Tell me about your toe fusion

Grant H wrote:

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.

Hi Grant - i’ve completed around 15 runs now, no more than 6.5kms. I’m still getting fitness back so have stuck to hill / 800m reps etc.

I also bought a peloton which was really good for maintaining fitness. I got back on that asap but avoided  any standing.

When I first started walking I found I was subconsciously avoiding placing too much weight on my toe and instead placing weight on the side. My surgeon had warned me about this and after a couple of weeks it became a non-issue. I’ve done a few 5 mile plus walks now.

As far as running goes, my form has changed a bit. I was never an elegant runner but my right foot (the non operated foot) now points out a bit. I was always a mid foot striker and still am, but i’m running in shoes that aren’t the best for me. I need some rockers, something like Hokas to give me that forward roll i’ve lost, but lockdown has prevented me from buying these plus I want everything to settle. Pace wise my short reps aren’t far off the times I was posting previously.

I have no plans to run any more marathons.....before the op I would have been happy to be able to run a 400m circuit, now i’m targeting 10k, 10 miles and perhaps the odd half. I ran 2 marathons with arthritis (before I was diagnosed) and it was so painful. I get the odd aches and pains now, but nothing like before. I do find myself looking down more as I’m paranoid about stubbing my toe for some reason. Also, i’m still learning how to manage uneven ground as I think the big toe helps in balance, but i’m sure that will come back.

It just struck me I should add that if I had more time i’m sure I would be running a lot further. Covid 19 has left me really busy at work and I’m not training as much as I’d like. I think it’s mainly lack of endurance that is holding me back rather than my foot. I was mentally prepared for the worse outcome  post op and am delighted with the outcome.

So glad I found this site! I'm not a climber but do suffer from hallux rigidus stage 4. I  will be needing a toe fusion sometime in the near future. I'm a very active 66 year old female. I think what scares me the most is the pain after the surgery.
I would appreciate anyone that could comment on this. 

Linda Smith wrote: So glad I found this site! I'm not a climber but do suffer from hallux rigidus stage 4. I  will be needing a toe fusion sometime in the near future. I'm a very active 66 year old female. I think what scares me the most is the pain after the surgery.
I would appreciate anyone that could comment on this. 

Day 1, the knee block and local anaesthetic meant I didn’t feel much. Days 3 and 4 (the 2nd night onwards) were the worst and not at all pleasant. I stopped taking the pain meds on day 5 I think it was as I didn’t like how they made me feel.

The worst bit after that was the boot I had to wear and all the bandages. My foot felt permanently hot, swollen and sweaty. I would take my boot off to find it quite damp inside. I was supposed to keep my boot on all the time, but I had to take it off from time to time just for some relief. When the bandages were removed and then a week later the stitches it was such joy!

Like you i’m very active and did as little of the resting up part as possible. This was against advice and probably contributed to the swelling issues, but I think it also helped me return to running so quickly.

In summary, I can’t pretend it was anything other than unpleasant. I was awake for the procedure and heard everything which was probably the worst part....but I wouldn’t have not had it done with the benefit of hindsight. Honestly my life is so much better and less painful. I did my first 10km run last weekendi

So I'm a nurse, I really should have known better.

Day of the surgery I was happy and numb. Excellent block. I didn't take anything for pain, about 5am the next day I thought I was going to die. Worst pain I've ever had. It took me all day to get ahead of the pain.

By day 2 and being smarter about meds, it was fine.

I'm 7 months out now and it's fine daily. Still working on climbing with it, it's a process. I did a 12 mile ridge traverse the other day and was fine.

For yardwork, possibly work, and general, I'd suggest casual steel toe shoes. There are cheap ones on eBay and Sketchers makes them too. Once you can get shoes back on, they add a lot of confidence to walking. They saved me a couple times. I don't need them now but still wear them at work, just in case I stub my toe.

highaltitudeflatulentexpulsion wrote: So I'm a nurse, I really should have known better.

Day of the surgery I was happy and numb. Excellent block. I didn't take anything for pain, about 5am the next day I thought I was going to die. Worst pain I've ever had. It took me all day to get ahead of the pain.

By day 2 and being smarter about meds, it was fine.

I'm 7 months out now and it's fine daily. Still working on climbing with it, it's a process. I did a 12 mile ridge traverse the other day and was fine.

For yardwork, possibly work, and general, I'd suggest casual steel toe shoes. There are cheap ones on eBay and Sketchers makes them too. Once you can get shoes back on, they add a lot of confidence to walking. They saved me a couple times. I don't need them now but still wear them at work, just in case I stub my toe.

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?

