24 October, 2014

Summary - a good place to start

I am sharing my experience from the treatment of hallux rigidus. It is a condition where one gets osteophytes (spurs) over the metatarso-phalangeal joint (this is the one on the base of your big toe), plus damage to the cartilage of the joint. With time, these cause big toe pain (right at its base), limited dorsiflexion (ability to bend your toe upwards), and there are "lumpy knuckles" that cause aesthetic problems especially to the ladies (we guys usually do not care that much, although some do....). The condition is developed after acute or chronic trauma, or is genetically conditioned, or - like many things in human medicine - one simply does not know the causes yet.

You will find the history of my recovery on the right side of the page, or below if you are viewing this blog on a mobile device (there should also be a link above if you prefer). It has a table of contents format, starting on the day of the surgery. Many readers have provided their comments, experiences, asked and answered questions (you can see in the table of contents how 'active' each topic has been so far.

There is also a Cheilectomy Recovery Survey that allows you to see the experience of others, and share your own experience.

This blog was created in real time, each post was written on the actual day following the surgery (and not retrospectively). You may get a good idea what is the post-operative recovery time for a cheilectomy, although there is an obvious element of variability here, and your healing and recovery may differ.

Your thoughts, comments, or questions to me or other readers are most welcome.


26 comments :

  1. This has been a great blog to read. Thank you for capturing your recovery. I was so unsure about the surgery before I had it, and I read such awful things about other's experiences. I was hoping my recovery would be more like yours, and so far it is pretty good. I had a great doctor and I think that makes a difference. Today is day 20 post-op. The stitches came out on day 10 and although I'm still in the post-op shoe I am trying to walk as normally as possible. Yes, it's uncomfortable, but I think that's to be expected. I am waiting a couple more weeks to go back to the gym (I previously worked out 4 days a week) but I feel better every day. I know that things will continue to improve - and again I thank you for blogging about your experience. I really appreciated it!

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  2. I'd like to first thank you for taking the time to write this blog, it helped me a lot with my decision to go ahead with my cheilectomy. Now to briefly share my experiences. In am 3 days after my surgery and feeling great. In am a 42 y/o male, fairly active, but not an athlete by any stretch. I had been suffering with an increasing sore right foot in the big toe joint over the last few years and since I started a new job that is a 25 min walk each way from home it had become really annoying, but not unbareable. I had it checked into and after ruling out gout and a x-ray, they settled on halllux ridigdus. The doc said they could remove the one spur and perhaps fuse the joint. It really wasn't that bad, I didn't like the idea of fusion, but decided to go ahead with the Cheilectomy only. They did anankle block and put me into a light sleep, but not full general anaesthesia. That worked great, I was asleep for to op, but felt fine an hour later. The ankle block lasted about 24 hrs after, so I really didn't feel much pain later. I did take the prescribed oxycodone the night and day after, but didn't need it after a day. I was able to walk/shuffle on it immediately and it's been getting steadily better since. 3 days after I am able to walk about mostly pain (and drug) free. I am still using the post-op shoe at work, but think I will back in regular shoes in a few days. Toes movement is still limited, but that feels more due to the sutures than mechanical. Doc said they got 90 degrees movement post-op. glad I was asleep for that... Anyway, just wanted to let folks know that in perhaps less severe situation, the recovery seemed quite manageable. Did it on Friday, back to work on Monday, walking to work on Wednesday, hope to play rec beach volleyball 6s next Wednesday, stitches out the following Thursday. Good luck folks.

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  3. Are you in NZ? You sound like you were pretty happy with your specialist - can I ask who you used?

    Cheers!

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    1. I have lived in a few countries, but not yet in NZ, maybe in a few years. Now I am in North Carolina, USA. I am sure you have a few good orthopaedic surgeons there!

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  4. Thanks for sharing all of this. Just had the surgery two days ago. I am also an avid runner/highly active person, so was grateful to read your successful account of recovery.

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  5. Thank you for this blog. As someone who loves to run and play squash (pretty sure I am one of 100 people in the States that plays this outside of New England) the slow degradation of hallux limitus has been excruciating both physically and mentally. I had the surgery on 11.22.13 and now, 4 weeks out I am finding that my joint is still double, maybe closer to triple the size of the opposing great toe joint and the pain and stiffness seems to be getting worse, rather than better. It is nice to know that I may just be expecting too much too soon and to just keep plugging away at the recovery.
    Cheers!
    Tony Robinson

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  6. Thanks so much for your blog. I'm a 63 year old female, but extremely active and fit. I usually play tennis six days a week, and am also a steady gym rat. I will be scheduling my surgery as soon as possible. I've been trying to hold off until our tennis "playoffs" in March 2014, but realized the pain is now slowing me down on the courts so much that I can no longer play competitively. We're opting for the cheilectemy rather than fusion because I hope to be able to wear heels again some day! Again, my sincere thanks!!!

