Tell me about your toe fusion

Nikolaj wrote:

Here to join the toe party. I am about 2 months post op and am surprised how quickly this is healing. About to schedule the same thing on the right foot. Will have to wait to report on running, climbing, and hiking but so far I am impressed at how normal walking feels without any flex in that joint. For what it's worth, one doctor I saw had the same fusion and had since run marathons with little to no pain. 

Hi - i'm 27 and was previously pretty active but the last 2 years have had pain in this joint on just walking - literally sitting and flexing my big toe with a gentle finger push causes me huge pain. I now walk on the outside of my foot which isn't doing great things for my knees and hips. I've been told i'm too young for this, but its looking like MTP joint fusion may be the only solution to this pain. MRI due soon.

Did those of you with fused toes need to change the kind of footwear you use? Does walking feel strange with a fused toe? Is bending down/ crouching difficult? I work as a vet and so need to be pretty flexible when wrangling uncooperative patients and for someone who performs surgery on our furry counterparts, the idea of having surgery myself is pretty sweat-inducing. Thanks.

I made a few changes.

I now get incredible pain under my toenail, especially if I need to do a move where I rock forward on my toe. I also can’t deal with pressure on my toenail. I am pretty sure that my crack climbing days are over.

I wear Evolv Rave, basically a mocc knock off. I’ll probably get upclimbing mocs next. I can no longer wear a stiffer or supportive shoe. I can do very short sessions in an Anasazi pink but not too much.

So I’ve recently given away around 20 pairs of shoes.

As for running, no problem right now but I barely ever run. I’m more of a cyclist and riding shoes don’t bother me.

No issues at all with hiking. I’ve been on some really big traverses since and it’s been fine. No issues in ski boots either. Really, I’d be 100% happy if I weren’t a climber 

I live 2 hours from the Creek and you are telling me I can't crack climb anymore!!??  Ooof. Great to hear running and scrambly hikes aren't an issue. Similar hardware to the photo I posted above? Welp, off to get the other foot done today. 

I would give absolutely anything to reverse my fusion.  It is the worst thing I could have ever done.  I am desperately searching for someone to reverse it.

I would give absolutely anything to reverse my fusion.  It is the worst thing I could have ever done.  I am desperately searching for someone to reverse it.

Can you elaborate Stefanie? What sort of issues are you having?

Steven Teofilo wrote:

Hi. Any update on your toe/foot?   I’m debating having this procedure in two weeks and worried about recovery for next Spring, which would be about 6 months.  A casual walker and jogger, I would go crazy if I couldn’t return to that by spring and would rather endure the current pain to have that ability.    Would you do the surgery again knowing all you know now?

Steven did you have the surgery?

 Stuart Phillips wrote: I thought maybe my story might help some.

I was a keen runner and developed pains in my left foot which after trying everything from new shoes, inserts, multiple physio sessions and doctors was eventually diagnosed as Hallux Rigidus. I was told it was severe so the only option was fusion. My only concerns were would I be able to run and would I be able to walk long distances - I was told we'll have to wait and see. i had actually run 2 marathons with this pain and had I know the cause I wouldn't have done this - but I kept getting assured it was everything other than arthritis up to the xray.

I had the Op on the 26/2/2020 and within a week I was walking in a boot. End of 2 weeks I was walking in a shoe (very short distances) and now (3/6/2020) I have done a 5 mile walk and last night did my 6th run (5km). It was much slower than before, but that is mainly due to fitness. I even managed a bit of a sprint for the last 500 metres.

The scar sometimes feels a little strange to touch (pins and needles) and sometimes I get a weird shooting pain which comes out of nowhere, but generally there have been no issues. I need to find a pair of running rocker trainers to give me back the roll I've lost and during the day I now wear a pair of Oofos (running recovery shoe). I am now 51 (50 when I had the Op) and I was concerned at the impact this might have on my mobility, but other than squatting down or standing on tip toe there has been very little change.

The Op wasn't pleasant.....I don't know how it's performed elsewhere but mine was carried out with a knee block meaning I heard everything . I didn't enjoy the noise or sensation of the power tools, but that was the worst part along with the pain on nights 2, 3 and 4. Post Op I was told the joint had crumbled and there was no cartridge left, so I'm sure it was the right decision.

I hope this helps somebody.