Stuart Phillips wrote:

Day 1, the knee block and local anaesthetic meant I didn’t feel much. Days 3 and 4 (the 2nd night onwards) were the worst and not at all pleasant. I stopped taking the pain meds on day 5 I think it was as I didn’t like how they made me feel.

The worst bit after that was the boot I had to wear and all the bandages. My foot felt permanently hot, swollen and sweaty. I would take my boot off to find it quite damp inside. I was supposed to keep my boot on all the time, but I had to take it off from time to time just for some relief. When the bandages were removed and then a week later the stitches it was such joy!

Like you i’m very active and did as little of the resting up part as possible. This was against advice and probably contributed to the swelling issues, but I think it also helped me return to running so quickly.

In summary, I can’t pretend it was anything other than unpleasant. I was awake for the procedure and heard everything which was probably the worst part....but I wouldn’t have not had it done with the benefit of hindsight. Honestly my life is so much better and less painful. I did my first 10km run last weekendi

Hey Stuart - any update on your procedure and toe?    I am very encouraged by your recovery as I don’t want to consider that I couldn’t be as active as I am today, regardless of the pain.  

Steven Teofilo wrote:

Hey Stuart - any update on your procedure and toe?    I am very encouraged by your recovery as I don’t want to consider that I couldn’t be as active as I am today, regardless of the pain.  

Hi Steven,

Yes an update of sorts.

The big toe that was fused is pretty good generally. My running was going well and my walking distances are over 20km. But........when I went in for my op there was some debate amongst the surgeons over whether they would correct the orientation of the toe next to my big toe at the same time. They decided to do nothing and I've now noticed on longer walks this toe rubs on my now straight big toe, causing blisters and some pain in that uncorrected toe. I did do a longer walk last week and used hikers wool that helped a great deal. I also find if I'm slightly less active my feet can often hurt. This is generally solved by using them, I'm just more aware of it.

So, onto other news - my running was going really well, until I noticed I was getting pain in my other big toe similar to that of the now corrected toe. I had an x-ray and it showed arthritis there, albeit rated as mild. As the doctors had rated the x-ray on the other foot as mild and the surgeons decided it was severe during the operation I have pushed to get back on to the consultants lists. This is a common requirement in the UK as it's effectively treated as a new event, so I'm now waiting for that appointment. Covid may have a part to play in how quick that is.

I've dropped my running down to once a week until I see the surgeon as I don't want to make matters worse.

8 months on, still no regrets!

So I'm basically healed up and just rebuilding.

For several months now, I've climbed in a pair of Boreal Aces that are too big. It was an imprecise but workable solution. I generally had no trouble on most 10's and couldn't do 11's. I got out approximately 3 times a month since probably March.

Over the summer I did some steep hill-walking. Crestone Traverse, Little Bear to Blanca, and some other thing off I70. These are long days on the feet and due to the semi technical nature, must be done in approach shoes, not some heavy duty clodhopper. Other than obvious fatigue, I was fine. I do have a new hotspot on my toe since it's now straighter and interacts inside my shoes differently.

About a month ago, I tried climbing in my regular shoes. Anasazi VCS and Pinks. Snug not tight. To my surprise, I was fine. I've been doing a lot of stuff at Shelf and also some SoCo slab climbing and it's been fine. I thought I'd have to relearn some technique due to missing a joint now. Not so, it's just like before without the pain. Probably because the toe was so stiff it was essentially fused anyway, just very painful. I haven't tried thin cracks yet and don't know what footwear I'd choose and if I could do it at all. I probably won't climb .75's barefoot ever again.

I can hike with a full pack and a 27 pound toddler on my shoulders now. No foot problems there.

Still haven't run. I might give it up. I kinda wanted one mile under 5:00 in my lifetime but I'm not sure my knees and hips agree.

It's been like 10 months since I got it done. It's been 8 or 9 of not sure if it was a good idea, and the last month I've been very pleased. 

 

Stuart, same here. My good toe is starting to act like the one I ended up fixing.

From where it is now, if it follows the path of the other, I've got 10 years before fusing it.

highaltitudeflatulentexpulsion wrote:

So I'm basically healed up and just rebuilding.

For several months now, I've climbed in a pair of Boreal Aces that are too big. It was an imprecise but workable solution. I generally had no trouble on most 10's and couldn't do 11's. I got out approximately 3 times a month since probably March.

Over the summer I did some steep hill-walking. Crestone Traverse, Little Bear to Blanca, and some other thing off I70. These are long days on the feet and due to the semi technical nature, must be done in approach shoes, not some heavy duty clodhopper. Other than obvious fatigue, I was fine. I do have a new hotspot on my toe since it's now straighter and interacts inside my shoes differently.

