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toe fusion surgery

Posted by SherylW on 6/22/03 at 09:55 (122600)

I need a first MTP fusion with interpositional bone graft. Has anyone had this surgery? How were your results and how did you find the appropriate surgeon?

Re: toe fusion surgery

Dr. Z on 6/22/03 at 13:34 (122613)

HI

Have you discussed other surgical procedures such as joint implant, cheilectomy, or an osteotomy. Joint fusion is vey effective but is typically used as last resort. Most orthopedic surgeons will use the fusion as a procedure of first choice. Have you have failed foot surgery.?

Re: toe fusion surgery

SherylW on 6/24/03 at 21:45 (122854)

I did have surgery before but I think I used a butcher instead of a surgeon - so here I am one law suit and four years later and I have no joint left - just dead bone on bone and pain 24/7 - and I am faced with this difficult surgery as a salvage operation. I don't want to make the same mistake twice? How do you 'check out' a doctor? The last one was recommended by two friends and look where that got me? When I ask how many of these specific surgeries they have done and what is the success rate, they get all offended !!!!!!! I would also like to know every detail of the recuperation - no weight bearing for 6-8 weeks??? How do people manage??

Re: toe fusion surgery

Dr. Z on 6/26/03 at 14:01 (123004)

I keep patients non-weight bearing between 10 and 12 weeks. Where do you live maybe I can help you out with a doctor ?

Re: toe fusion surgery

Ed Davis, DPM on 6/26/03 at 23:13 (123041)

SherylW:
What type of surgery was done initially? I agree with Dr. Z that fusion of the big toe joint should be reserved as a last resort and that options such as implants designed to restore joint function should be considered first. One source of referrals is http://www.acfas.org
Ed

Re: toe fusion surgery

SherylW on 6/28/03 at 21:55 (123136)

I am currently seeing two doctors who are in practice together. One is an orthopedic surgeon who specializes in foot and ankle and the other is a podiatric surgeon. They are doing the surgery together. One said no weight bearing for 6-8 weeks, the other said 8-10, they both said physical therepy for 6 weeks after to learn how to walk. One told me he has done 10 of these operations and the other said he has done 25. When I ask about success rates they keep telling me that this is a salvage operation, my foot can never be fully functional again and that the purpose of the surgery is to reduce pain. I live on Long Island close to the Manhattan border.

Re: toe fusion surgery

SherylW on 6/28/03 at 21:58 (123137)

I did consider implants. Since my original surgery I have been to four different foot specialists all of whom did not recomment implants. I was told again and again that I am not a candidate for implants, that they would fail and I would end up having them removed.

Re: toe fusion surgery

Ed Davis, DPM on 6/30/03 at 20:00 (123257)

Sheryl:

Did they give you a reason why you are not a candidate for implants?

Ed

Re: toe fusion surgery

SherylW on 6/30/03 at 23:16 (123278)

All the doctors said that there was too much bone lose - that there was nothing strong enough to attach an implant to. I saw the ex rays and the bones look like swiss cheese. This doctor plans to insert bone (from a cadaver, not me) and secure it with a metal plate and screws on top. What do you think?

Re: toe fusion surgery

Ed Davis, DPM on 7/01/03 at 20:51 (123382)

Sheryl:

The reason provided to you is certainly valid. There are different type of implants out there, some requiring more bone present than others -- so I would hope that the doctors advising you are familiar with all of the implant alternatives.

How did such siginficant bone loss occur? Was it due to the prior surgery?

Ed

Re: toe fusion surgery

SherylW on 7/03/03 at 06:23 (123491)

Yes, I had surgery in 1999. Within 2 weeks I knew that something was not right. I have since sued the surgeon and am not allowed to discuss the details of the case. Currently, I have no joint left at all, I have pain 24/7, I have difficulty walking and my toe has shrunk about a 1/2 inch.

Re: toe fusion surgery

Dr. Z on 7/03/03 at 18:54 (123533)

Fusion does work. It is a procedure that has and will stand the test of time. Make sure your surgeons have experience in doing this procedure. There are pearls involved. Must position the big toe at the correct angle for shoe comfort.

Re: toe fusion surgery

Ed Davis, DPM on 7/04/03 at 11:23 (123576)

SherylW:

Usually one can discuss such details once the case is over as it does have bearing on your ability to get medical care thereafter -- something you will need to ask your attorneys. Fusion with a graft may be your only choice if there is insufficient bone to support an implant. Get a couple of opinions on that including an opinion by one who has expertise with implant use.

I largely follow the philosophies of Bruce Lawrence, DPM of San Diego, CA when it comes to implants. He is the designer of the most successful implants around. He is the 'man' to talk to.
Ed

Re: toe fusion surgery

SherylW on 7/06/03 at 15:35 (123663)

My suit has already come to trial and my doctors know all the details. I have gone for other opinions and the only alternative is a keller and I am too young for that. How do I find an expert on bone grafts and fusions, not implants.
I thought more people would respond to my posted message, but as you can seefrom the thread, nobody has. Apparently this is not a very common surgery.

Re: toe fusion surgery

SherylW on 7/06/03 at 15:50 (123664)

Dr. z
What do you mean by pearls???????
Sheryl W

Re: toe fusion surgery

Dr. Z on 7/06/03 at 17:17 (123665)

What I mean is you have to have some experience in doing the procedure. Ask how many your doctor has done. Where do you live?

Re: toe fusion surgery

Dorothy on 7/06/03 at 18:49 (123669)

Maybe 'perils'? Just guessing...

Re: toe fusion surgery

SherylW on 7/07/03 at 10:56 (123703)

The orthopedic surgeon says he has done 25 and the podiatric surgeon 10. I live on Long Island.

Re: toe fusion surgery

Dr. Z on 7/07/03 at 13:36 (123705)

It sounds like you have chosen the correct procedure and you have doctors who can do this procedure.

Re: toe fusion surgery

Ed Davis, DPM on 7/12/03 at 16:33 (124253)

Sheryl:

It generally does not take a large amount of expertise to do most fusions. As such, finding an 'expert' is generally not an issue. The real expertise comes in finding a way to make the joint work. If a Keller has been listed as an alternative, that would imply that enough bone exists to do an implant.

Ed

Re: toe fusion surgery

bob b on 2/18/07 at 09:45 (222924)

My podiatrist saya I have hallux rigidus. he wants to think about surgery options and the joint is still ok. Would you do a cheilectomy first?

we have tried non surgical methods and they are not working