Hey Stuart - thanks for sharing, this is really useful for me. Same age, my history is very active person, broke both big toes at some point during my childhood (jumping off stairs/playing football etc), always had big toe pain throughout my teens onwards. Always been active, keen martial artist (muay thai and jiu jitsu), circuit training, cycling etc. About 8yrs ago started getting pain in both feet which was subsequently and only about 2yrs ago, diagnosed as Morton's neuroma. Opted for cortisone over a neurectomy, which actually calmed things down for quite some time and was able to walk the West Highland Way (96 miles) over 5 days not long after. I've tried metatarsal pads/orthotics but was hard to gauge whether they had helped at all, or whether it was the cortisone. Have private healthcare options through my employer and had tried to get cryosurgery through them, but they don't see it as a proven outcome and actually ended up having it done through the NHS as they had a programme running in my area. Had my first cryoablation on my right foot (3rd/4th web space) about 9 months ago, which unfortunately, left me in worse pain than before. Had a second procedure in the same place last week. The first procedure was carried out by a Dr who was doing it for the first time and they think maybe they missed the part of the nerve causing the pain, so was recommended to have another cryoablation, deeper into the tissue. Too early to tell yet whether that's worked, but the elephant in the room all along is the HR in my right foot was diagnosed as 4 out of 4 in terms of severity for arthritis and the specialist basically just said, you'll never get the range of motion back so fusion is the gold standard and will give you the same range of motion (zero) but with no pain. I have been really looking at what other options might help, Cartiva implants, cheilectomy, decompression osteotomy ( davidredfernsurgery.com/min…) MTP fusion. My main concern around fusion was not being able to bend the toe at all and whether that would effectively stop me working out etc. Was keen on Cartiva/other implants until I'd read up on them and spoken to different specialists. The decompression osteotomy looked interesting however seems to have a similar recovery period/approach as MTP fusion, but I guess anything other than MTP fusion is still going to leave you with a joint that is perishing over time? Really useful to hear your experience and would be interested in understanding where you are now with it and whether you're still getting strange sensitivity and how far you've recovered to getting back to 'normal' activity. Out of interest, where did you get your fusion done/who did it and was there a particular reason you were given a knee block as opposed to general anaesthetic? Cheers

Every once in a while someone comes across this thread and t reminds me of just how many people, climbers and non, are dealing with similar problems. The lack of information is why I started it, and hopefully it’s been useful to some people.

Now it’s time for some more updates. It’s been a little over 3 years.

Where the two pieces of bone healed together, I’ve developed a rather large bone spur. This is a minor nuisance in climbing shoes and definitely bothers me in cycling shoes, especially the flat pedal MTB 5.10’s. I know this because the soreness has almost disappeared in the winter. Ski boots vs cycling shoes. I’m going to experiment with shoe stretching or new shoes before more big rides.

My biggest problem is still the pain under the toenail. I assume an X-ray would probably show more bone spur there too. It’s slightly better than a year ago. Small edges still hurt and featureless cracks aren’t really in the game anymore.

I do have some plans to climb some easy splitters this spring. Maybe I can kludge a way to make it manageable.

If there wasn’t hardware in that toe, I’d take a few shots and remove the toenail myself. Eventually I’ll go somewhere and have the nail removed. That will introduce a new problem of sensitivity but will relieve the pressure.

I ran a 5k without any training or concerns and it was fine. I still don’t think I’m going to be a runner.

If I had to do it again, I’d ask the doc not to use bone graft. I don’t know if it caused the overgrowth problem but it might have.

I would also have asked him not to change the angle my toe faces. Straight seems good but is definitely a little bit in the way now.

Mark M wrote:

Hey Stuart - thanks for sharing, this is really useful for me. Same age, my history is very active person, broke both big toes at some point during my childhood (jumping off stairs/playing football etc), always had big toe pain throughout my teens onwards. Always been active, keen martial artist (muay thai and jiu jitsu), circuit training, cycling etc. About 8yrs ago started getting pain in both feet which was subsequently and only about 2yrs ago, diagnosed as Morton's neuroma. Opted for cortisone over a neurectomy, which actually calmed things down for quite some time and was able to walk the West Highland Way (96 miles) over 5 days not long after. I've tried metatarsal pads/orthotics but was hard to gauge whether they had helped at all, or whether it was the cortisone. Have private healthcare options through my employer and had tried to get cryosurgery through them, but they don't see it as a proven outcome and actually ended up having it done through the NHS as they had a programme running in my area. Had my first cryoablation on my right foot (3rd/4th web space) about 9 months ago, which unfortunately, left me in worse pain than before. Had a second procedure in the same place last week. The first procedure was carried out by a Dr who was doing it for the first time and they think maybe they missed the part of the nerve causing the pain, so was recommended to have another cryoablation, deeper into the tissue. Too early to tell yet whether that's worked, but the elephant in the room all along is the HR in my right foot was diagnosed as 4 out of 4 in terms of severity for arthritis and the specialist basically just said, you'll never get the range of motion back so fusion is the gold standard and will give you the same range of motion (zero) but with no pain. I have been really looking at what other options might help, Cartiva implants, cheilectomy, decompression osteotomy ( davidredfernsurgery.com/min…) MTP fusion. My main concern around fusion was not being able to bend the toe at all and whether that would effectively stop me working out etc. Was keen on Cartiva/other implants until I'd read up on them and spoken to different specialists. The decompression osteotomy looked interesting however seems to have a similar recovery period/approach as MTP fusion, but I guess anything other than MTP fusion is still going to leave you with a joint that is perishing over time? Really useful to hear your experience and would be interested in understanding where you are now with it and whether you're still getting strange sensitivity and how far you've recovered to getting back to 'normal' activity. Out of interest, where did you get your fusion done/who did it and was there a particular reason you were given a knee block as opposed to general anaesthetic? Cheers

Hi Mark - so the toe that was operated on is pretty good now - still some aching every now and again but nothing like before. My other big toe is close to needing a fusion and as I’m walking the coast to coast May 24 I may have that done sooner rather than later. I don’t run anymore - mainly due to an aging body and I walk lots instead.

My surgeon was Ewan Kannegieter who is based in a hospital in Essex (Great Baddow). He and his team have been fantastic throughout and are active people themselves so “get” me.

The movement I have left is more than I was expecting and to be honest it’s silly things where I notice it….certain stretches for example, putting on shoes, but honestly for me not a big deal.

I hope this helps.

Stuart Phillips wrote:

Hi Mark - so the toe that was operated on is pretty good now - still some aching every now and again but nothing like before. My other big toe is close to needing a fusion and as I’m walking the coast to coast May 24 I may have that done sooner rather than later. I don’t run anymore - mainly due to an aging body and I walk lots instead.

My surgeon was Ewan Kannegieter who is based in a hospital in Essex (Great Baddow). He and his team have been fantastic throughout and are active people themselves so “get” me.

The movement I have left is more than I was expecting and to be honest it’s silly things where I notice it….certain stretches for example, putting on shoes, but honestly for me not a big deal.

I hope this helps.

Yes it does. Thanks Stuart, I appreciate the response. I have to wait 6 weeks for the neuroma to settle but will go for the fusion probably st the end of the summer. Thanks again. 

I’ve a very similar issue. Jumped off a longboard two years ago and smashed my left big toe. Had it pinned and then the pins removed six months later. I have some mobility in the joint and lots of pain while climbing. I had given up for a year and started back into it. But figured that I had to go see if there were any options because the pain is too much. I was told that the joint is wrecked, all the cartilage is now gone and the surgeries I had probably made it worse. The surgeon said cortisone injections or prp would be throwing money down the drain and the only option at this stage is fusion. I’d be interested to hear more about your experience. I’m having a hard time deciding what to do. Rock climbing was such a big part of my life for 15 years. 

I figured I would add a glimmer of hope to the toe fusion discussion. It has been about 14 months since my second toe fusion and 17 since the first one. I still have the occasional bit of pain from certain things but ultimately I am very happy with the results and largely back to "normal". I haven't been climbing a ton but the little bit I have done has been reasonable and I am excited to get fully back into it this season. Trail running, skiing/snowboarding, every day use has all been pain free. 

Crack climbing at the creek has been pretty good with stiff shoes in the hands and bigger sizes. It's when I put on the thinner shoes for fingers and tight hands that I find some pain trying to really twist in any sort of toe that I can fit. I also noticed that aggressive down turned shoes on small edges has caused some pain but is manageable. I tend to just stretch and roll out my feet a lot and this helps with any stiffness/pain after climbing. A rubber ball the size of a golf ball has been really helpful for me. I have never been a super high end climber so maybe it will impact those tight shoes, small holds, etc more compared to 5.10 cruisy climbing. 

