Tell me about your toe fusion

I've mentioned in other threads that my right toe is pretty jacked up. So I can now do about 3-4 short routes in a day with significant pain, about once a week. If I do climb once every week though, after a couple weeks, the toe will be so sore that I need a few weeks off. So basically I am not a climber anymore.

Xray shows severe arthritis and bone spurs. My proximal IP is basically perfect, this is entirely in the distal. He's also pretty sure I broke the toe at some point and walked it off.

He said removing the bone spurs would help for a while but they'd grow back. He said fusion would be my best bet.

The doc is a young guy who is not one to tell people to stop doing things they love (except for the uncontrolled diabetics who are losing toes for the love of Pepsi).

Basically he'd nip off all the remaining cartilage and arthritis and bone spurs so the distal joint is bone on bone. Then he'd drive a screw into the two to bring them together. They'd heal together, essentially we're removing the joint and with that, any pain of it moving. He's pretty sure that with me, once the toe is fused, he'd go back in and remove the screw. Walking boot time is probably 6-8 weeks. I have just about that much sick time, so this could work. I'd hope to start climbing again by this spring and would probably not ski this winter.

I know some here have had this fusion. I'd have a few very specific concerns.

- How is it when edging?

- How is it on splitters?

- Can you run (long distance and 1 mile all out are the two types that I'd be most interested in)?

- How does it feel in ski boots?

- Can you climb 2-3 days in a row, or 2-3 days out of a 4 day trip.

- How does it do on a death march into an alpine climb? How does it do on the even deader march back to the car afterwards?

- Would you do it again?

Thanks for the reply's. Some of this is going to help inform my decision as whether or not I go forward.

Bump. I can't be the only one who has a bum toe.

This is your right big toe? I’ve had my right pinki toe fused 3 years ago with no problems. Broke it in a martial arts sparring match 12 years prior and it dislocated all the time, finally fused it. Rarely bothers me except for crack climbing when lots of pressure is on the toe, but heck that hurts on the other foot too.

Good luck.

highaltitudeflatulentexpulsion wrote: Bump. I can't be the only one who has a bum toe.

You're not.  

Hallux Limitus of the left big toe.  Cheilectomy in 2011.  Joint is much stiffer - ROM never returned to what is was before surgery.  There's still pain though much, much less than before.  Bone spur is growing back.  Was warned that a second cheilectomy would eventually be needed.  Podiatrist stated fusion later after that would likely mean switching to golf as my sport (BARF!).  

What about Cartiva implant?

Geez, it's so frustrating how hard it is to find medical case studies. I'm interested in toe issues because I have a bad feeling I'm going to wind up with them, so I've been following your posts.

You might want to PM gblauer who also has big toe issues. She also discussed it at RockClimbing.com.

Here's a triathlon forum post with some commentary from docs.

There's a guy named "edge" at rockclimbing.com who had osteoarthritis and mentioned accupuncture helped (2010) He said the doc "basically told me that the x-ray showed advanced osteoarthritis, and the pain could be reduced by surgery or titanium joint replacement. The operation would not help me walking, running, or climbing, just with the pain". (gblauer also responded there.) I think edge is here at Mountain Project and still climbing so you may want to contact him too.

Did your doc mention "microfracture surgery"? Some guy at webmd forums had success with it, but he did give up climbing and took to kayaking instead.

Here's a thread about toe fusion on a cycling forum.

I found these forum posts by using google's inurl feature. You can search for climbing "toe fusion" inurl:forum and see what you can get. If you are persistent, you can try the same search, only substitute other sports like running, biking, hiking, skiing, etc. Hopefully you'll find more people who are willing to discuss their experiences in public.

Here's a podcast which has some discussion of big toe fusion in running. I haven't listened, but I would if I were contemplating surgery.

FWIW I think doctors suck, based on my own personal experience (i.e. they are frequently useless or worse). I've read too many accounts of people being assured by a doc that they can do x, y, and z after the prescribed treatment, when in fact it turned out to be untrue. If I ever get into the position where a doc recommends surgery of this sort, I will get multiple opinions, ask for references from former patients (not sure if it's possible to get them), and go off into accupuncture and "woo woo" land to try solutions before thinking about biting the bullet. YMMV.

