Hi ! I have a question? I have written here before regarding surgery I had on May 6th to remove a bone spur. It has been 3 months now and I till have pain in the toe when I walk even when I continue to wear the post op sandal that keeps my toe from bending mroe than it would in the shoe. Last week i spoke to the surgeon and he said to give it a few more months. There is still some swelling on the side and top of the big toe, but I had hoped by now to be able to walk pain free. I don't think that this surgery worked for me and I knew going into it that I'd still have the athritis. The dr told me before the surgery I was in beween removing he bone spur and having the fusion. I knew that the fusion surgery was much more involved and was willing to try this one first. H had told me before the surgery that I sould come back afer a year and say it didn't work and want the fusion, but I hate to have to wait that long. My question abou the fusion are 1) after the fusion surgery, can arthritis redevelop around the pin that is inserted ro aorung the joint to cause the same pain I am having now? 2) I know everyone is different, but how much pain do people experience and for how long? 3) do people have a fiberglass case or a removable cast? 4) I was told I would not be able to put pressure on it for 6 weeks. Generally do people go to a less rigid cast or covering aftr teh 6 weeks<? 5) what type of physical therapy is required after the cast comes off? Any other infor would be greatly appreciated.

Hi and welcome!

I have some interesting stuff on bone spur surgery, vs total joint implant vs fusion. Go to this link for more information:

Discuss on Hallux Limitus

I have recommended bone spur removals for simple hallux limitus. If there is advancing arthritis, the only other options are joint replacement and fusion. Fusions are great, but can cause other problems like transfer pain to the sesamoids and MTJ arthritis due to lack of toe motion. To learn more about joint replacement surgery go to the following link:

Joint Replacement Surgery or Total Joint Implant for the Big Toe Joint

To answer some of your questions:

1) Arthritis can develop after joint fusion , but usually to surrounding joints.
2) Pain varies from person to person, but it takes 6 to 8 weeks for fusions to heal
3) Usually casting after a fusion is required. I start with a posterior splint, then cast for 6 to 8 weeks.
4) You may progress from cast to CAM walking boot after 6 weeks
5) No PT is usually required after fusion

GOOD LUCK!

Al Kline DPM

Podiatry Associates

Hello again,
The pyshician's asssitant to the surgeon said they don't do joint replacements as they feel they don't work. I know things vary from person to person, but

1) does the pain less as timegoes by after fusion surgery?

2) how long does it take to develop arthritis in other joints after fsuion surgery.

3) It sure sounds like a long road to recovery with a cat for 6-8 weeks! Yuck. I was told that I wouldn't be able to put any pressure(jsut a little on the heel) for 6 weeks. I had a problem woith balance wehn i copuldn't put any weight on my foot. I am hoping to go to a rehab during this time as I live alone and it would be impossible to care for myself.

4) is the fusion surgery usually done as a day surgery?

Thanks for answering all my questions.

Andrea

Yes, a fusion is often done as a same day surgery, however the recovery may take 6-8 weeks to heal. Some patient's will require some physical therapy to help reduce swelling, decrease the pain and helpt to increase function and motion. If you are still pondering the issue then you should discuss physical therapy with your doctor before the fusion. It just may help.

Foot.com staff member

I have arthritis and as a result, I developed a bunion on my big toe. Due to the advanced degree of arthritis, my orthopedic surgeon recommended fusion. He mentioned that my foot flexibility would ultimately be decreased, but he did not go into detail. I am in my early 30s and very active (tennis, snowboarding, dancing, etc). I am wondering if the surgery is going to permanently limit my activities.

I had a fusion done of my left beg toe - actuallt had to have it done twice. I am havinf a heck of a problem finding shoes. It is fused so that it sticks up a bit. Has anyone been successful finding comfortable shoes following a similar surgery. I do have orthotic inserts but I am not even sure they are working.
Thanks

Dear Deekudos
I would recommend that you wear a shoe with a deep toe box. For example, the "Apex ambulator" series has an array of shoes with deep toe boxes and can accomadate for an orthotic device. I would suggest going to either your podiatrist or your pedorthist who may be able to help you choose which pair of shoes would best suit your foot type.


Good-luck and thank-you for contacting foot.com,
SBarlizo, DPM, C Ped

hi, i had bone fusion done on the top right foot where it bends at to meet the leg, this was done 3 years ago the first surgery the doctor tried pins, but when he removed the pins my bones didn't fuse right, so it was too painful , so my doctor sent me to a better doctor Dr. Ruck, in Atlanta Ga. He did a really good job, he fused my bones withe 3 long screws. After the surgery my foot stayed swollen for at least 3 months, but after i began to go back to work my foot and ankle swole up like a softball every night after work it was still painful, but about a year after surgery it finally stoped and it dosen't hurt as much, but i still get pain in my foot at the end of the day, but not nearly as bad, but now my other foot the left one on the inside where the ankle all the way to the mid foot, and on top of the left side of the foot , is so painful at the end of the day i can hardly walk i just hope i don't have to do the same thing to this foot. i just moved to maryland so i haven't seen a doctor yet, i'm trying to get some health ins. first so i can do what needs to be done. but good luck just don't worry it's normal for swelling the first year and some pain too, it'll get better. oh where my doctor cut my foot on both sides to put the screws in, when i touch the scars, the skin feels a little numb go figure.

