i had interpositional arthroplasty for hallux rigidus 8 months ago and i am still suffering with the pain and stiffness of my big toe and now have problems with my sesomoid which really hurts when walking. i have had cortizone shots and have used a bone stimulator and am still seeing no relief. doctor who did surgery said to give it a full year to see if the surgery was successful but three other doctors saw my x-rays and mri and said i needed a fusion. what to do at this point. wait or go for the second surgery because the other doctors don't think the 1st procedure worked.

Try rocker bottom shoes such as Dansco. Some of the devices I make or provided for people feet are the same before the surgery to the foot as after surgery.

In other words you might need a rocker bottom shoe after the surgery as well to accomadate your fused diget.

Take care, tell us how things go?

Dear soffette
Conservatively, you may consider a rockerbottom shoe/orthotic device. It will help to reduce the pressure at the affected area without involving surgery. However, if conservative management fails, a second surgical procedure may be required. It is difficult for me to recommend a particular surgical procedure or alternative without seeing you. However, if you want another opinion see a third doctor and get re-evaluated. It's frustrating but the effort will not be in vain.

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

I hope you don't mind me posting to your initial note but I had the same surgery 2 months ago and had a very hard time finding any info on this procedure. Someone then told me it's the same as a Keller bunionectomy - which I did find - and it's documented as an old procedure to be done on older, inactive people. (I found all this after I had the surgery). My toe is loosening up a bit - but I think it's only due to my manual exercises - did the doctor instruct you on these ? Did they say how they determined that the surgery was unsuccessful ? My foot still swells and is a darker color than my other one - I'm hoping this will subside. Walking still hurts - I can only wear sandals that have velcro straps across the ball of my foot.
(also, the big toe is now slightly shorter than the other one - a bit disconcerting to me).

thanks

Dear Karen
An inteporistional arthroplasty of the big toe usually involves a Keller arthroplasty and the term "interpositional" usually implies that a tendon such as the flexor hallucis longus or even the extensor brevis is used to maintain the space between the two bones.
The discoloration is usually related to post-inflammatory hyperpigmentation, when an extremity has been inflammed for a period of time as the swelling subsides the color of the skin sometimes turns darker. The color of the skin usually returns to the preoperative color.
Unfortunately, people heal at different rates, it is difficult to give you a precise estimate as to when the swelling and pain will completely subside, it can vary from a couple of weeks, to a couple of months, to a couple of years. Physical therapy is excellent to help with the post-operative stiffness, swelling and pain following surgery.

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

Hello again Doctor. I'm the poster who had the interpostional arthroplasy on the big toe in early July. The healing process is much slower than I expected, but it is coming along. I've been bending the toe both actively and passively, and the swelling is almost gone. However, I recently noticed that when I bend my big toe downwards (actively), I feel something snap into (or out of) place. This is at the 'knuckle' of the big toe and it's on side next to my 2nd toe. Perhaps it's a tendon that's being pulled over that joint? I'm seeing my doctor next week and will mention it to him. But, in the meantime - do you have any ideas? I'm worried about it - and was wondering if I've done something to cause this. Thanks - Karen

Dear Karen
The "snapping" sound that you hear may be associated with joint fluid moving from one side of the joint to the other. It is unlikely that it is the tendon being pulled over the joint. Rehabilitation is always more challenging than people imagine however, it is also an extremely important process following surgery, in order to regain function of the joint and breakdown of scar tissue formation.

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

OK - here I am 4 months out from the IPA procedure - and still in pain when I walk. I went back to the doc who took X-rays and found some adhesions/scar tissue that need to be 'broken up'. He scheduled a 'manipulation under anesthesia' for next week. Is this common? He says it happens about 10% of the time, but I've only found info on it regarding a frozen shoulder, never about the foot. Should I be optimistic about this ? thanks - Karen

What kind of shoes are you wearing?

I've been wearing sneakers most of the time. Once in awile I switch to a very flexible soled leather shoe.

If you have hallux Limitus or Rigidus you foot is less flexable than normal your flexable shoes are not protecting your feet. You should consider a metatarsal bar or rocker bottom shoes. Some sneakers have a mild rocker bottom that might work for you. Try the brooks "beast" or shoe like them. Also some Dansko have rocker bottoms.

Hope this helps