Hopefully that helps a bit but feel free to shoot me some questions. Quite happy with where I am at and hope that the bit of pain from climbing goes away with another 6 months - year.

highaltitudeflatulentexpulsion wrote:

Every once in a while someone comes across this thread and t reminds me of just how many people, climbers and non, are dealing with similar problems. The lack of information is why I started it, and hopefully it’s been useful to some people.

Now it’s time for some more updates. It’s been a little over 3 years.

Where the two pieces of bone healed together, I’ve developed a rather large bone spur. This is a minor nuisance in climbing shoes and definitely bothers me in cycling shoes, especially the flat pedal MTB 5.10’s. I know this because the soreness has almost disappeared in the winter. Ski boots vs cycling shoes. I’m going to experiment with shoe stretching or new shoes before more big rides.

My biggest problem is still the pain under the toenail. I assume an X-ray would probably show more bone spur there too. It’s slightly better than a year ago. Small edges still hurt and featureless cracks aren’t really in the game anymore.

I do have some plans to climb some easy splitters this spring. Maybe I can kludge a way to make it manageable.

If there wasn’t hardware in that toe, I’d take a few shots and remove the toenail myself. Eventually I’ll go somewhere and have the nail removed. That will introduce a new problem of sensitivity but will relieve the pressure.

I ran a 5k without any training or concerns and it was fine. I still don’t think I’m going to be a runner.

If I had to do it again, I’d ask the doc not to use bone graft. I don’t know if it caused the overgrowth problem but it might have.

I would also have asked him not to change the angle my toe faces. Straight seems good but is definitely a little bit in the way now.

I'm quite delighted to run across this conversation. I'm facing a toe fusion in my future. I had a cheilectomy two years ago, and I'm still in a lot of pain. I broke my fibula in April, and now I have two plates in my leg. I think that walking in a boot for two months exacerbated a lot of foot problems. If I walk around, the entire bottom of my foot hurts, and my big toe is in tremendous pain. The doctor is talking about removing a sesamoid bone and doing a fusion, but I'm not sure that he really knows what the problem is, and I know he does not understand climbing.  I need to get a second and third opinion, I think. 

Anyway, this entire thread has been helpful. I'm glad that you are able to climb. I'm located in Tennessee and mainly boulder and sport climb.

Super grateful to have found this thread and see some light at the end of the tunnel.

I have severe arthritis and joint narrowing in my right hallux and moderate in my left. I went from having a sore big toe joint to pain that keeps me awake at night almost overnight. Looking back, my right big toe has given me problems since around 14 years old when it would go numb while surfing. I am 38 currently and have seen 2 surgeons whose opinions vary so wildly it is hard to know who to listen to.

Surgeon 1: Two options- Option One: go in and clean it out and inject some stem cells, should give me 5-8 years before the next step. Option Two: Partial joint replacement of proximal side of the hallux joint. Should give me 10+ years and can do a revision in the future and do the distal side of the joint making a full joint. The revision should give me 10-20 years.

Surgeon 2: Only real choice is to fuse it. With the activities I do, the joint replacement will only last 5 years, 7 if I am lucky.

I am an avid climber, backpacker, skier (front and backcountry) and runner (although I only run to stay in shape for the other sports). I spent a decade seriously into surfing, and another seriously into downhill biking. I have plates and screws in various places from biking, and at some point I decided that I was getting too old to get my adventure kicks from hitting 20 foot doubles. I have only been climbing for about 5 years, but it has fast become one of my favorite sports and I would be gutted to have to give it up so early in my journey.

Realistically I want to try to get another 25 years of skiing and climbing in, but would reassess that if it impacted my ability to continue backpacking (my one true outdoor love) deep into my 70's (should I be fortunate enough to live that long). I am still hiking with my father who is 68 with no sign of stopping in sight, and our age gap is identical to mine and my oldest daughter. 

My two challenges at the moment are 1: What surgery and 2: when. I am tentatively trying to limp along till mid April so I dont miss ski season. However I have an annual backpacking trip with my daughters over Labor Day, an ascent of Rainier in mid August, and a planned trip to climb El Cap East Buttress in October. I feel right now that I either miss Ski Season, or I miss Everything Else Season. It all sucks and I hate surgery.

