Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

6 months bilateral big toe joint replacements

Posted by Connie on 3/19/04 at 18:10 (147348)

I am 6 months bilateral big toe joint replacements. I have a lot of hip, knee, and back pain. When I went to the podiatrist, he told me because of the operation the big toes were too short which is a comoplication sometimes and the hallux wasn't touching (no purchse) ground correctly and was elevated. He also said the implants were perfect. He described several operations to fix including a graft or making a cut and making the toe longer. In your experience, which operation has the better rate of success. I really just want to get back to a normal life and exercise routine. Thanks so much.

Connie

Re: 6 months bilateral big toe joint replacements

Ed Davis, DPM on 3/19/04 at 21:40 (147361)

Connie:
What type of big toe joint replacements did you have?
Are you wearing orthotics?
Ed

Re: 6 months bilateral big toe joint replacements

Connie on 3/19/04 at 22:27 (147364)

Dr. Davis,

I have modular toe implants and I am wearing orthotics. Besides the hip, knee and back pain I have severe hallux extensor longus tendinitis. I just really feel that I'm not walking right but kind of fumbling around. After the podiatrist looked at my feet he put a paper towel under my big toes and he could remove it easily no matter how I tried to keep the paper towel from moving underneath my feet. After he took an xray, it confirmed his diagnosis about my toes not touching the ground. He said this was a big surgery and he would do the surgery one toe at a time with a recovery time of two months. Would I have to wear a cast? How sucessful is an operation like this? He gave me no recourse and I really can't tolerate the pain any longer? Thanks for your help.

Connie

Re: 6 months bilateral big toe joint replacements

Ed Davis, DPM on 3/20/04 at 19:34 (147428)

Connie:
I am not sure I know what you mean by 'modular?' There are two type of great toe joint total implants, the hinged variety such as the Futura Biomedical Lawrence Gen 2 hinged implant and the type that looks like a small ball and socket (like a miniature hip) made by Osteomed or KMI (Kinetikos). I believe that Richards has a similar implant. Most patients who have significant hallux rigidus, have had the problem for a long time and, as such, the muscles that control the big toe joint are atrophied. When an implant such as the Osteomed or KMI is used, the joint has restored motion but poor stability due to long term muscle atrophy and it takes quite a long course of physical therapy to bring the muscle strength up to par. There are three reasons why the Futura Gen 2 is the big toe implant of choice: 1) It has intrinsic stability via its built in hinge, therefore accounts for muscle atrophy, 2)minimal bone is resected, which enhances stability and, in the long run allows for easier implant replacement when the implant wears out, 3)Has a potentially long life compared to the Osteomed and KMI which we are seeing as high as a 30% failure rate in 5 years. When the ball and socket type of implant is removed, a large gap exists due to the amount of bone resected and it is thus harder to rebuild and often requires a bone graft.

If you have one of the latter two implants, it is important to have a fairly intensive course of physical therapy. It is also important to be using a good prescription custom made orthotic to control the abnormal mechanics of the foot that caused the hallux rigidus in the first place.
Ed

Re: 6 months bilateral big toe joint replacements

Connie on 3/21/04 at 10:50 (147464)

Dr. Davis

Sorry that I was so unclear about the implant. I have a Futura Gen 2 implant and I am wearing custom orthotics. The podiatrist I saw made a modification to them. He put a morton's extension and a post in the back of the orthotic. The result was that my big toes brush up against the top of the shoe no matter what. I just don't know what to do. Since I have severe hallux longus extensor tendinitis maybe after physical therapy do you think when the swelling goes down, my big toes could negotiate the ground better.

My podiatrist gave me a trial of only one month physical therapy and said that the operation to cut the bone and lengthen the toe would definitely be indicated. Could you please tell me under what conditions you would undergo such a procedure.? It sounds like a complicated, painful procedure. What is the success rate for this kind of procedure??? Any other avenues available??

I am really tired of being on a Cox-2 inhibitor all the time.

Thanks a million for your good advice. Connie

Re: 6 months bilateral big toe joint replacements

Ed Davis, DPM on 3/22/04 at 17:42 (147535)

Connie:
Without the advantage of seeing your foot, I have to make some assumptions which may or may not be correct. The extensor hallucis longus, at times will contract and bind down with scar tissue after this type of surgery. The rubbing may be due to a contracted EHL tendon pulling the big toe upward. For this, I would numb the area and manipulate the area, stretching out the tendon and loosening adnesions and inject the area about the tendon with celestone soluspan (a steroid) and hyalurondidase (an enzyme).
Ed

Re: 6 months bilateral big toe joint replacements

Connie on 3/22/04 at 21:14 (147560)

Dr. Davis,

I will run your suggestion by my podiatrist. If he doesn't agree, is there another way to prove you have adhesions? Will those adhesions show up on an MRI, sonogram? I really want to get something done to give me relief. Every step is so painful.

Thanks again for your assistance! Connie

Re: 6 months bilateral big toe joint replacements

Ed Davis, DPM on 3/22/04 at 22:23 (147566)

Connie:
Testing usually does not need to be done since one can feel the adhesions and see their effect.
Ed

Re: 6 months bilateral big toe joint replacements

Connie on 3/23/04 at 12:36 (147618)

Dr. Davis,

Went to see my doctor and he said the only thing he could feel in the toe was air bubbles and he's telling me the only other thing he can do for me is to lengthen the big toe. Any suggestions? Prolotherapy?

Thanks Connie

Re: 6 months bilateral big toe joint replacements

Dr. Z on 3/23/04 at 14:43 (147625)

Connie,
I am not sure why he is going to lengthing the toe. I agree with Dr. Davis that you may have some adhesion. What about a fusion instead of cutting and graphing?

Re: 6 months bilateral big toe joint replacements

Connie on 3/23/04 at 14:50 (147626)

Dr. Z,

The lengthening of the toe would be done to change the angle of the toe.
The podiatrist said by x-ray and visually the toe was just too short. I have two friends who have had fusions and have had nothing but trouble. At all costs, I don't want a fusion.

Thanks for your help! Connie

Re: 6 months bilateral big toe joint replacements

Dr. Z on 3/23/04 at 15:46 (147628)

When you say angle you mean that the tip of the toe is pointing up and is rubbing against the top of the shoe. Or is the toe twisted and turned and rubbing against the second toe. Is this correct?

Re: 6 months bilateral big toe joint replacements

Connie on 3/23/04 at 16:10 (147632)

Dr. Z,

The big toe is pointing up and against the top of the shoe. The big toe is not twisted and touching the second toe. On the left foot I have calluses on my fourth and fifth toe and on the right foot I have a callus on the little toe. My physical therapist said I wasn't extending my big toe on the left at all and extending my right big toe too much. He based this on tek scan readings.

Any suggestions?

Thanks so much for your help! Connie

Re: 6 months bilateral big toe joint replacements

Dr. Z on 3/23/04 at 17:16 (147638)

Hi
I would lengthening the tendon first, if posssible. This would stop the rubbing of the toe against the top of the shoe. Does your podiatrist feel that the left foot calluses are related to the implant?

Re: 6 months bilateral big toe joint replacements

Connie on 3/23/04 at 20:17 (147643)

Dr. Z

My podiatrist thinks the Futura Gen 2 implant is perfect.

How long would you stick with the physical therapy before giving up on it? Would prolotherapy of that tendon help stretch it?

Thanks a bunch! Connie