Should I get a fusion?

Posted , 5 users are following.

49 Year old Male with stage II to III HR in my left foot. 

Ive heard some people and doctors say that the loss in ROM after a fusion doesn't inhibit activities for the most part. My toe is stiff and barely moves already, and there is nagging pain. With the fusion, it would still be stiffer, but there wouldn't be any pain which would free me up to do the activities I've had to give up (jogging, tennis, etc).

What I've read/heard/been told is that:

    Cheilectomy has mixed results. Patients often need a fusion down the road anyway.

    Cartiva still has mixed results and is unproven long-term.

    Fusion has the most positive results and patient satisfaction.

My only concern about a fusion is causing a problem with other toe joints due to a transfer in pressure.

Would love to hear your experiences or opinions.

 

1 like, 22 replies

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  • Posted

    i was told my foot fusion would improve my walking , I am more a cripple now than I was b4. live with  it don't do  it 

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    • Posted

      I'm sorry to hear that. I will definitely consider your advice. Hope your walking improves over time.

      Can you tell me what wrong? Was the surgery not executed properly or did you have problems in other toe joints after the fusion?

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  • Posted

    the implants have taken away a lot of  movement  after  nearly 2  years I'm  in n pain and affects my walking  in turn affects my replacement knee in turn affect  my back . if I could turn back  time I would in a instance, if I had  the chance  to have them removed I would in a instance

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  • Posted

    i had a fusion and implants to  the middle and heel part, if you can walk  normally now then don't do  it

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  • Posted

    I am interested in any responses you get to your question, Garet, as I am considering a fusion as well. 22 months ago I had my big toe joint replaced with an implant and it is not working well for me. I don't recommend that at all. It's only now that I read that there seems to be a lot more patient satisfaction with toe fusion. My dad has one as well as his brother so I think there is something in our genes that contributes to this problem. But they seem to be fine with the fusion. My dad is 80 and walks a lot to control his diabetes. For me, the fusion choice is a little more daunting because they will have to do a bone graft (probably from my hip) to replace the bone that was removed to place the toe joint implant (my doctor didn't tell me that part when he said we would fuse the joint if the implant failed). 

    One thing you might consider at your stage that worked for me is an osteotomy. I have had problems with my toe for 30 years. I first had a cheilectomy which worked for a short while and then I regularly had cortisone shots. Then I had an osteotomy where the doctor cut part of my bone to allow more space in the joint (I was so against a fusion at that point so he offered that). That worked for me for about 16 years. There are many types of osteotomies and he called that one a "modified Moberg" not that it specifically relates to your case. Just something to consider before fusion.

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    • Posted

      Did you find the osteotomy reduced pain and increased range of motion for the whole 16 years?

      I'm just trying to decide: if a fusion has higher long-term success rates, and if you can still do activities such as running and playing tennis (as many claim) after a fusion, then why bother with other procedures (cheilectomy, osteotomy, implant) that have less favourable outcomes when a fusion is often done down the road anyway?

      Of course I've read a few bad fusion stories which, but not as many as I've read for failed cheilectomies.

      I've got time to decide, as I've been living with this for 2 1/2 years already.

       

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  • Posted

    The ROM wasn't as good as my other toe, of course, but I was pain free. Recently, the ROM had decreased and I started have less propulsion off that foot and I experienced pain while walking on the treadmill on an incline. So I went to the doctor and got an implant thinking that would fix the biomechanics primarily... my pain was sporadic and not as much of an issue. Big mistake going for the implant. I cannot fully bear weight, I now have the beginnings of hallux vagus, I have instability of the first ray and I have pain. On Monday I see a foot ankle specialist for a second opinion since my original surgeon says I need to have my back checked out (regarding my lack of propulsive gait). sad

    Even though the osteotomy prolonged my eventual future surgeries, I kind of wish now that I had just done the fusion then and have been done with it. Here I am about to have my fourth surgery on this toe. 

