B]. says that he doesn't want to do surgery, because nothing will be as good as my own bones. If he can get me "30% improved," that'll be good. The two surgeries he suggested were (1) Decompression osteotomy, which would cut 2-3 millimeters out of my bone to plantar-flex it, and add one screw to hold it in place. The question is how much arthritis is within my toe joint; if they got in, this might not even be an option. (2) Austin/Chevron cut (like a V and close to what Dr. S. mentioned) that will last about 10 years.

He says that I am too young for an implant: he wants me to hold off until I'm 55+, and that implants fail every 10-15 years.

[B][COLOR="DarkOrchid"]Dr. V[/COLOR][/B]. said that orthodics are a good try but aren't going to work for me. He suggested two surgeries: (1) a fusion (which I DON'T want and he said would be hard for me to adjust to since I have good range of motion), and (2) the implant of an artificial tendon between my toe joints. Dr. Z. himself said that that a tendon implant is a temporary solution. How quickly will the tendon wear down?

Dr. V. says that implants in the hip might fail every 10-15 years, but implants in toe joints fail much quicker: I'd be lucky to get 8 years out of an implant.

Everyone has their own opinions; I understand that. However, there is little continuity among what each doctor says, and that's frustrating. If I heard the same thing twice or three times, I'd have a greater sense of confidence. I'm frustrated because I know something NEEDS to be done, but I don't know which doctor has the "best" opinion for me. I know what I SHOULD want is the conservative, and I feel like I've given that a good try. Right now I can't deal with 5% improvement or 30% improvement to MAYBE come over the next 6+ months. What IS 5%?! I don't even know what that would feel like! I won't always be wearing shoes, either. To be quite frank, I hate wearing shoes. And socks.

I am in constant pain, constant achiness..I get intermittent sharp pains in my toe joint even when I'm not doing anything. I can FEEL where the pain is coming from, and I KNOW it's from within my joint and at the bottom sesamoids. The fact that I have cysts and bone-on-bone rubbing (which Dr. C. also said wasn't the case, which I don't believe based on PT and other doctors). When I take off my shoes at home or am standing on my feet, they hurt. And I've been noticing that I avoid putting any pressure on the ball of my foot. When I walk at home in bare feet, it's with weight on the side of my foot. I feel like what I'm really going to end up needing - even though I don't WANT it - is a joint replacement. And I know that can't even be done until my foot (first metatarsal, elevated elbavatis) lays right.

But yes. I'm extremely frustrated and am really tired of not hearing any one "right" solution. I'm tired of being fit for orthodics that don't work. I'm tired of looking at ugly shoes to fit the orthodics. And I'm so, SO tired of the constant pain. And I'm soo tired of having this conversation, and mulling it over in my own mind over the course of weeks and months.

I know my joint is the problem. And, from what I understand, the way my bones lay and put pressure on the joint is a big contributor.

My first worry is having lots of bone cut, because once the bone's gone, it's gone. And then, if I need more bone in the future, worrying about that (of course, they'd have to use cadaver bone, but that will never be the same). My bone is good; it's my joint that's the problem. And I don't want too much of my own bone removed.

[B]Which doctor?[/B]
I know I can't pick-and-choose which doctor is going to do what: I can't pick Dr. V. for one and Dr. Z for another. I also don't want multiple surgeries because one doesn't work right, or one wasn't aggressive enough, or whatever. If I DID have my way, I'd go to Dr. V. and see if adding an artificial tendon between my joints can buffer some of the pain. That is conservative, and nothing of my own is cut or removed. But, again, it's temporary. His only other suggestion was joint fusion, and I'm not comfortable with that idea...ever. I know I wouldn't stick with him as a doctor. And I've only seen him once.

My gut feeling tells me to go back to [B][COLOR="Red"]Dr. Z.[/COLOR][/B] for the Sagittal Z surgery..I wish someone else would give me their opinion.

Given all of this information, does ANYONE have an opinion? I'd definitely be glad to hear it.

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