Also FWIW, it may take many days/weeks/months before people with your experience notice this thread; I've seen posts in Injuries and Accidents being revived years later. Someone else might tell a person about it, or someone might be off in the mountains or on vacation somewhere doing their thing and not see this till they get back. So you might not get a quick response from the people who have the most experience with it, unfortunately.

Best of luck to you!

Not sure how this differs from a bunion; I'm sure I have surgery for mine in the future. The pain is getting a lot worse and an x-ray two years ago showed moderate arthritis. I heard buinionectomies are hit or miss and folks can opt for fusions. But I also read about about a newer procedure called a lapiplasty that has more promising results. Also, this cartiva implant sounds intriguing but also not in standard practice. I run alot too so between edging and that, I'm sure I'm doing no favors. I usually try not putting a lot of faith in Dr. Google without scrutiny.

Bunion is a different affliction than Hallux Rigidus. I too have the latter.

Cartiva is specifically for Hallux Rigidus, and many doctors including the podiatrist and orthopedic foot specialist from Steadman Hawkins I saw here in Colorado offer them for more severe cases of Hallux Rigidus. My own case is not that severe yet.

Thanks for the replies. I'll look into those links after work.

Some clarification. My distal IP joint is the fubared one. In cases of hallux rigidis and limitus, it's the proximal IP joint. Also, the proximal is the joint that a chilectomy and the hemi-joint replacement is done. 

My PIP is fortunately in excellent condition. I need to fuse the tip of the toe, so essentially I'd be making my phalange 1/2" longer but losing the joint.

I figured I'd bump this with an update.

I have scheduled the surgery for September. My wife is going to have a baby next week so I'm sort of waiting to make sure everything turns out fine before committing. My doc knows this and is fine with the uncertainty.

I have less than ten degrees of motion in that joint. The ROM is not causing any problems. A fusion on that joint would just eliminate a source of pain.

Side note, I have insurance and literally work in the operating room where I'm going to have this done. Everyone in the room are my friends. It's still going to cost me about what a brand new high end mountain bike would cost, give or take a new AT setup. America.

This was my experience with a bunionectomy four years ago. I got t-boned on a motorcycle by some guy and had to have three surgeries to rebuild my tibia joint (ankle), figured I'd get rid of the bunion that was becoming excruciating while I was at it. Our first child was born a few weeks prior to the surgery, had to put it off to make sure I was able to drive when the time came. I still have a small screw in the tarsal connected to the big toe. It was excruciating, took forever to heal (probably additional complications from the crushed ankle) but I'm finally back to sending and running and alpine approaches with reasonable pain. Good luck! 

I haven't had this surgery, but I do have some big toe issues that come up when running or walking. I'd look into Hokas if you haven't already. The rocker sole is designed to let you walk or run without bending your toes as much or at all. Given your surgery I'd probably go with the tallest shoe they make, for maximum rocker action. 

I put off the surgery so I could focus on the newborn and my wife.

It's rescheduled for December. Still puts me in decent place for recovery and allowed me to care for the little ones and my wife.

I've been getting out once a week lately. I can climb 11a/b using my right heel only. I can't support any weight on the toe anymore. Somehow, I don't limp. Pretty sure I can't run but with how much fun cycling has been lately, I haven't tried.

I'm actually shocked about how bad it's gotten. I've been at a nice (un) happy balance for several years. Climbing hurts but if I force it, I could do it. This fall saw terrible toe pain. Now there is no question, I either fix it or quit.

highaltitudeflatulentexpulsion wrote: I put off the surgery so I could focus on the newborn and my wife.

It's rescheduled for December. Still puts me in decent place for recovery and allowed me to care for the little ones and my wife.

I've been getting out once a week lately. I can climb 11a/b using my right heel only. I can't support any weight on the toe anymore. Somehow, I don't limp. Pretty sure I can't run but with how much fun cycling has been lately, I haven't tried.

I'm actually shocked about how bad it's gotten. I've been at a nice (un) happy balance for several years. Climbing hurts but if I force it, I could do it. This fall saw terrible toe pain. Now there is no question, I either fix it or quit.

You're borderline one of my people ...

