Another shoeless one.

[Cirrus2000]

I've been dealing with a degenerating big toe joint in my left foot for the last 8 or 10 years or so. Something called "Hallux Rigidus" - which is Latin for "stiff big toe", a very descriptive name. (I've described it to a few hiking/canyon partners while out on trips.)

Here's my x-ray of my big toes:

http://lh5.ggpht.com/_O_8PLe3Zn6g/TTfEKOu5yBI/AAAAAAAAae4/1XjD0RR556Q/s512/image1.jpg

This is how my left and right big toe joints looked a year ago. On the left, note how narrow the gap between the two bones is (less than half the size of the right). Also note the ridge of bone just below that joint, and the blurred protrusions to the sides, especially the left, just above and below the joint. Compare to the clean joint on the next toe over.

Been dealing with a lot of pain and restricted motion. Decided, in consultation with my orthopedic surgeon, that the best solution would be to fuse the joint. In brief, they open the foot, grind the ends of the 2 bones, and screw on a metal bar holding them together. As time goes on, the abraded bones grow together.

It will look like this when all healed up (someone else's x-ray, off the interwebs):
http://lh4.ggpht.com/_O_8PLe3Zn6g/TTfEAwixcPI/AAAAAAAAaew/LvzyHanNFyg/nanufig1.jpg

Well, my surgeon's office dropped the ball, and forget to let me know when I was scheduled for the surgery. I got a phone call on Monday saying "this is your reminder about your surgery tomorrow..." WHAAATTT??? Well, it all worked out, and in I went.

So now, here I am:
http://lh5.ggpht.com/_O_8PLe3Zn6g/TTfEAspnMBI/AAAAAAAAaeo/V-RJR8ijxZU/IMG_6740.JPG

The surgery was done under a local anesthetic, which was kind of wild - listening to the grinding and drilling, and feeling it transferred up my leg. Took about an hour.

The anesthetic wore off around midnight last night, and... :cry1: Ouch!

Anyway, Tylenol 3s are keeping me going, but there's still a lot of pain.

I should be off work for 2-3 weeks, depending on my pain situation. I can stay off my foot at work, but can't use any pain killers there. The walker boot will stay on for about 8 weeks or so, with minimal weight bearing on my toes until then (I can put weight on my heel any time.) I should be able to resume "vigorous" activity in 10-12 weeks.

In the meantime:

:cripple:

[Felicia]

"Toes above nose!"

Take it easy and get well. :-)

[blueeyes]

The surgery was done under a local anesthetic, which was kind of wild - listening to the grinding and drilling, and feeling it transferred up my leg. Took about an hour. I would have puked on the spot and passed out. Local! Seriously. Yeah I can't do that. Just the thought of that is turning me green.

Heal up quick!!

[Cirrus2000]

I would have puked on the spot and passed out. Local! Seriously. Yeah I can't do that. Just the thought of that is turning me green.

Heal up quick!!

That's what I thought beforehand. It kind of freaked me out that that's how they were going to do it. But they pumped some sedatives into the IV, and I spent the hour chatting with the anesthesiologist... It was way easier than I expected.


OH - if anyone is good with surgery photos & stuff: Here is what they did to me, using the same product - you can click the previous and next links near the left side of the page to follow along at home.

Semi-gory warning!!
http://www.footsurgeryatlas.com/wright-mtp-fusion-01.htm

[Win]

Get well soon, you look way to comfy on that couch!!

Win

[greyhair biker]

:eek2:I agree with Chere'. Knock me out and give me drugs...course' I"M not directing planes & such:mrgreen: Get well soon dude!

[ststephen]

I'm guessing that sedative combo includes items designed to make one less nervous about the activity going on. They don't want you freaking out either!

Hope the pain subsides quickly Kev, and it heals up exactly as advertised. I want you back out and submitting TR's ASAP!

[oldno7]

Heal up quick, Kev. Sounds somewhat like what dbaxter had done.

[JONBOYLEMON]

WOW, kinda sounds like Lasik where they shoot laser beams at your eye and burn your eye meat while you sit there going, hmmmm that smells like bad bacon burning........ but I'm ok with it.....

Get well soon buddy, need to see you out in Gods country ASAP!!!!!!

[canyonphile]

Best procedure for an active person with hallux rigidus and arthritis - a fusion (aka "arthrodesis") of the joint. Back in the day when I was a foot surgeon, I did a few of these in private practice, and assuming everything goes well and you follow your surgeon's instructions exactly, you'll love the result.