About a month ago, I tried climbing in my regular shoes. Anasazi VCS and Pinks. Snug not tight. To my surprise, I was fine. I've been doing a lot of stuff at Shelf and also some SoCo slab climbing and it's been fine. I thought I'd have to relearn some technique due to missing a joint now. Not so, it's just like before without the pain. Probably because the toe was so stiff it was essentially fused anyway, just very painful. I haven't tried thin cracks yet and don't know what footwear I'd choose and if I could do it at all. I probably won't climb .75's barefoot ever again.

I can hike with a full pack and a 27 pound toddler on my shoulders now. No foot problems there.

Still haven't run. I might give it up. I kinda wanted one mile under 5:00 in my lifetime but I'm not sure my knees and hips agree.

It's been like 10 months since I got it done. It's been 8 or 9 of not sure if it was a good idea, and the last month I've been very pleased. 

 Man that’s a long recovery time but now it’s a matter of deciding to live with lain for rest of my life or get it fixed and hope for the best   Thanks for the feedback!

It has been interesting to read this thread as I have had 2 toe fusions (one on each big toe) so I thought I would chime in. I’m not a climber but  I’ve always been extremely active and became a triathlete at age 47.

I was my surgeon’s youngest patient when I was first diagnosed with severe arthritis in my right toe. I was 38. Years of cheerleading, soccer, running and step classes were most likely the cause.

My surgeon, considered the preeminent in this field, recommended shaving the bone down to maintain my flexibility. She didn’t like the idea of a fusion because I was so young. So, I had that done, but 6 months later was in so much pain it was determined a fusion was the only option. I had 2 screws put in (no plate) and, lucky for me it fused perfectly because I have strong overall bones. I was now 40. She told me my left foot would probably need to be done in10-12 years.

12 years and 13 Triathlons later, I walked into her office limping. This time she put in 7 screws and a plate. I went on to do a couple of more triathlons and have been pain free, however I fear, the left toe fusion changed my gait and, despite the fact that I am not overweight, still active and my surgeon’s only triathlete, I am now facing a left hip replacement at the soon to be age of 60.

i won’t let that stop me from being active again, but just a cautionary tale to ask about how a fusion will affect your gait years down the road and whether a joint replacement is a better option. A friend of mine who is equally active and has two toe fusions had them reversed by a Doc at Georgetown who put in the newest implants at the time. She is doing very well biking, walking and hiking.

constance C wrote:

It has been interesting to read this thread as I have had 2 toe fusions (one on each big toe) so I thought I would chime in. I’m not a climber but  I’ve always been extremely active and became a triathlete at age 47.

I was my surgeon’s youngest patient when I was first diagnosed with severe arthritis in my right toe. I was 38. Years of cheerleading, soccer, running and step classes were most likely the cause.

My surgeon, considered the preeminent in this field, recommended shaving the bone down to maintain my flexibility. She didn’t like the idea of a fusion because I was so young. So, I had that done, but 6 months later was in so much pain it was determined a fusion was the only option. I had 2 screws put in (no plate) and, lucky for me it fused perfectly because I have strong overall bones. I was now 40. She told me my left foot would probably need to be done in10-12 years.

12 years and 13 Triathlons later, I walked into her office limping. This time she put in 7 screws and a plate. I went on to do a couple of more triathlons and have been pain free, however I fear, the left toe fusion changed my gait and, despite the fact that I am not overweight, still active and my surgeon’s only triathlete, I am now facing a left hip replacement at the soon to be age of 60.

i won’t let that stop me from being active again, but just a cautionary tale to ask about how a fusion will affect your gait years down the road and whether a joint replacement is a better option. A friend of mine who is equally active and has two toe fusions had them reversed by a Doc at Georgetown who put in the newest implants at the time. She is doing very well biking, walking and hiking.

Thank you for sharing.  Did you develop Hallux Rigidus in both joints before fusion?  I have an interesting confounding factor, in that I have Ehlers Danlos HT, so my feet are super flexible, and always will be, despite the fact that I have arthritic changes in the MTP joint of my great toe on my left foot.  All stemming from a barefoot running "accident" 8 years ago, where I hyperdorsiflexed my big toe and put all of my weight on it.  I go through periods of having zero pain, and other periods where its hard to walk, and squeezing my feet into climbing shoes is not an option. I average about 50 trail miles per month (scrambling and hiking), and climb about 10 days outdoors, mostly projecting hard sport climbs and boulders, meaning I cram my feet into extremely small, painful shoes.  Certainly doesnt help.  Wondering if anyone else in this forum has Ehlers Danlos HT, and is dealign with great toe MTP joint arthritis/arthrosis. 

