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Foot & Ankle Problems Message Board

Foot & Ankle Problems Board Index

This may be a long read, but I'm going to start my own thread describing my foot problem and my upcoming MTPJ Joint Fusion. (MTPJ is the joint between your big toe and your foot)

Briefly, when I was 15 I smashed the interphalangeal joint (second knuckle) of my big toe, the one furthest from your foot. My brother and I were kicking a soccer ball bare foot, and I had my foot straight against the ball rather than against the side of my foot. I did not think he was going to kick the ball, but he did, and the ball smashed against the top of my toe, basically causing the interphalangeal joint to explode. Now, unfortunately when you are 15, things feel better after a few weeks, and I figured that my toe was jammed real bad, but it would go away. Fast forward 15 years, I finally go to the doctor because the interphalangeal joint and the MTPJ both have large humps of bone growing over them, and I am in pain when I walk.

My podiatrist takes an x-ray, and is really amazed at what he sees. The interphalangeal joint had exploded into about 15 bone fragments, and as such, stopped bending. Because it was painful for me to walk properly, I also stopped bending the MTPJ (subconciously) by walking on the outside of my foot. Because I didn't bend those joints for 15 years, the cartilage had died in each joint, and my body, in an attempt to heal itself, began to grow bone over the joints, in an effort to fuse them on it's own. Interesting how the body works.

Ok, so I'll try to speed up here. First doc does a surgery to take away the extra bone growth, clean up the interphalangeal joint, and inserted a pin down through my toe into my foot to straighten everything out, which was later removed after 8 weeks. This surgery was a HUGE success, I was pain free for the first time in 15 years, and I was extremely active. One thing my doc mentioned was the hope that the cartilage in the joints would re-grow with activity, but it didn't happen. After 3 years, the MTPJ joint was painful, grinding against each other, and the doc gave me two options; joint implant into the MTPJ, or fusion. His thinking, and I agreed, was that I was 34; it is a little early to have a joint fusion for someone as young as I was. So an implant went in.

This surgery was not nearly as successful, I haven't really gotten the benefits of the MTPJ implant. My foot has been swollen since the surgery, sometimes very swollen, sometimes not so bad, but I have yet to have a pain free day since that surgery. My foot doc also passed away, and that was very devastating to me, because I truly enjoyed seeing him. He took a lot of personal interest in my well being and was a very good doctor.

Now, I know I'm not using the medical terms, but this is what the orthopaedic surgeon has explained to me. The head of the implant butts up against my foot, and where it rests against my foot, the first doc carved a bowl for the implant, sort of like a ball joint. That part of my foot is starting to degenerate, leaving space for the implant to move backwards away from my toes. The other end of the implant is still screwed into the toe, so it's pulling backwards, causing my toe to have about a 15 degree angle pointed upwards. Also, in the past 6 months, I have been dealing with a lot more pain, the area of my foot is much more swollen than normal, it burns, it's hot, it's just a mess. Completely.

The ortho has told me there are no other options; the implant needs to come out, and the joint needs to be fused together. However, because of the work already done to my foot, my big toe is considerably shorter than the other good big toe. So he needs to do a bone graft off my hips to get the bone he needs to properly fuse the joint together.

Here is where my thread is going to begin; I have the surgery scheduled for the 4th week of October, 2007. I had a handful of questions for the ortho which I will post and his answers, and plan to update this thread after the procedure, in case anyone is considering this, or is going through it. These answers are from my ortho; please don't take this as me stating medical opinion or fact. However, I am confident in the answers I have been given; if anyone feels differently, please let me know.

1. Is the space between my toe and foot small enough to take a graft from my heel, or does the graft need to come from my hips? [B]Answer:[/B] the space is too great, and the hips are the best place to get graft material. If you donate bone marrow, this is where they would take it from, so it's the best spot.

2. Do you advocate taking a graft from a donor rather than from my hips? What is the risk involved with taking if from a donor? [B]Answer:[/B] No, there is a saying in Orthopaedics, No bone like your own. If it comes from a donor, there's a chance that your body rejects it, and honestly, after two extremely painful surgeries, this is the end of the line for me. I don't think I can do a fourth. I didn't think I could do a third, but I really, really don't think a fourth is for me. At least I hope.

3. Immediately following the surgery, what is the recovery time? 6 to 8 weeks non-weight bearing I know about, but will I be in a cast? Will I be on painkillers? Will I be able to drive? (My foot that needs the work is my right) Will I walk with crutches? A walker? Will I need a wheelchair? Would I need some sort of home care nurse to come in during the day? [B]Answer:[/B] Cast, yes. Painkillers, yes. Drive, no, because it's my right foot getting worked on. Crutches, yes. Walker, wheelchair, nurse, no. One other note, my ortho is going to have me admitted overnight because of the hip graft. He is going to have the bone graft surgeon take material off both sides so that I am even, not favoring one side over the other. Also, the second surgeon is involved so they can both be working at the same time. (I feel sort of sick and lightheaded even thinking about the procedure)

4. After the first 2 months, what's next for recovery? Is there any physical therapy required? [B]Answer:[/B] PT for my foot, no, because the joint is going to be permanently fused. However, I should go to PT to have someone analyze my gait, which will change and should be adjusted correctly.

5. Does the hardware inserted come out at some point? Does it stay in forever? What's involved with removing the hardware if it does come out? [B]Answer:[/B] No, the hardware, consisting of a plate and screws, should stay in permanently if there are no complications. It can come out if needed, as the toe, foot, and bone graft material will eventually be fused together naturally, growing and healing as if it is one solid bone. The doc says that can be done under a local anesthetic, but I don't see how. I had a local when the pin was pulled from my foot, and I almost passed out from beinglightheaded and sick watching the procedure. This one I'll have to revisit as I progress through the recovery. Hopefully, my foot is not swollen and it doesn't have to come out.

6. I don't think shoes should be an issue for me, but I already have wide feet, will I have trouble finding shoes that fit? Should I look to wear only running shoes, or boots? Am I limited in my shoe choices and if so, what are they? [B]Answer:[/B] There are a lot of women who try to wear heels after this type of procedure and they have trouble doing so. Fortunately, I don't wear heels, so I should be ok. The ortho doesn't forsee any issues with footwear.

Ok, that's quite a string I have going, hope I haven't put any of you to sleep. The surgery is a few weeks away, I will post again as I get closer to the date, and will also update quite often afterwards, as I will be home for recovery with nothing else to do. Wish me luck. Foot problems are terribly depressing to deal with, I sympathize with all of you going through your foot pain.

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