Tell me about your toe fusion

Hi, was it your big toe? I'm glad your surgery went well and your pain is easing and I'm so glad you started this forum as everyone has provided some great info. I found this forum whilst trying to find success stories of toe fusion having been given that as the only option now. Funny thing is I used to be a climber - pre kids and injuries and am now wondering if climbing exacerbated my joint degradation as so many climbers have it. I have hallux rigididus of the right big toe - MCP joint which is the one at the base of the toe. I had a cheilectomy in 2008 and was advised I'd get 10-12 years before needing surgery again. I had a great 5 years before the pain started to come back. It was gradual and with constant use of orthotics, no heels, dry needling and mobilisation exercises and cortisone injections in the last year I've gone 11 years. In hindsight that probably wasn't the best idea as I have had increasing problems with my back and hip due to my gait - even with constant use of orthotics - and now can't have another cheilectomy as it's so bad - fusion is my only option. I am very nervous about having that joint fused as I've heard it can put extra pressure on the ankle and then the knee and hip. Surgeon reckons not having it done has and will continue to cause other problems. I have started to develop it in the left foot now which is very common once you have it and also have mortons neuroma in that foot due to poor gait. I am regretting not having a 2nd surgery a few years ago when the bone spurs were back and I started to get pain - could have had another cheilectomy then. The effect it's had on the rest of my body - hip especially - is really what has prevented me from returning to climbing and I can no longer go hiking or even brisk or long walks due to the pain in my foot. Swimming is my thing now.

I'd love to hear from someone wh has had the MCP fused. I heave searched and searched and can't find any success stories or forums on it within the last 5 years. Have asked surgeon to put me in touch with his patients as he told me they'd had great success and gone back to sport and even run marathons. I'm 47 but feel like 87 right now so it's a comfort to hear of all you lovely, fit, adventurous people with similar issues. Makes me feel normal   I have enjoyed indoor climbing with my kids since my op as long as I don't try anything challenging I'm fine. 

The big toe only has 2 joints - doesn't have a distal. I found this when I got confused about which joint is which:

From https://www.arthritis.org/about-arthritis/where-it-hurts/foot-heel-and-toe-pain/foot-anatomy.php:

Joints in the feet are formed wherever two or more of these bones meet. Except for the big toe, each of the toes has three joints, which include:

metatarsophalangeal joint (MCP) – the joint at the base of the toe
proximal interphalangeal joint (PIP) – the joint in the middle of the toe
distal phalangeal joint (DP) – the joint closest to the tip of the toe.
Each big toe has two joints:

metatarsophalangeal joint
interphalangeal joint

Thanks and happy healing!
Shelly

You should ask your doc about joint replacement. It looks like a hemi-knee but teeny tiny.

I've seen several of these done and haven't heard of them failing. I do have a co-worker with one and she's happy. Not a climber but she does spend all day standing, so it must be ok.

I'm not a podiatrist but I just can't imagine having the PIP/mcp (same thing for the big toe) fused. 

I'm 82 and have had arthritis in my right toe for almost 20 years which  my podiatrist said was probably caused by rock climbing, ice  front-pointing ,  and skiing . I declined surgery & instead wrap my toe joint in lambs wool and can walk, cycle, ski all day without pain. Good luck !

Gerald Adams wrote: I'm 82 and have had arthritis in my right toe for almost 20 years which  my podiatrist said was probably caused by rock climbing, ice  front-pointing ,  and skiing . I declined surgery & instead wrap my toe joint in lambs wool and can walk, cycle, ski all day without pain. Good luck !

Can you say more about how you wrap the joint? I can’t picture this. Is it a high pressure wrap?

highaltitudeflatulentexpulsion wrote: You should ask your doc about joint replacement. It looks like a hemi-knee but teeny tiny.

I've seen several of these done and haven't heard of them failing. I do have a co-worker with one and she's happy. Not a climber but she does spend all day standing, so it must be ok.

I'm not a podiatrist but I just can't imagine having the PIP/mcp (same thing for the big toe) fused. 