Dear Nhcyoume
Dr Ruck is a great doctor. Thank-you for your insite. Good-luck.

Thank-you form contacting foot.com
SBarlizo, DPM, C Ped
foot.com expert

Hello. I had an achillies tendon lenghtening and a fusion of the bones in my arch on the same foot. How long is standard for a hard cast to be on?

Dear Jackie
Theoretically, it takes approximately 4-6 weeks or eight weeks for bone to heal or fuse. However, there are actually several factors that influence bone healing such as age, patient compliance, nutritional status, bone stock, activity level, etc...etc...etc...

Thanks for contacting foot.com,
SBarlizo, DPM, C Ped
foot.com expert

Hi,
My name is Jen and I was reading about your bunion and arthritis. I am actually going in for surgery for fusion on the big toe May tenth. So I can let you now what happens on that. On bunions though do not let any Dr talk you in to getting them removed. It did not help and honestly it grew back a year later. I got nerve damage from the surgery and couldnt walk for three months. The only reason im doing the fusion is my big toe is so deformed that I need it straightned. I just started taking a medication called metherterxate and it is suppose to slow the destrucition down and have less pain. I have been on it for 2 months and I can honestly tell you I feel alot better. So try asking your doc about that.
Jen

Custom inserts with a carbon plate(mortons extention) could be benificals before surgery.

Are you get this surgery for cosmetic reasons (too straiten the toe) or for the pain? (the being bent causes you pain?

After the surger you may need shoe with a rocker bottom for your toe or an insert with a sesmoid post.

How everything turns out well

Dear Jen
Methotrexate is an effective medication however does have some potential side effects and requires close monitoring. Good-luck with your surgery in May.

Good-luck and thank-you for contacting foot.com,
SBarlizo, DPM, C Ped
foot.com expert

Im getting it because I cant put my big toe in shoes and if I wait any longer my big toe wont touch the ground anymore. Do you know much about fusion with the big toe? Did you ever here of kellers proceduerm?

Dear Jen
A Keller procedure is quite different from a joint fusion. A Keller invovles removing the base of the proximal phalanx to the big toe. Keller's are usually reserved for older patients who are generally less active individuals.

Good-luck and thank-you for contacting foot.com
SBarlizo, DPM, C Ped
foot.com expert

I am a Pedorthist so I do not perform surgeries on the foot. I do make devices that allows a foot to perform more normaly after a surgery or to prevent a surgery. Your toe is it raising up? becomeing more clawed? Is is still flexable? Does it cause pain while standing or walking? or do just have difficulty with shoe wear?

After a fusion surgery if the toe is too strait (less than 10 degrees of extion relitive to the foot) is the most common problem I see. Sesmoid (a thick fim pad placed under the ball of the big toe) post is the most comon modification I use for hallux rigidus.

Hi
My name is Jen and I had surgery last week which was fusion surgery on my big toe and second. The third day I was walking boot. It comes off very easily. I was in pain the second day. The next honestly I was ok and walking with the boot. Believe it or not I went to target the fourth day and walked around with the boot. The only thing i cant do now is drive. Getting stitches out today. I can keep you posted. If your goona get it done dont be scared. Not sure about the cast for six weeks your talking about. Mine was two days and then they took it off and just have gauz and a wrapping and the boot!
Jen

Quick recovery.

where you given shoe recomendations for when you recover and after you have recovered?

Please, keep us posted on your results.

Take care heal well.

I hope you have a speedy recovery. You can find "recovery" footwear on this Web site, Foot.com! I bought a pair of Ambulator Stretchers for my great-grandmother (yes, great-grandmother) a few weeks ago. She has diabetes; these shoes give her so much more room than a regular shoe. I would imagine, you'd be able to find somthing on this Web site for your recovering feet. Best of luck!

Chennell

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Hi Jen,
I am scheduled to have a fusion on Sept. 8. I am scared as the Dr. say this is a very common operation, yet I have never met anyone who has had this done. Can I ask your age and activity level?
I had a failed bunionectomy last year and I am fighting becoming depressed due to the fact of the debilitating effect it has had on every aspect of my life. I am scared of the permanence of the fusion.
How and where do you purchase fashionable shoes? Can you still do yoga, power walking, weightlifting etc.
I know ball room dancing is out (can't wear heels) Thanks for any reply. and happy healing!
Karen

Can't Respond to this on a personal level. Proffessionally a success full surgery should fusion your foot in to a proper roll over shape.

Shoe retail shoe with a stiff sole, rocker bottom should be comfortable. Wieght lifting should be fine sqats are probaly out. Yoga is fine just avoid or modified position that would force your toes to extented. walking okay sprinting out.

Your toe will be locked one position, so any activity the force your toe to extented has to change. Your can't walk strait up hill without bending your toe back farther then on flat ground so walk at angle or turn your foot out like your going up hill in skis.

Heels are out but you can dance so long as the dance does not require you to pop up on your toes or take a step greater than walking stride.

If your toe is fused strait or in flexion you made need a sesmoid post.

Hope your get well soon