Based on my experience, and on all comments on the blog, here is the advice I would like to reiterate:
- Choose a good surgeon for your cheilectomy
- Be very patient - expect long - or rather very long - recovery (months/years)
- Remain sceptical about any ways to "rush" the healing process.
- No forced bending/extending of your toe after the surgery, unless there is a very good rationale for that
- Remain positive and make your life after cheilectomy as easy and pleasant as positive. In most cases, there is no need to suffer post-op pain (use proper painkillers under medical supervision), there is no need to go smelly without a shower for a day or two (use shower protector), go back to exercise and daily routines as quickly as your body allows, but do not rush. There is nothing to lose by not running for another month or so - compared to what might happen as a result of an injury to the healing joint that is not ready for the exercise.
And remember: being reasonable is not a sign of weakness (on the contrary, acting on your emotions usually is).
Thank you for writing this blog! I was diagnosed with hallux rigidus a couple of days ago and am having a difficult time processing my thoughts. The podiatrist's fist direction is to wear a shoe insert with a steel plate to keep the toe immobile. This appears to be Step 1 of a long term plan of keeping the toe immobile forever. Step 2 is to go back in 4 weeks and get fitted for a custom shoe insert. I asked about how to regain range of motion, and he seemed hesitant to suggest surgery. (I had a bunionectomy in 2003, so this would involve cutting the same bone again, additional scar tissue, etc.) However, to me, choosing a path of making not only my big toe stiff but by default of not using them, making all of my toes more stiff does not seem preferable to suffering (relative to the rest of my life - I'm 44) short-term surgery and healing and then regaining range of motion. I am very active, though not a runner like you, I like walking, traveling, cross-country skiing, swimming, biking, etc. I'm overweight but not a couch potato. Why would someone not push for this surgery? Do the results last or is one at risk for the toe stiffening up again even with this type of surgery? I appreciate any insight relative to your experience.
ReplyDeleteIt is very hard for me to comment on why your podiatrist does not push for surgery. Perhaps there is a good reason - have you asked him or her explicitly? And,if I had doubts, I would probably request a second opinion from an orthopaedist specialising in foot problems.
ReplyDeleteThank you! Yes. When I asked, he said that there is a difference between managing and fixing and first we try alternates to manage the pain and prevent further deterioration before jumping into surgery since surgery involves risks. When I let this soak in as I continue to think about it, it does make sense. If I went to the appointment and he immediately said I need surgery I probably would think he wasn't doing his due diligence with alternates first. Although in this case not having surgery seems to me to be giving up and settling allowing the toe to be stiff forever. I plan to go to my follow-up appointment and talk to the doctor further then, and I have his e-mail address and may e-mail some questions since it can be hard for me to process things "on the spot" during appointments. But yes, I will not be shy in getting a second opinion and even so before I finalize my decision to have surgery will research the best person to do the job.
DeleteWell, I would think that in most cases it might be better to operate early - before there is too much damage to the joint/cartilage caused by the spurs or perhaps loose pieces of bone or other tissue in the joint itself, etc. But I am neither a specialist in this area, nor do I know what exactly is happening there (perhaps there is a good reason to wait). I would definitely speak to another specialist if I had any doubts.
ReplyDeleteHey there! I came along to your blog just a few weeks ago and read every inch of it! First, thanks for the posts of your progress and happy your life has moved forward so well. I had a fall last Dec and fractured my right ankle. While falling I jammed my left big toe/joint into the floor. NO one believed me that I needed help with this left foot for almost 9 months. I finally found a wonderful specialist who listened to me and took new and quite different XRAYS that NO one else would do. And there it was, a broken cartilage /bone spur and post traumatic arthritis . He gave me a cortisone shot and I wore a hard plastic thing in my shoe for the toe/joint. Didn't work. Needless to say, 2 months after seeing him I had the operation on August 2nd. Nerve block in my leg to manage pain (which didn't wear off for around 18 hours) Gave me perc's for pain and time to heal. Two weeks later the stitches came out and now I'm moving it quite a bit. I will say having a pool and doing the physical therapy in the pool has been much better for me. Now that I'm 26 days out of it, the pain seems a bit worse when I'm doing anything. I tried my sneakers and got my foot in it but after wearing it for a few hours and taking a walk I was in agony!! So my question is this: why now with the pain? Also my husband has been moving it up and down for me daily and it sends me through the roof. I haven't taken any strong meds since day 3 or 4 just advil, but wondering , has anyone else experienced this? Am I pushing to much? But man, I just want to move on with life! Thanks in advance and thanks again for this blog!
ReplyDeleteWhot is your specialist saying?