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  • Posted

    I had fusion 18 months ago on my left foot and am very happy with results.  I am an active 66 YO and was cycling with stiff sole after 7 weeks and hiking at 12 weeks.  Every week was an improvement over the previous.  I hardly ever think of the joint now - even flexing the remaining joint feels as though I am wiggling my toe.  I am limited as to which brand of ski boots I can get on now, but nothing else.  I can rise up on my toes and have very few things I can't do.  Absolutely no change I my gait.  Impact on other toes is non existent for me.  I roll up on my foot just like the good old days.

    I had a cheilectomy later on my right toe which was not satisfactory, and the end of September 2017 had a Cartiva implant. (10 weeks post op as of now)  I am not yet happy with results.  I haven't seen much improvement for the last 4 to 5 weeks.  In a follow up my orthopedic surgeon was noting the space is no different between the joint than presurgery.  I would do the fusion again if I had the choice to do over. 

    ?What ever you do, just make sure your surgeon has a good track record. Good luck

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    • Posted

      Thank you for the encouragement. My favorite part of your post was “I hardly ever think of the joint now.” How I long to be like that! It’s the first thing I think of every day when I wake up and it’s so depressing. I think the implants sound great but are problematic. People seem so satisfied with their fusions. I see my original surgeon tomorrow to discuss my situation. 

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    • Posted

      I'm glad the fusion worked out for you. I'm leaning toward getting one next year, but I am hesitant because of some of the negative accounts I've read. Most of the accounts have been positive though.

      I'm 49 now, so doing nothing is still an option, but getting a chilectomy or cartiva might just be a temporary fix. I only want to get one surgery.

      Do you run, play tennis or do any activities that might be affected by a fusion?

      Thanks

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  • Posted

    I gave up tennis and running years ago because of foot pain, and back, knee and shoulder issues. I did some short running after the fusion on left foot but still had too much pain in the right one. Ten weeks post Cartiva I am still a long ways from trying running again and probably won't due mostly to the knee and back issues.  Many people that post are ones that have issues with their surgery.  I know three others that had the fusion and only one had a complaint about the plate hardware but that was minor. The hardware can be removed after a year if healing is complete.

    ?Rarely, a bone doesn't fuse.  I was told not to take any NSAIDs for at least 6 months after surgery since the inflammation is an essential part of the healing process. NSAIDs can affect the bone knitting.  Mine did quite well.  Glad I finally did it, but I waited until I retired because of the time off issue.  Any surgery has risk, and I ended up with a blood clot. It was 2 1/2 weeks post-op in the gym doing leg presses (yes with both legs).  I was on Xarelto for 12 weeks after that.  Everything is fine now though.  Let me know if you have any other questions. 

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    • Posted

      Thanks for the detailed info. 

      Since you had a positive result with the fusion, why did you opt for the cartiva on the other foot instead of another fusion? I'm Level II to III HR and a candidate for cartiva, but I'm wary of getting a  cartiva or cheilectomy due to less successful outcomes compared to a fusion. People claim to be able to run and play tennis normally after a fusion which is my goal. 

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    • Posted

      The Cartiva seemed a simpler solution and was supposed to be a faster recovery. The fusion is very limiting for a number of weeks post surgery. Also, as an avid skier I have trouble putting on a ski boot as well with the fused toe.  The other thing about a Cartiva is the joint can be fused later.  It is a one way street with fusion.  I know how you are feeling trying to make the decision.  It is not easy when the procedure is permanent.  

      ​I had hoped for something in the way of a stem cell development or even cartilage transplant which some research facilities are working on.  I have no clue how long that would have taken to come into use and decided to go ahead.   Are you going to an orthopedic physician or DPM? 

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    • Posted

      Garet: Check out this tennis player my doctor told me about: Google Lleyton Hewitt and fused toe. He had his toe fused and continued playing pro tennis and won matches. -- Monica
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