Greetings,

I write to you now in the hopes that you might be able to shed some light and possibly give me some advice on a situation that I can only describe as a living nightmare.

Several years ago I was diagnosed with a Hallux Limitus condition with accompanying bone spurs in the first metatarsal joint of my right foot that was subsequently treated with non-invasive techniques such as icing and stretching. Unfortunately, even after two years of this treatment, the condition eventually worsened, and I was prompted to seek out and interview surgeons in the hope that surgery might help.

After a considerable amount of research, I was able to locate a surgeon that was not only was highly respected in the field, but that specialized in this type of procedure. This doctor led me to believe that although cleaning up the bone spurs around the joint would give me more movement and subsequently reduce pain, it would only be a matter of time before the condition returned, and thus, an osteotomy was strongly recommended. As I’m sure you probably know, this surgery required that the first metatarsal bone be slightly shortened and reattached with screws, insuring pain-free movement in the joint without the return of bone spurs over time.

I had the first surgery in the summer of 2004, and after many months of post-operative rest, manual manipulation of the first phalange, and prescribed exercise, it became very clear to me that another serious complication had arisen. Although the doctor was continually describing my recovery as being unusually positive, and the osteotomy had certainly provided me with reduced pain and more movement in the first metatarsal joint, I now had a second metatarsal joint that appeared to be out of place. Because the first metatarsal bone was now significantly shortened and because the second metatarsal joint was now placed significantly forward, every time I placed weight on the foot, or engaged in forward momentum such as walking, it felt as if my second metatarsal bone was tearing through the bottom of my foot. This new unexpected turn of events completely blindsided me, and made my initial hallux limitus pain seem like a walk in the park by comparison.

It was at this point that the doctor informed me that roughly 30% of all patients who undergo the initial first metatarsal osteotomy report this ‘off-loading’ problem, and that I happened to fall into that category. Furthermore, he mentioned that both my athletic background and my high expectations for total recovery pre-disposed me for disappointment, since most patients wouldn’t care as much or wouldn’t report complications if they arose, since those individuals weren’t as committed to an active lifestyle.

Over the course of the next two years, I visited the doctor every other week for post-operative visits, refrained from wearing normal shoes and went through no less than four pairs of prescribed orthotics in an attempt to rectify the problem without surgery. Because of the swelling and accompanying pain, I had to receive cortisone shots directly into the second metatarsal joint every other month just to walk without screaming. Because of this pain, the inability to walk and/or exercise for extended periods of time, and the bizarre feeling that I had someone else’s foot attached to my leg, I managed to put on 50 unwanted pounds to my once athletic frame and enter into a state of severe depression.

I had the second surgery to shorten the second metatarsal bone and reattach with screws in the summer of 2006. This time, I was informed that there was less than a 10% chance that off-loading would occur after surgery, and less than a 10% chance that I would subsequently experience pressure in the third metatarsal joint. After several months of post-operative rest, manual manipulation of the second phalange, and exercise as directed, it appears that the second surgery has not gone as planned. Although the x-rays appear to be normal, there is excessive swelling in the second metatarsal joint accompanied by more pain than ever. Furthermore, it appears that a hard callous has developed between the second and third metatarsal joints, presenting even more complications and discomfort. To offset the pain and reduce the swelling, a cortisone shot was recently injected directly into the second metatarsal joint once again. This time, however, the pain has not subsided.

I have come to the end of my patience regarding this situation, and have accumulated a considerable amount of regret with having had both procedures. I write to you out of desperation, and in the quest to determine whether I will be able to walk normally ever again, and what I can do in the interim. Perhaps you might be able to provide some answers and some hope to someone who has practically run out of both. I look forward to hearing from you.

Thanks.

Matthew,
Sorry about what you are going through.
Conservative treatment for painful toes would contain shoe modifications to reduce the demand for your toes to bend upward (Dorsiflexion). This would be a Rigid Rocker sole shoe modification. Its not overly visible, and is not very expensive. If your toes can't bend up, they won't hurt as much. If your 2nd met head is still painful, then an extension under your 1st met head offloads the 2nd, while at the same time brings the 1st met head to the end of its range of motion, making it rigid and less painful to walk on as it doesn't bend upward as much.

Don't feel bad. You did what you did. Let see if we can get you to walk more pain free and get that 50 lbs off.

Best,
Spencer Weisbond, C.Ped.

Matt

Without examining your foot I cannot tell you the minimum modification your could get away with.

These suggestions are not much different than Spencer's suggestions.

Shoe modification:1/4" rocker bottom with extended shank

Custom foot Orthosis: full length, with met bar or pad, combination sesmoid post and met post ( to even out toe break and added a rocker to the insideof the shoe.That will increase range of motion inside of the shoe and reduce the need for a rocker on the the outside) and a carbon plate ( springlite foot plates available from Otto Bock is what I prefer).

With these modifications walking should be obtainable, jogging possible, running and sprinting doubtful.

I have delt with patients simular to you both presurgery and those who have come post surgery.