ReplyDeleteYou could probably see from my comments on the blog that I am not a particular advocate of intensive excercising. The joint needs time to heal - probably 4 to 6 months. The range of motion should come back - slowly. In my opinion, gentle exercise is OK - gentle means that it must not cause pain. There is no way to accelerate the healing process.
Thank you. I haven't seen my specialist yet. Sept 15th is my appointment for him. I did think it was gentle exercise just by walking a little down the road. I guess from where I am today I have pain but still very sore. Today is a slow down day!
DeleteI too would be very careful with intensive excercising of the toe. I had my surgery on August 1st and had the stitches removed on August 11th. At that point I was not required to wear the boot and my foot even fit in regular shoes. I walked pain free and without a limp. However, I was sent to a physiotherapist and at my first appointment (on August 16th) she chipped the bone on my first metatarsal by being overly aggressive. This was confirmed by x-ray on August 25th. I am never going back and now I have to be careful as I heal from the surgery and from the avulsion.
ReplyDeleteOH I'm so sorry to hear this for you! That must be very painful. I wasn't required or as of yet anyway to see a physiotherapist. I or my husband have been doing the exercises. I will say this is what causes most pain when we do them. Grabbing onto the joint and moving it in a up and down motion. Its unpleasant to say the least. Shoes are still a challenge on that foot. They told me to get a pair of CROCs which I don't want. I can't imagine that has enough support. After almost a yr of going through the pain and aggravation I just want to be better!! I wish you well in healing!!
DeleteHi there!
ReplyDeleteI'm so happy to read that there are positive outcome stories like yours.I hope your big toe stays painfree for many years to come.
I have just one question. I used to practice Aikido and stopped due to big toe pain during techniques done on the knees with toes up. In your case, after your swelling and night pain was gone, were you and are you today able to sit on the floor japanese style with toes up on the floor (and sitting on your feet)? This information would be very motivational for me (if you can do it without pain) :)
Thank you in advance and all the best. Hope next year it will say again "So far, so good!" :)
Cheers
Hi, thanks for the comment. I have to admit that - until today - I never tried Japanese style sitting. I have just looked up on the internet what exactly it is, and peformed the test. Results below:
Delete1) no pain or inconvenience in my toes/feet - whatsoever,
2) the muscles of my thighs are not used to such position, even though I am a fit and well streched person despite my age - they hurt like hell!
With regard to Aikido, I would probably by very cautious about the likelihood of repeated injury and further damage to the joint - because one wears no shoes (other than tabi, which do not give any proetection either). I would definitely switch to something else. FYI, I started regular fenicng this year - lots of fun. I wish I had found that out when I was 15, not being 51..
Hi there!
DeleteThank you so much for your test and answer. Much appreciated! :)
Just one question to clarify: Have you been sitting on your feet with toes tucked under (dorsiflexed) or with your toes flat on the ground? Here is what I mean (second picture from the top):
http://crossfitdc.com/2011/06/30/465/
This stance if often in Aikido, yoga and several other ways of exercising and I would love being able to do it once again. That's "my definition of healthy toes".
I kind of recently found out that I'm in an early hallux rigidus stage (after hitting my first MTP joint badly) and I wanted to weigh my options regarding treatment, recovery, professional and free time activities options.
Long story short, I'm trying to understand the consequences of a Youngswick osteotomy + cheilectomy to my 1st MTP joint and what I'm going to be able to perform with it afterwards and what not.
Of course I will be cautious in every situation, but mainly I would like to know if my favorite activities are out of question or maybe still possible.
And yes, one has to be grateful for being pain free and mature enough to live his life in a constructive and positive way. I'm happy for you that you've found a new fun activity in fencing.
I'm 39 and hopefully very active soon again...
Best regards,
Jay
Jay, I can do dorsiflexed position for 2 minutes (to my own surprise - never in my life have I tried to sit like this). I canot put full weight of my body onto the feet, likely because I am not stretched enough to be able to do it. There is a little bit of discomfort in the right foot, but there is no pain.
DeleteFlat is not a prblem
Just found your blog and there is so much great information! I am 8 weeks post-op and have been feeling quite discouraged with the slow progression of healing. I am a nurse and have not returned to work yet. I decided to go to my wonderful massage therapist (who used to be a physical therapist) and I feel so much better. She released a lot of the tightness in my affected foot and leg. It was painful during the massage, but my foot feels much better now. It was a great compliment to my own physical therapy.