Hate to throw this out there, but have you considered avoiding provocative activity (climbing) and giving it a chance to heal?  I have a wrist problem that, similarly, climbing is absolute murder on.  Avoiding climbing for a couple of months has helped a lot.  While I'd love to be crushing the gnar, pain is pain is pain, and when pain gets bad, life gets hard.

I had the same attitude for a while ("fix it or quit") and there is a middle ground: taking a break.

Christopher Smaling wrote: Hate to throw this out there, but have you considered avoiding provocative activity (climbing) and giving it a chance to heal?  I have a wrist problem that, similarly, climbing is absolute murder on.  Avoiding climbing for a couple of months has helped a lot.  While I'd love to be crushing the gnar, pain is pain is pain, and when pain gets bad, life gets hard.

I had the same attitude for a while ("fix it or quit") and there is a middle ground: taking a break.

Actually yes. I didn't climb from March or April until early October. No change. I sure got a lot of great bike rides in though.

Bummer.  I'm in the same boat.  Tough to say whether surgery will actually result in functional improvement in a bunch of these cases (mine included).  Have you asked your doc these questions?  What has he had to say about post-surgery functionality, rate of complications, etc?  Numbers matter.

Edit: actually, we're in really similar circumstances.  I have Midcarpal Instability.  The instability is bad enough that I can't climb, but lets me still get out and do a lot of other stuff.  My treatment options are a fusion or thermal shrinkage of some of my wrist ligaments.  Fusion is something to wait for because I would lose more functionality than I would regain at this point.  Thermal shrinkage is effective in the short term, but have a tendency to stretch back out over the course of a few years.  What do?

Christopher Smaling wrote: Bummer.  I'm in the same boat.  Tough to say whether surgery will actually result in functional improvement in a bunch of these cases (mine included).  Have you asked your doc these questions?  What has he had to say about post-surgery functionality, rate of complications, etc?  Numbers matter.

Edit: actually, we're in really similar circumstances.  I have Midcarpal Instability.  The instability is bad enough that I can't climb, but lets me still get out and do a lot of other stuff.  My treatment options are a fusion or thermal shrinkage of some of my wrist ligaments.  Fusion is something to wait for because I would lose more functionality than I would regain at this point.  Thermal shrinkage is effective in the short term, but have a tendency to stretch back out over the course of a few years.  What do?

I think I remember your posts. You've got a far more debilitating issue than me. 

Mine is simple, I have an extremely painful arthritic joint in a joint that barely moves and really doesn't need to move. Fusion surgery will leave me about where I am but without the pain. The downside is time off work, time off climbing and really anything on my feet. I have two notable risks, one is infection just like with any orthopedic surgery. The other is that the fusion breaks. Ill probably be very careful for a while.

You are in a position to lose real function. It's not simply a pain thing. It's a hard decision you have to make. As a climber, I'd probably go for the thermal shrinking and loads and loads of time off.  Reassess later.

I wonder what timescale the bone spurs would come back on if you removed them?  Or is the joint damage so complete that that isn't an option? 

I'm finally starting to see results from PT, and I'm out of a splint and able to do light yoga and stuff.  Healing takes time, but being patient has yielded results, and I still have the irrational hope I'll eventually get stronger than I was before.

Side note: what's your milage with aid climbing?  My "comeback plan" involves a lot of aid climbing because I think it'll be easy on my wrist, maybe the same is true for your toe?

Bone spur removal would probably give me motion again. Not change the pain, and give me the scar/healing time of the full surgery. There's not a toe arthroscopic surgery I'm aware of.

I'd rather get it done and put it behind me.

For recovery, I'll be cycling, hiking, and chasing kids. I have very little time and no local access to aid, it wouldn't be worth it to me.

I'm actually in the process of scheduling an osteotomy for my hallux rigidus (and terrified about getting back to climbing form).  My podiatrist says she doesn't really like the cheilectomy because it doesn't decompress the joint at all and will still wear away the joing.  She thinks a fusion was more of the last resort.  Have you looked into a decompression osteotomy?  I'm sure you have and ruled it out for one reason or another but it sounds like results are generally very good.  Figured it was worth mentioning just in case.  Good luck!