BK, in my early 20s I did two Ironmans and maybe 50 (75?) shorter ones. So I can understand that. I vividly remember losing an entire big toenail when I went for a 20+ mile brick run because I kept a blistered toe taped up. It literally smelled like raw meat.

As I stated earlier in the thread, I am a circulating nurse in the OR. I've seen hundreds of total hip replacements. Your age is only a little young. Honestly, it's not abnormal for an active person your age to have a total hip. Regardless of your toes. 

Ask for an anterior approach and make your doc justify why not if he doesn't want to.

Good luck. 

I did develop Hallux Rigidus in both great toes.

Congrats on your Ironman successes. Because of my toe fusions I can’t do an Ironman, the run is too long of a distance for me. And thank you so much for the advice regarding hip replacement, I really appreciate it! I want to remain active so I’m going to have it sooner rather than later. I’ve had x-rays but not an MRI. Do you believe one is needed?

Hello,  Can anyone on this thread let me know the Dr's you have seen for Hallux Rigidis that resulted in surgery...Possibly fusion... I am in a very bad place with my HR and it is getting very nearly time for surgery.

Only let me know if you loved your Dr.  I live in the basalt and aspen area.  Will travel to the best Doc.  You can private message me too.   via text..970-618-7221

Thank you!

Amy

constance C wrote:

It has been interesting to read this thread as I have had 2 toe fusions (one on each big toe) so I thought I would chime in. I’m not a climber but  I’ve always been extremely active and became a triathlete at age 47.

I was my surgeon’s youngest patient when I was first diagnosed with severe arthritis in my right toe. I was 38. Years of cheerleading, soccer, running and step classes were most likely the cause.

My surgeon, considered the preeminent in this field, recommended shaving the bone down to maintain my flexibility. She didn’t like the idea of a fusion because I was so young. So, I had that done, but 6 months later was in so much pain it was determined a fusion was the only option. I had 2 screws put in (no plate) and, lucky for me it fused perfectly because I have strong overall bones. I was now 40. She told me my left foot would probably need to be done in10-12 years.

12 years and 13 Triathlons later, I walked into her office limping. This time she put in 7 screws and a plate. I went on to do a couple of more triathlons and have been pain free, however I fear, the left toe fusion changed my gait and, despite the fact that I am not overweight, still active and my surgeon’s only triathlete, I am now facing a left hip replacement at the soon to be age of 60.

i won’t let that stop me from being active again, but just a cautionary tale to ask about how a fusion will affect your gait years down the road and whether a joint replacement is a better option. A friend of mine who is equally active and has two toe fusions had them reversed by a Doc at Georgetown who put in the newest implants at the time. She is doing very well biking, walking and hiking.

Hi Constance, may I ask why was it the left fusion which changed the gait and not the right toe fusion that was done earlier? Did you go through any PT post surgeries? Thank you!

Hi can anyone help me please I had my surgey yesterday when I woke up I can briefly remember the doctors saying it was worse than expected

constance C wrote:

It has been interesting to read this thread as I have had 2 toe fusions (one on each big toe) so I thought I would chime in. I’m not a climber but  I’ve always been extremely active and became a triathlete at age 47.

I was my surgeon’s youngest patient when I was first diagnosed with severe arthritis in my right toe. I was 38. Years of cheerleading, soccer, running and step classes were most likely the cause.

My surgeon, considered the preeminent in this field, recommended shaving the bone down to maintain my flexibility. She didn’t like the idea of a fusion because I was so young. So, I had that done, but 6 months later was in so much pain it was determined a fusion was the only option. I had 2 screws put in (no plate) and, lucky for me it fused perfectly because I have strong overall bones. I was now 40. She told me my left foot would probably need to be done in10-12 years.

12 years and 13 Triathlons later, I walked into her office limping. This time she put in 7 screws and a plate. I went on to do a couple of more triathlons and have been pain free, however I fear, the left toe fusion changed my gait and, despite the fact that I am not overweight, still active and my surgeon’s only triathlete, I am now facing a left hip replacement at the soon to be age of 60.

i won’t let that stop me from being active again, but just a cautionary tale to ask about how a fusion will affect your gait years down the road and whether a joint replacement is a better option. A friend of mine who is equally active and has two toe fusions had them reversed by a Doc at Georgetown who put in the newest implants at the time. She is doing very well biking, walking and hiking.

Hi Constance,

My wife is due to have a fusion in a few months time and she is wondering how much does it change what you can do and if it will feel odd having the big toe fixed and unable to bend? It seems unnatural but your story and others like it seem to suggest it still gives you most of your day to day functionality.

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. 

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