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  7. Hi there!

    I'm so grateful to have found and read your story. I'm a runner with a very painful right big toe. Orthotics have helped, but I'm again symptomatic to the point that I'm considering this surgical intervention. The only time it does not hurt is when I'm in my running shoes!!! I live in Connecticut and wonder how to best find a surgeon that can do the procedure. I'm very worried that I won't be able to run even after having this. I'm nearly 60 and a female, but I've been running since I was 25.

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  8. I am not in position to advice the names in Connecticut... but it is always good to ask around for recommendations, especially if you know any physicians etc.

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  9. Surgery for my right toe is scheduled for April 14. I'm both apprehensive and looking forward to getting this done, as I'm sick of being in pain. I'm very worried about a long lay off from running, as I've been a runner for a very long time. Encouraged by the comments that you've made, Parsifal, about the possibility of speedier healing time due to being in shape. Hope that's the case for this old gal...

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    1. Hope your surgery went well. Mine was yesterday - same procedure - Cheilectomy. More pain today after the ankle block wore off - but percocet helps. All the best - Scott

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    2. Scott,

      Hope you see this reply! My surgery went extremely well!! I took exactly 5 percocet pills, 5mgs each. A couple Motrin after that. I'm wearing this big boot nearly 24/7, but I'm wiggling this toe like crazy! I have no pain, except for the mental thing about not being able to run. Hoping to get these stitches out by my orthopaedic surgeon tomorrow. I kept the foot elevated for most of the first 3 days, but started running (well, not really, just staying on my feet) around thereafter, elevating and icing it if it felt "full." I notice you're a DO. I have used the services of one of your colleagues in Hamden, CT with great success. I have such respect for you all!! Wonder if you have words of advice re: how much I should work this toe. I do plan to do PT ASAP. I can't stand not being able to run. Bought a new stationary bike to ease me back into exercise, but it's just not the same high. My DO also did acupuncture. I wonder if that would help with healing??

      How are you doing with your post op?

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  10. I am in Charlotte, NC. Did you happen to have your surgery there? Would you share your surgeon's name--if not here then via email? I've been to OrthoCarolina for another issue and was very pleased, so had planned to start there. Thank you for this great blog!

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    1. Actually I had my surgery in Wilmington, NC. I can give you the surgeon's name by email, you can contact me on inwi00-chtmy@yahoo.co.uk (this is a temporary address and will expire in a few days).

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  11. For those of you who have done this surgery, did any of you have an experience that was significantly different from that described by Parsifal in his most helpful blog?

    Also, what kind of surgeon performed the surgery: podiatric; orthopedic; orthopedic specializing in foot surgery?

    Finally, did anyone also do subchondral drilling? This is intended to stimulate the body into producing fibro-cartilage, which is a kind of second-rate cartilage; not as good as the stuff with which you are born, but better than no cartilage at all.

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    1. I had a very difficult first six weeks, beginning with the complete failure of the nerve block during surgery and continuing with a high level of pain that prevented me from sleeping at night for weeks on end. My progress has been well below the benchmark set by Parsifal and most of the other posters. At 12 weeks post op I still have pain when walking, and my dorsiflexion is only 30 degrees after stretching. I can finally get into some regular flats though - until recently it looked like I'd be stuck with gym shoes forever.
      I'm a 58 y/o athletic female, regular cheilectomy with no drilling, performed at regional hospital by an orthopedic surgeon who specializes in foot/ankle.
      - Melissa

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  12. Thank you for such inspirational blog. Will track my own recovery. I am 49, live in Scotland, and suffered for a year before being referred. I haven't run during that time, but have been able to cycle long distances and challenging hills. My yoga teacher has compensated me for the lack of toe be nds but I have struggled even to walk the 10 mins to work and have been using my bicycle as a wheelchair.

    Yesterday I had my cheilectomy and cannot fault the staff of our wonderful NHS. My father-in-law is a retired podiatrist surgeon, but came off the register too late to operate on me.

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  13. Thanks so much for this blog! I have had pain in my toe for many years and started getting cortisone shots about 2 years ago. The doctor said the only way to truly relieve it was surgery, but I have been putting it off, living with the pain, etc. I am sure I have exacerbated the problem by continuing to run, but I love it so - I can't quit.

    I now have pain all the time when walking/running and cannot wear any shoes with a heel. What feels the best is running shoes with a carbon fiber plate in them to limit the bending, but I can't run with the plate thing in the shoe.

    I have been thinking of having the surgery this year and after reading this blog I feel so much better about it. I am going to schedule it in late October or November and I will post my progress as well.