Have your your four previous Orthothisis been full length? (did they have modification that went under the ball of your foot?)

Hope this helped please let us know what you do.

hy it's your brother christopher please email me at peral39@hotmail.com[



quote name='matthew murdock' date='Nov 13 2006, 01:25 PM' post='4003']
Gre
I write to you now in the hopes that you might be able to shed some light and possibly give me some advice on a situation that I can only describe as a living nightmare.

Several years ago I was diagnosed with a Hallux Limitus condition with accompanying bone spurs in the first metatarsal joint of my right foot that was subsequently treated with non-invasive techniques such as icing and stretching. Unfortunately, even after two years of this treatment, the condition eventually worsened, and I was prompted to seek out and interview surgeons in the hope that surgery might help.

After a considerable amount of research, I was able to locate a surgeon that was not only was highly respected in the field, but that specialized in this type of procedure. This doctor led me to believe that although cleaning up the bone spurs around the joint would give me more movement and subsequently reduce pain, it would only be a matter of time before the condition returned, and thus, an osteotomy was strongly recommended. As I’m sure you probably know, this surgery required that the first metatarsal bone be slightly shortened and reattached with screws, insuring pain-free movement in the joint without the return of bone spurs over time.

I had the first surgery in the summer of 2004, and after many months of post-operative rest, manual manipulation of the first phalange, and prescribed exercise, it became very clear to me that another serious complication had arisen. Although the doctor was continually describing my recovery as being unusually positive, and the osteotomy had certainly provided me with reduced pain and more movement in the first metatarsal joint, I now had a second metatarsal joint that appeared to be out of place. Because the first metatarsal bone was now significantly shortened and because the second metatarsal joint was now placed significantly forward, every time I placed weight on the foot, or engaged in forward momentum such as walking, it felt as if my second metatarsal bone was tearing through the bottom of my foot. This new unexpected turn of events completely blindsided me, and made my initial hallux limitus pain seem like a walk in the park by comparison.

It was at this point that the doctor informed me that roughly 30% of all patients who undergo the initial first metatarsal osteotomy report this ‘off-loading’ problem, and that I happened to fall into that category. Furthermore, he mentioned that both my athletic background and my high expectations for total recovery pre-disposed me for disappointment, since most patients wouldn’t care as much or wouldn’t report complications if they arose, since those individuals weren’t as committed to an active lifestyle.

Over the course of the next two years, I visited the doctor every other week for post-operative visits, refrained from wearing normal shoes and went through no less than four pairs of prescribed orthotics in an attempt to rectify the problem without surgery. Because of the swelling and accompanying pain, I had to receive cortisone shots directly into the second metatarsal joint every other month just to walk without screaming. Because of this pain, the inability to walk and/or exercise for extended periods of time, and the bizarre feeling that I had someone else’s foot attached to my leg, I managed to put on 50 unwanted pounds to my once athletic frame and enter into a state of severe depression.

I had the second surgery to shorten the second metatarsal bone and reattach with screws in the summer of 2006. This time, I was informed that there was less than a 10% chance that off-loading would occur after surgery, and less than a 10% chance that I would subsequently experience pressure in the third metatarsal joint. After several months of post-operative rest, manual manipulation of the second phalange, and exercise as directed, it appears that the second surgery has not gone as planned. Although the x-rays appear to be normal, there is excessive swelling in the second metatarsal joint accompanied by more pain than ever. Furthermore, it appears that a hard callous has developed between the second and third metatarsal joints, presenting even more complications and discomfort. To offset the pain and reduce the swelling, a cortisone shot was recently injected directly into the second metatarsal joint once again. This time, however, the pain has not subsided.

I have come to the end of my patience regarding this situation, and have accumulated a considerable amount of regret with having had both procedures. I write to you out of desperation, and in the quest to determine whether I will be able to walk normally ever again, and what I can do in the interim. Perhaps you might be able to provide some answers and some hope to someone who has practically run out of both. I look forward to hearing from you.

Thanks.
[/quote]

wow what a nightmare. I was considering having the surgery and now I am very reluctant. I have had inserts, custom orthotic rockers as well as two surgergies to " clean it out". I am still in so much pain I can only walk 3 blocks with the custom orthotics on. Let me know if you find anything that works.

wow what a nightmare. I was considering having the surgery and now I am very reluctant. I have had inserts, custom orthotic rockers as well as two surgergies to " clean it out". I am still in so much pain I can only walk 3 blocks with the custom orthotics on. Let me know if you find anything that works.
bob101

Did your custom inserts have any modification near the ball off foot to transfer pressure, off load the joint, a carbon plate to limit motion or balance out your forefoot?

The rocker bottom shoe should have allowed you to walk farther than 3 blocks if your pain is and problems are limited to your toes.

Did you follow up and tell whom ever provide the rocker that you still cannot walk more than three blocks with out it being to painful to continue?

In some cases the rocker bottom can be modified with a met bar this shortens the rocker (the weight bearing surface) of the shoe to unload the met heads.

Hope this helps