Hi! I have written in her several times about the pain I have in my Rigth Great Toe. 8 months ago I had a chilectomy and unforantely it didn't help. When I returned to the surgeon I went to, he didn't seem to like all the questions I had and I looked for a new surgeon. I have found on whom I like and see him again on Thursday, January 13th, 2005. I would appreciate if the staff of Foot.com could answer my questions before I see the dr. During my last visit he mentioned the "interpostional arthoplasty. From what I understand it is usuing tissue from the toe as a relacement for the lost cartialiage in the joint. I want to know if you have an information on it and also know about the long term benifit from this surgery as oppposed to the fusion which I am strongly considing as I don't want to endure any more pain and/or another surgery if the internpostional arthoplasty didn't work. It sounded like an interesting alternitive for the fusion, but would not want to have it fail and still need the fusion. The dr said that for the fusion he would use a CamWalker. Is it bulky and/or heavy (making my foot, hot and sweaty? After the recovery from the surgery do people need PT? Is there a lot of pain after having the fusion?
Thanks for you assistance.

Andrea

Dear Andrea,
Unfortunately, whether or not you have fusion or interpositional arthroplasty you will have pain...because they are both surgical procedures. Historically speaking fusions tend to have a longer recovery time than arthroplasties. Cam walkers do have a tendancy to be big and bulky however there are some companies now which have lighter models (I'll look into that for you). Cam walkers are definately a good alternative to a below the knee cast.
Most of your questions regarding the surgergies should really be asked to your surgeon, because your surgeon is the person who is making the final decision to fue or not to fuse. Usually patients do well with both procedures but as I have sais before, the procedure chosen is based on radiographic appearance of the bone, extent of bony damage secondary to arthritis/trauma, age of patient, bone stock, activity level, occupation, patient compliance, extent of osteoporosis (if any) etc.
It is your surgeon who will decide what procedure to perform based on the above as well as his past experience.
Interpositional arthroplasty and fusions are both in the same category classified as end stage procedures. The interpositional arthroplasty would involve removing the base of the proximal phalanx and then (depending on the surgeon the following will vary) One may then take the medial casule and interpose it between the head of the 1st metatarsal and the remaining stump of the proximal phalanx. Some benefits: faster recovery time, excellent for older patients, does not relay on good bone stock to be successful, generally sucessful. Some disadvantages to the interpositional arthroplasty: shortening of toe, floppy toe, cocked -up toe, transfer metatarsalgia....By the way the tissue applied at the joint is used to maintain space between the bones, not to replace cartilage.
Talk to your doctor, he/she should answer these questions,especially since they will be making the final decision, in terms of which procedure they feel will best suit you.

Good-luck,
SBarlizo