    Lanier

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  14. Thank you for your blog. It has been very helpful both before and after my surgery, which was 9days ago, my recivery has been very similar to yours thus far, although I also had an Austin Youngswick osteotomy to address the elevated 1st metatarsal bone which caused the joint problems in my big toes. I look forward to my follow up appt tomorrow, and to having the second foot done in a few months. Hopefully things will continue to progress well, and it will all be worth it in the end! Very happy so far. Not nearly as bad as some other posts made things seem.

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  15. Thank you for this blog. It has been really helpful to me. All the responses and different recovery times have been very helpful also. I am on day 10 but I had a newer procedure done. It involves putting a metal cap over the joint and screwed in to the base of the joint. I had no cartilage left. I have had more swelling than you but I think it was due to more trauma to my joint. I can bend my toe 90 degrees albeit with pain. I feel it will definitely get better. The md says that he has done this new procedure on patients that have had previous cheilectomy with great success. He only does fusion as a last resort. I am looking forward to waking normally again.

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  16. Thank you for your blog. i had my chilectomy/moberg 2 weeks ago. had stitches out today. down to one crutch and post op shoe. hope to be in crocs tomorrow. i am 44 and very active (or was before this). no exercise for 2 weeks spent horizontal and my back is wrecked. can't wait to return to gym, hopefully today for upper body anyway. your blog has been very helpful at knowing what to expect. i had surgery at HSS in nyc with dr david levine, everything according to hoyle so far

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  17. Thank you so much for your blog and all of the information. I am scheduled to have a cheilectomy in a few weeks. I am an avid runner and am very nervous about the amount of time it will take me to get back to trail running. I have found a decent amount of information about the recovery time for running, but I have not found any information on the recovery time for trail running. I know that it will be a longer process with the uneven terrain, rocks, etc. But I was hoping someone reading the blog might be able to post their recovery time for getting back out on the trails. Thanks!

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  18. It's been a while since I've posted on this blog. I'm almost 9 months post surgery, and I can tell you I'm very glad I did it. But I will say, running 5 weeks post op was a very stupid thing for this gal to do. I didn't realize how much I'd been depending on the left leg to compensate for the right foot that was operated on. I returned to running too much, too soon, and ended up with runner's knees.....yes, that was plural! Then, my illiotibial band became irritated, along with the periformis muscle....all on the side that was not operated on. I ended up having to take an additional month off from running. I thought I could just start running, especially since cardiovascular-wise, I was fine! I could run 5 miles without a problem. The foot that was operated on felt only a bit sore after each run of 3-5 miles. But I must have been using the other side too much throughout my recovery and while I was returning to running. Also, my orthotics needed to be adjusted to compensate for the change in my gait on the operated foot, as well as on the other foot. What a mess!
    But I'm happy to say that rest and new orthotics did the trick. I'm experiencing only that same kind of sensitivity that Parsifal describes. Not really pain. It still feels like a nice healing kind of sensitivity. Now, if I could only get rid of the extra weight I'm carrying around, it might take care of the other aches and pains I feel. But darn, I love my bread!!!

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    1. Marilyn,
      I'm a 43 year old runner about to have a cheilectomy on my right foot...which has been killing me for about five years. I run 5 miles 4 to 5 days per week. Can you tell me if you're back to your running distance and ability now? Thank you for the information. I'm terrified that I'll never to be able to run again like I do now. (And can you wear heels? :)
      Nicole

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  19. I've posted here before about my trials and tribulations with hallux rigidus and my cheilectomy procedure. I am 30 years old, very active, a runner (25-30 miles a week), a hiker, skier and all of the above. I am currently 8 weeks post op, and i'm finally returning to semi-normal.

    Let me first say that as far as amount of bone removed and stiffness of the toe pre and post op I was on the worse side of things. My orthopedic surgeon performed a cheilectomy combined with a bunionectomy and a sesamoid release. He removed a lot of bone which is why my recovery has gone somewhat slowly.

    I highly recommend that anyone who has this procedure done gets a good physical therapist and goes to see them as soon as they are allowed to by the doctor. This has been the single biggest part in my recovery so far. Without a physical therapist I would be weeks behind where I am today (I jogged on and off for 4 minutes the other day).

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  20. My name is Jim. I am 39, semi active, and 6 weeks post cheilectomy. I will not lie to you, the first several weeks were painful. Every day the swelling gets a little less and I get just as much more movement. Right now I would say that the swelling is down 95% except for the wound itself (its bumpy). I was in gym shoes by week 3 as the boot is just stupid annoying. I have pain everyday while walking, esp on the bottom of my big toe joint. Sometimes on the side of the big toe. This makes no sense to me as the operation was on the top of the joint. Its to the point where you won't put your full weight on the toe while walking and at the end of the day, I relish putting my feet up. I push it as I want to recover as fast as possible. I crank on it doing my own physical therapy, stretching it hard. I am looking forward to the day the pain is gone...so I can do this whole crazy process over again on the left foot. Yippee.

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