I have had enough surgery to know that 6-8 weeks is Bullshit with a capital B and that it is really 1 year before you are really back to whatever level you are going to be able to make it back to, and 2-3 years before you are as pain free as you are ever going to be (at least my ankle, clavicle, knee and hip attest to these numbers). As a backpacker, backcountry skier and climber, I am obviously no stranger to the proverbial suffer-fest and have developed a high tolerance for pain in my adulthood, however the big toe pain is shockingly crippling. That one joint is making my whole right leg hurt, making my ankle stiff and inhibiting the mobility of the whole leg in general. Ive had some serious injuries, but that one little joint is making me more miserable than any of them.

I wish I found this thread earlier.. I’m in recovery (month 3) of my big toe MTP joint. I felt pretty disappointed that I can’t climb yet but this thread gave me hope!

My experience: 

- for over a year I felt MTP pain after climbing. It was getting more and more intense. Walking a bit bothersome , can’t run anymore.
- xray showed perhaps a mild arthritic changes. MRI showed inflammation perhaps due to cartilage damage (couldn’t really tell) 

- first round of cortisol injection- no improvement. 2nd round was under ultrasound to guide the needle to the joint - also no help.
- out of pocket PRP injection (it suppose to help rebuild the cartilage). No change. 

- scheduled surgery. They saw a big tear in my cartilage (I have pics if anyone wants to see some raw meat lol). They cleaned it, did micro fracture of the bone under, injected stem cells from my hip, and patched it with some cartilage like material.
- postop first 3 days were painful but ibuprofen was enough.
- booted for 6 weeks with zero weight on my foot (crutches and knee scooter) 

- then transition to smaller boot, sneakers with inserts. Basically I need to avoid bending the toe.
- as of now I can walk in my mountaineering boots no problem, cycling and snowboarding in small doses are ok. Walking in sneakers is still bothersome.. haven’t tried climbing yet but I’m thinking of trying some cracks in my tc pro (pre surgery sport climbing was hurting more, while cracks were okish)

I’m a bit disappointed I’m not pain free yet , and my surgeon said I may never fully recover because cartilage damage is difficult to fix. He thinks next step is fusion..

Stefanie Killian wrote:

I would give absolutely anything to reverse my fusion.  It is the worst thing I could have ever done.  I am desperately searching for someone to reverse it.

Can you tell us why you need to reverse your fusion please?

For those who have had cortisone injections for their toe OA, wondering how long that lasted for? And if there was much down time right after?
Am debating getting one for the first time because I am supposed to be doing a climbing trip for about 2 weeks later in Jan (and also don't want too much downtime so I can prep for the trip by climbing a lot between now and then?!), and also a few months of travel which means plenty of time on my feet (walking).. but am also wondering if it's worth it when I have read that it may worsen/speed up OA in the long term even if there is some pain relief in the short term.

I think normally I might opt for trying the physiotherapy route first but I don't really have time because my work health benefits (which would pay for this) run out in about 1.5 weeks and like I said, the trip is coming up soon. 

Helen El wrote:

For those who have had cortisone injections for their toe OA, wondering how long that lasted for? And if there was much down time right after?
Am debating getting one for the first time because I am supposed to be doing a climbing trip for about 2 weeks later in Jan (and also don't want too much downtime so I can prep for the trip by climbing a lot between now and then?!), and also a few months of travel which means plenty of time on my feet (walking).. but am also wondering if it's worth it when I have read that it may worsen/speed up OA in the long term even if there is some pain relief in the short term.

I think normally I might opt for trying the physiotherapy route first but I don't really have time because my work health benefits (which would pay for this) run out in about 1.5 weeks and like I said, the trip is coming up soon. 

I had multiple cortisone shots in my toe over the years. I climbed years, and also at my absolute best between shots.

The first time I got one, I had noticed that my toe was really swollen and I couldn’t bend it. It felt like it just needed to pop but it was too swollen to. Went to a doctor and he injected the toe. Within a day or two, it was fine and I didn’t give it another thought for another 2 years.

After that, I think I received 2 or 3 more shots as the pain got really bad. It was a 10 year long process to go from an unexpected sore toe to so affected that I basically couldn’t climb. 

On the last one, the doc (the one who did the surgery) told me that having a cortisone injection that doesn’t work is one of the ways to “prove” to the insurance company that the patient needs a surgical fix. By that time we both knew the joint was a goner.

So if were me, hell yes, I would get the shot.