Seriously, you'll be able to hike and probably run (if'n you were a runner) after this baby is all healed up...and with no pain! About the only thing that isn't going to happen after a hallux MPJ fusion is wearing heels...but I'm going to guess that's now how you roll :haha:, so you're good.

I'm so glad he didn't offer you an implant procedure :roll:. Hip, knee, shoulder and some finger implant arthroplasties work great, but the big toe implants all ended up being abysmal failures over time; I took out several put in by other surgeons.

Hope you have a fast and uneventful healing, Kev :2thumbs:.

[Cirrus2000]

Thanks for the well-wishes, folks! Today is a big improvement, pain-wise, from yesterday, as I approach the 48 hour mark post-op.

Sonya, interesting to read your comments. When I first talked about this with my podiatrist, years back, he did mention implants but strongly recommended against them. Said they'd just fall apart over time - especially with the kind of wear and tear I put on my feet. He also talked about bone spur removal - cheilectomy, and fusion - arthrodesis. When I asked what would happen if I just kept hiking and doing what I was doing, he said that if I could take the pain, the joint would eventually seize right up on its own. Well, that's what I did for years, but it reached the point where it was time to do something to finish things off...

I managed to get in to see an orthopedic surgeon fairly quickly, and had done my homework. He examined my foot, and I said I wanted arthrodesis. He concurred. The rest is... well, not history, but the surgery is!

I'm really looking forward to having a painless foot. Now I have to think about the other one - it's headed down the same path as my left one. I think I may opt for some bone spur removal on this one, prior to fusing it. I just found out that a friend has had that done twice in the last five years, and will probably have the arthrodesis done in another 3 years or so. So he's watching my recovery with a lot of interest!

(By the way, every time I read your signature line, it cracks me up!)

[tanya]

It's nice to have a Doc in the group! :clap:

[dbaxter]

Hey Kev! Take it easy and recover fast! Keep it up (your foot I mean), keep ice on it and LOTS of vitamin I. Hope everything goes smoothly for you.

I had similar surgery done a year ago. At first, I was wondering WHY on earth i had chosen to do that to myself...But after just a few weeks, I was SOOO glad I did it. I had two or three orthopaedic surgeons tell me they wouldn't do it. But I talked to a podiatrist who said he could fix my problem and I'd be back on my feet in time for spring. He was right. :clap:

Extra benefit: The screw in my foot tells me when it's going to rain--no need to watch the weather channel...

[Don]

Good time to catch up on some reading? Take care buddy, best wishes for quick recovery.

[dbaxter]

Hope you're having a good day with little pain. Is there someone taking care of you? I know it helped a TON to have Thane do stuff for me all day. Even the simple stuff like getting a glass of water back to my chair was a horrible task at first. But it will get better and I think you'll be happy you did it.

[Cirrus2000]

Thanks, Dana! Yeah, the pain is getting better. Yesterday I went from 2 T3s every 4 or 5 hours to just one every 5 hours. Last night I went 9 hours without, and at 8AM I was fine (until I started moving around - so I had one then.) Planning to move down into T1s today.

The pain isn't bad while my foot is up, but as soon as it comes down, for a trip to the bathroom, or just to move around a bit, it definitely flares up!

Karyn is being terrific. Our son is home sick from school (temperature hit over 103 the last couple of days - looks like it's easing off finally) so she's been pretty busy, fetching and tending and so on. She had to work for about 5 hours yesterday, but otherwise has been around. (The boy and I just kind of went into suspended animation while she was gone...)

Planning on actually bathing today - that should be a challenge. Funny, 20 years ago I had a cast on my entire left leg for 6 weeks - I don't even remember how I did it! Had a look at my dressing last night, under the walker boot (plan to look underneath the dressing later - I'll post a pic :eek2:) and apparently there was a fair bit of seepage. Looks dry now, though.

Yeah, Don, been doing some reading, but I've been kind of queasy from the T3s, so alternating between reading, computing, and spedning a lot of time resting with eyes closed. I have also spent a lot of time reading the "Seriously, So Blessed (http://seriouslysoblessed.blogspot.com/)" blog. Cracking me up - oh my heck, is it funny!

[accadacca]

Heal up quick dude. You can catch-up on Bogley. Haven't seen you around as much lately. :2thumbs:

[canyonphile]

Thanks for the well-wishes, folks! Today is a big improvement, pain-wise, from yesterday, as I approach the 48 hour mark post-op.
Awesome. That's how it usually goes, esp. when you stay off of it as much as possible.