ReplyDeleteHi Audrey,
ReplyDeleteI find that my healing from my surgery August 2nd is slow also. I think I was making some good progress but really truth be known the pain has never gone away. When I went back to my surgeon for my six week follow up he did say I had a ton of post traumatic arthritis in there, so that could be it. Also could be from my recent surgery on my right ankle and using the left foot for my scooter, but it is slow.......... love your idea of a massage therapist! I may have to try that!
Thanks!
Rose
Hello, and thank you so much for keeping such a detailed account of your progress! I was diagnosed with bone spurs a couple of days ago, but am delaying surgery until the spring so I won't have to worry about navigating snow and ice when I'm recovering. I plan to be as educated as I can about the process in advance so I'll know what to expect and what I can do to ease my recovery. Thank you again and cheers!
ReplyDeleteThank you for doing this! I was just told last week had my options are to deal with the pain or surgery and I’m not sure how I feel about the idea of surgery. I’m fairly young to be dealing with this (31) and am nervous about the idea of surgery. This has really helped me! Thank you!
ReplyDeleteHi Parsifal,
ReplyDeleteThank you for the all of this useful information. I've recently been told I have advanced hallux rigidus and offered a fusion. I'm really unhappy about losing movement and having to change my gait. I have enough difficulty walking for other reasons, although I'm very active and aim to do 10000 steps daily. Walking is very much part of my daily life/exercise routine. I asked about alternatives to fusion and was told they don't work. Do you suggest I get a second opinion? How do I find a good surgeon to do this? Is it true that cheilectomy doesn't last for more than 5 years? I can manage as I am at the moment. Is it better to leave well alone or is that just making treatment less likely to be successful in the long run? I realise that there are no guarantees in life and would like to draw on the general experience you've gained from this site. I'd really appreciate hearing your thoughts.
I do suggest a second opinion. Or perhaps even third one. Ask around about the best surgeons, specialising in foot and ankle. Check online. See them, make sure you follow the advice of someone whom you feel you trust. With respect to cheilectomy lasting not more than 5 years - I do not know how anyone could formulate such opinion, IMHO it is complete inappropriate. One could perhaps say that ‘in most cases’ it does noI am a living example that it is not true - approaching 6 years since my cheilectomy, and for me each year las fee 5 years - but I am a living example that this does not apply to everyone. I am approaching 6 years since my surgery, each year is better - currently no pain and very good range of motions. My sister had cheilectomy one year after me, and as far as I know she is doing perfectly fine as well. I can imagine how difficult my life would have been had I not had the surgery. Of course one never knows, perhaps I have been lucky so far - but I do not think things could be worse than before cheilectomy.
DeleteI have just had a bone fusion as my surgeon noted that the trim is not always the best long term solution for advanced Hallux rigidus. I am highly active (or have been!) And this is the best solution to resume my activities post op (I am 54 years old).My surgoen is a specialist in the private sector in the UK and somewhat of an expert in his field.You can monitor my progress on my blog over the coming weeks/months. My aim is complete my next half marathon Sept 19.With regard to gait if you have severe Hallux rigidus...its already affected https://pwilson8.blogspot.com/?m=1
ReplyDeleteI have followed your wonderful blog since you first posted it. I was diagnosed a few months before I found this. Before jumping in I searched the net. I then proceeded to get second and third opinions. First in 2012 was from pediatrist who recommended the joint decompression and remove the growth. he insisted on 5 to 6 months recovery, my employer allows 6 then it is unemployment. So I put it off, since I have gotten two opinions from Pediatric Surgeons, both recommend the plate and screws. I do want to go this route, I am a lineman for a power company and on my feet all day in all kinds of situations. Metal plates and electricity concern me!
ReplyDeleteThe pain and mobility has gotten worse, I walk on the side of my boots. Now affecting my back. So all this said, the insertion of cartilage into the joint along with cheilectomy interests me. Is this new technology common? I had asked one surgeon about stem cells in the joint, but he had no input either way and hadn't heard of it being done. I am about ready to take the step as I am long tired of the pain. I just don't want fusion and a plate. Thank you everyone for the info and comments.
Thank you so much for posting this blog. I had my stitches removed four days ago and appreciate reading about variations in progress. It seems recovery is going much faster than originally advertised, but I won't be discouraged if/when it slows some. Also a swimmer, cyclist, hiker, runner, I look forward (as you an imagine) getting back to it. This blog is a huge resource, both your perspective and the range of experience in the comments. Very grateful.
ReplyDeleteI'm at 4 1/2 years, posting earlier as Chi Judo. I mostly don't notice my toe anymore. Sometimes it hurts a little during walks with flexible shoes or after long walks. I've jogged without pain in Brooks running shoes intended to minimize front toe pressure. Yes. Surgery was the right decision. I'm not good as new, but none of me is at 54.
ReplyDelete