I know. I expected it to be the absolute last resort. Surgeon’s words were “implants and joint replacements have been tried and tested but they don’t last and often don’t work for advanced HR.  Possibly his opinion as I’ve already had cheilectomy and only have 20-30 degrees range there now with gait already affected a lot of pain and problems. I’m going to get a second opinion. 

If anyone is worried about my toe, here's an update.

I can walk again. I'm not sure how much but I'll find out soon since Im returning to work.

I haven't attempted to get a climbing shoe on yet and won't until x-ray shows a complete fusion. I've climbed a few times with the walking cast and now can in a mountaineering boot. I can live with that for a while.

I lightly stubbed my toe the other day and didn't scream, so it really is a lot better. I'm finally starting to feel like I'll be able to do things again.

And holy crap, one gets soft sitting around for 6 weeks.

Glad to hear your toe is moving to resolution!  What's your docs estimated time to complete fusion?  Is it really a good idea to be risking climbing with an incomplete fusion?

Christopher Smaling wrote: Glad to hear your toe is moving to resolution!  What's your docs estimated time to complete fusion?  Is it really a good idea to be risking climbing with an incomplete fusion?

We don't have an estimate since I am really far ahead. I guess the typical podiatry patient is type 2 diabetic, gouty, and smokes. Probably sometime in March.

My risk is minimal. I use the boot to immobilize the foot, crank off the heel if I can. Otherwise I will use my other foot. No bouldering or leading. It's probably less strain than the cycling I am allowed to do (carbon fiber cycling shoes ftw).

I kind of want to turn this into a bitch fest about health care fees.

I am a full time RN with the employee policy from my hospital. The procedure was done where I work. One hour in the OR $31,000, one screw and some bone graft $12,900, and hour in the PACU $7000. The fee's from the people who actually did the surgery, the surgeon and anesthesiologist/CRNA were quite reasonable $1000 and $2700. I'll owe $4000, which I expected and planned for. Still, it's absolutely mind boggling the prices when you break them down.

So if you get arthritis in your toe, maybe move to literally any other developed country in the world first.

Thanx for this super informative thread. after stuffing my tootsies into vice-like climbing kicks for ... ever.
I've been trying to find/use stiff (board-lasted) shoes. original Ballets & the newer "Golds" Also (white) Schyncros & (blue)Kaukolators.
 I've been best served by adding popsicle sticks to the underside of a foam & leather custom orthotic.
placed into a (yellow w/ velcro)climbing slipper/shoe made by Mammut that is a 1/2size larger than my usual size.

highaltitudeflatulentexpulsion wrote: I kind of want to turn this into a bitch fest about health care fees.

I am a full time RN with the employee policy from my hospital. The procedure was done where I work. One hour in the OR $31,000, one screw and some bone graft $12,900, and hour in the PACU $7000. The fee's from the people who actually did the surgery, the surgeon and anesthesiologist/CRNA were quite reasonable $1000 and $2700. I'll owe $4000, which I expected and planned for. Still, it's absolutely mind boggling the prices when you break them down.

So if you get arthritis in your toe, maybe move to literally any other developed country in the world first.

yUP  For many,  the real reason that we have to stop climbing (hard) has more to do with the cost of health care, than anything else.   The cost of "Elective" procedures can snow-ball.  The risk of poverty due to crushing medical debt is not an option when trying to have a family. 

highaltitudeflatulentexpulsion wrote:

We don't have an estimate since I am really far ahead. I guess the typical podiatry patient is type 2 diabetic, gouty, and smokes. Probably sometime in March.

My risk is minimal. I use the boot to immobilize the foot, crank off the heel if I can. Otherwise I will use my other foot. No bouldering or leading. It's probably less strain than the cycling I am allowed to do (carbon fiber cycling shoes ftw).

So good that I have found this forum. While I am not a climber, I have the same condition with fusion surgery recommended. 