I'm really looking forward to having a painless foot. Now I have to think about the other one - it's headed down the same path as my left one. I think I may opt for some bone spur removal on this one, prior to fusing it. I just found out that a friend has had that done twice in the last five years, and will probably have the arthrodesis done in another 3 years or so. So he's watching my recovery with a lot of interest!
I did cheilectomies a LOT in practice, because: 1) they work great, assuming that the majority of the problem is a mechanical blocking of the motion due to the dorsal spurs, vs. degenerative changes to the joint; 2) healing time is significantly faster - patients can walk right away, and there is nothing to heal other than soft tissue. Less work done = less post-operative swelling = less pain = faster return to pre-operative activities. In my clinical experience, they worked great, and can spare you possibly several years before you need an arthrodesis.

[ratagonia]

Best thought for a quick recovery... Tom

[tanya]

Feeling any better?

[Bo_Beck]

I was thinking it was just a sprained ankle when I saw you a few weeks ago? Hey...I hope you heal up quickly and are back on the trail very soon!
Bo

[Cirrus2000]

Thanks, guys! Bo, when I saw you in the store, I was pretty much normal - I always had a bit of a hitch in my stride from the bum left knee plus the degenerating toe... My big problem at that point was being almost dead, I was so sick over new years! :lol8:

Tanya, the pain keeps improving. I'm down to one Tylenol 1 every 6 hours, so from where I've started, I've gone from up to 360mg of codeine per day to about 32mg. I figure another day or two, and I'll be down to plain extra-strength Tylenol. (They don't want me on ibuprofen, yet, but it's what I'll use when I get to go back to work.)

Foot hurts like a son-of-a-gun when I am upright and the blood rushes in. Still have to stay flat, with foot raised, as much as possible.

Was going to get a photo under the dressing yesterday, but when I started opening it up, it was wrapped up more than I anticipated - plus there was no card in the camera, and I wasn't about to go get one! Another time...

[Scott Card]

Nice boot. The least they could do is give you a matching one for the other foot. Hope you heal up quickly. :2thumbs:

[Cirrus2000]

Nice boot. The least they could do is give you a matching one for the other foot. Hope you heal up quickly. :2thumbs:

Ha - give! Stupid boot was $160. Wasn't going to spend that on a matching one for fashion! :haha: At least my extended medical care covers half of it...

Thanks, Scott!

So I took off the boot yesterday, and unwrapped the cling bandage around my foot. There was a lot of cotton under that, and the incision had leaked quite a bit after the surgery, so it was all kind of caked on. I wanted to get a shot of the incision, but decided not to crack open the cotton. Not yet, at least...

Here's the dressing, though:

http://lh4.ggpht.com/_O_8PLe3Zn6g/TT9VUAN8jrI/AAAAAAAAagk/ISZwRyghXp8/IMG_6764.JPG

Yup, leaked a bit...:scared:

[Cirrus2000]

So, it's been just over 2 weeks since my surgery. Pain is mostly gone now, although after standing for long periods it can get pretty achy. I'll be back to work tomorrow at noon...

I had the stitches removed by my GP today. It was all sewn up in a running stitch (so only tied at the two ends). I expected the incision to be a little longer.

I decided not to just post the pics here, in case anyone was squeamish. (The doctor was rather amused when I pulled out the camera in his office.) Here's the foot prior to suture removal:

http://lh5.ggpht.com/_O_8PLe3Zn6g/TUt3HfqAvpI/AAAAAAAAa7k/6VuYFsP9VBo/s720/IMG_6821.JPG

Here's the foot after the sutures were out:

http://lh4.ggpht.com/_O_8PLe3Zn6g/TUt3H3odNwI/AAAAAAAAa7s/xZgOUPYCgIg/s720/IMG_6823.JPG

The pinky-red coloring all around (especially on the smaller toes) is the remnants of the antiseptic painted on prior to surgery.

I go in next week to see the surgeon again for follow up and x-rays. Looking forward to seeing that.

[Felicia]

Nice - looking good for two weeks! :2thumbs: Take it easy going back to work. Are you still on crutches?

[Cirrus2000]

Nice - looking good for two weeks! :2thumbs: Take it easy going back to work. Are you still on crutches?

Well, yes, and no. For any distance, I use crutches - when I walk the 1/4 mile in to work tomorrow, absolutely. But just walking around the house, I can put all my weight on my heel. Works pretty well. I kind of clomp and stomp around, and look pretty pathetic, though!

[tanya]

Gross photo :mrgreen:

[blueeyes]

Awe such cute toes. hahaha

Glad to hear it is healing up! You will be stomping around canyons soon instead of stomp clomping around your house.