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Comments on 1st MTP fusion

Posted by Carole on 1/27/05 at 18:25 (168060)

Dear Docs,
I wrote to you both months ago regarding my diagnosis of avascular necrosis in my Great Toe following a failed modified Keller procedure(and 2nd metatarsal stress fracture post-op) for hallux rigidus. I have since semi-retired to Florida and moved to a home on one level which has made a very slight improvment to my foot pain, but the problem still persists. I have started doing some distance walking, but the pain kicks in at about the quarter mile point, and I can just make it home at one mile. I am scheduled to see an orthopedic foot surgeon next week in Baltimore MD, and from our correspondence, he seems to think that I will need a 1st MTP fusion with bone graft and a plate and screws; possibly a shortening of the 2nd metatarsal to decrease the 2nd metatarsal overload.(He'll be more sure when he sees my MRI and Xrays) What can I expect? What kind of plates are used? Do you have any names that I can research on the Internet? Will I always have to wear oxford type shoes and orthotics? Is this a pretty sucessful procedure? Is it your opinion that I will be able to return to my four mile walks (ever??) after a fusion, or is this just a fantasy dream that things will be better? I am looking at returning to the nursing field after my recovery because I need to work at least eight more years, until I can finally retire at age 62. Any comments and info from you and the readers will be greatly appreciated!
Best regards,
Carole

Re: Comments on 1st MTP fusion

Dr. Z on 1/27/05 at 20:27 (168071)

Hi
Look up the term arthrodesis first metatarsal-phalangeal joint. Walking four miles daily ? Maybe but don't it expect this. Orthosis and oxford shoes?
Probaby. Successful? Very

Re: Comments on 1st MTP fusion

Ed Davis, dPM on 1/28/05 at 18:46 (168110)

Carole:
Please obtain a second opinion. Fusion of the big toe joint takes a long time to heal. Placement of an implant in the first MTP (bg toe joint) helps restore a more normal function and heals at a fraction of the time of a fusion.
Ed

Re: Comments on 1st MTP fusion

Carole on 1/31/05 at 16:26 (168206)

Dear Dr. Z.,

Thanks again for the reply. What do you think about a titanium implant?

Sincerely,

Carole

Re: Comments on 1st MTP fusion

Carole on 1/31/05 at 16:44 (168208)

Dear Dr. Ed,

I did seek a second opinion, and this doctor was the one who told me I had avascular necrosis, treatable with the bone graft. The foot surgeon I am going to see in Baltimore (my third opinion!)just gave me an email opinion. I do plan to ask him about an implant. I looked at the Wilson LPT titanium implant online. Is it metal only, or is there a silicon component with it? I guess there would have to be...I can honestly say that I am not real crazy about ANY silicon in my body. But, I am at my wit's end with this toe. Do orthopedic surgeons do the implant procedure, or is this just a procedure specific to podiatrists? I am really at a loss about what to do in view of the 'finality' of a fusion. I know I have real fears about it affecting my level of activity-walking, biking, working ten more years as a nurse, etc. These things are really important to me. When you say to get another opinion, are you meaning a podiatrist's opinion? I went to a great podiatrist before the bunionectomy, but chose the orthopedic specialist because he siad it it would take only one procedure when the podiatrist said it would be a two-shot deal? I look forward to reading you comments, and again, I thank you so very much!

Most sincerely,

Carole

Re: Comments on 1st MTP fusion

Dr. Zuckerman on 1/31/05 at 17:36 (168209)

Hi

I use a titanium implant.