How has your recovery been going?
I have read of possible pain in the foot even after recovering from the surgery and the risk of non-fusion (I am a smoker) which makes me scared to go through with the op. 
Doctors here will “sell” treatments to you to get it done

Steve Dubai wrote:

So good that I have found this forum. While I am not a climber, I have the same condition with fusion surgery recommended. 

How has your recovery been going?
I have read of possible pain in the foot even after recovering from the surgery and the risk of non-fusion (I am a smoker) which makes me scared to go through with the op. 
Doctors here will “sell” treatments to you to get it done

Steve. You said you aren't a climber?

I don't know if I can recommend the surgery yet. Basically, while climbing I had such debilitating pain that I'd rather not do it. However, cycling, hiking, and running were fine except on very long days or occasional mis-steps. It just wouldn't have been enough of a problem to fix.

For healing, it's ok. I can now climb a bit more using a Boreal Ace 2 sizes too big on that foot. It's not agony and it's beginning to work. Due to covid, I just don't have the time on the rock this year to really know how well it is working. I did discover that I can again climb 2 days in a row. I haven't been able to do that for years.

I'm 6 months out. It's sore if I bump it and after a long day, the scar is sore from pressure inside the shoe. I wear steel toe shoes at work, and I think they've saved me twice. I won't be switching back to regular shoes any time soon.

I took an x-ray in early Feb, it showed near complete healing around the screw. I'd love to take another shot but I didn't have as much unfettered access to a C-arm recently so I don't know. I bet it's great.

Overall, I'm still hopeful that I'll be totally happy with it. I'm not there yet.

highaltitudeflatulentexpulsion wrote:
Steve. You said you aren't a climber?

I don't know if I can recommend the surgery yet. Basically, while climbing I had such debilitating pain that I'd rather not do it. However, cycling, hiking, and running were fine except on very long days or occasional mis-steps. It just wouldn't have been enough of a problem to fix.

Thanks for the update. Sound like it’s going well - I am told to expect a year for full recovery.

I am not really an active guy - I get to the gym occasionally, but my toe really limits my exercising ability - after walking for about 2 miles it will throb for 2 days - no way I can run for any distance - plus I get calluses on the base of my foot (As I am putting pressure on the other foot areas) which gets really painful at times. Overall it’s not really affecting my daily life, as I have an office based job and don’t get pain unless I walk a lot, but it’s only getting worse over time, so I guess I’ll have to get it done at some point.
It is only the risk of the non-fusion from smoking and leg pain after recovery that is putting me off (then of course finding the right surgeon)
Wish you all the best for a full recovery 
Steve

Smoking is just going to hinder your healing process - you’re quite literally shooting yourself in the foot.  As someone with a couple life-long smokers in my family, I sympathize with the difficulty of quitting, but quitting smoking to mitigate the risk of non-union seems like it should be the first step in your surgical journey.

I have an otherwise healthy 28 year old friend who was refused surgery for his labrum tear until he quit smoking.  These things matter.

Steve, nobody here should be lecturing on smoking. It's not 1945.

Anyway, I think that your case is more advanced than mine or the bone spurs are in a location to cause more pain walking than mine.

Fusion is an easy surgery. I walked into the surgery center around 9am and my wife picked me up by noon or so. It was about an hour and a half in the OR.

You have 2 options, a wire run down the toe to hold it together or a screw in the cortex. I opted for the screw because I thought it'd heal up better with something bigger holding it together. A k-wire is also sticking out of the toe and removed when decent fusion is achieved. So that's something to snag or stub for a while, it'll also keep you off your feet longer. On the other hand, once it's gone, no implant.

You'll be totally on crutches for 3-4 weeks spending most of your time dealing with swelling. A walking boot for 3-4 more weeks.

It probably started feeling good to walk at 3 months. It still does bother me a little every day.

I haven't run on it yet on purpose but I've got two little ones I've effectively chased recently. Found myself running the hall at work the other day too. So it's getting there.

If I was not a climber, I'd pretty much call it done. As you may imagine, this hobby puts tremendous and repeated strain on the toes.

Find a podiatrist between 35 and 50. You want one young enough that he's not completely surly about new techniques and technologies. You also don't want one fresh off their fellowship, experience matters. Aside from that, pick someone you like.

Thanks for the feedback.

Chris - your comments are encouraging. I have actually given up for a month now. My worry was I had only just given up and had thought having been a smoker for 10 years or so would be increasing the risk of non-fusion substantially. The medical system where I live is so commercially / profit driven that the doctors will “sell” you the procedure, downplaying the risks, so they can get the $ in their pocket.

high - my toe joint has zero movement - so it’s pretty much advanced. I just can see I am going to need this to be done at some point as it’s only going to get worse. I am 56, so healing / recovery time is only going to get longer the more I postpone it. I am just scarred of being left with ongoing pain that I had read about - but seems this is not something affecting you.

Good morning all,

Although I’m not a climber, I am a hiker and was drawn to this forum after researching great toe fusion. There is not a lot of info on the web but I came across this forum with hopes forrecommendations regarding best hiking boots, and I may be able to help offer insight after my experience.
I am a 56 year old fitness instructor and also a hiker with a goal to finish the 48-4000 fitters in the  White Mountains.

In 2015,  I was dx with Hallux Rigidus as of result of a unresolved broken toe in my teens. I could no longer fit into my fitness shoes and surgery was necessary. I was told the surgery would give me another two years and would likely need a joint replacement or toe fusion.
I was able to get by for 5 years. I started having lots of pain while hiking and difficult time  fitting into my fitness shoe once again.
I went for a 2nd opinion. I was told joint replacements are not perfected and makes for additional surgeries to correct. It was recommended to have a toe fusion at this stage which would be my final surgery. 
I decided for a toe fusion which was completed In March of 2020. 
I was unable to walk on it for 8 weeks. I discovered a shoe with good reviews, LEMS Primal 2,  and purchased them because of a wide toe box after being told I would no longer be able to wear shoes with a heel over an inch. They are perfect as I begin to walk.
It may take a good 6 months before full cardio workouts and hiking and a full year to be healed.
I’m wondering if there is anyone who has had a toe fusion, or educated in this area and would be able to provide insight/recommendations on best boot for hiking and offer their experience on hiking after a toe fusion. 
Thank you in advance,Denise

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.

I really appreciate the info in this thread. I'm 28 and am having dull aches in my left big toe MTP joint. I have not seen a physio about it (planning to) but I'm a little convinced it's chronic/arthritis. It doesn't hurt all the time but after climbing for a bit it gets sore. It also looks a little bruised right now. I plan on taping it up to help support it.

That said, has anyone had any experience with a fusion of the MTP joint (the one that connects the toe to the foot)? At the very least other people's success stories about fusions at other joints give me some comfort...

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.

I found this thread when I was searching for info on a big toe fusion - thanks to everyone who has contributed such useful information. Stuart - particularly good to hear your input since I too am not a climber, but a runner with more than 100 marathons and ultras under my belt. I've had issues with my right big toe for 5+ years, rendering running impossible. I tried a cheilectomy but the joint was already too far gone (moral - don't wait too long after the initial onset to have this procedure). Last year I tried a Cartiva implant that failed spectacularly. The implant became loose and rotated and causes pain through the entire top of my toe that is far worse than what I had pre-surgery. Some of the doctors I've talked to since the surgery are saying Cartiva procedure has come under greater scrutiny because, with time, the results are less encouraging than they had thought originally.  I looked into joint replacements but the research on that isn't any more promising than on Cartiva. And one doctor said that since the joint is already "so shredded" that fusion is the only viable alternative. 

Stuart - did you have to alter your gait when you started running again or do any extensive retraining of how you run/walk?  Were you a forefoot striker?  Seems like that would make the gait retraining all the more difficult.

I'm having the procedure in the fall and will gladly post back thoughts and recovery status if anyone is interested. I've had a lot of ortho-related issues over the years and sometimes I feel like these message boards are just as useful as anything you get from your doc.