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Toe Joint Fusion Recovery: One Patient’s Story

POSTED ON IN Ankle Foot Latest News BY Chris Centeno

toe joint fusion recovery

This week I met a patient who had a toe joint fusion. However, this was a disaster of sorts. The good news was that her toe felt better, but the bad news was that her ankle felt worse. Why? Because her toe joint fusion recovery was a long-drawn-out process that forced energy from her toe to her ankle. Let me explain.

Big Toe Arthritis and Hallux Rigidus

Big toe arthritis for some of us happens as we age. It’s more common in women, and we’ve observed it’s more common in people with chronic low-back pain. When it gets bad, it can result in lost range of motion in the metatarsophalangeal (MTP) joint, and the medical term for this is hallux rigidus (Latin for rigid toe). For some bizarre reason, one of the treatments is to fuse the MTP joint solid with one or more screws. As with any fusion, this surgery is a dog with fleas.

Fusion Is a Dog with Fleas

Surgically fusing joints together has become big business over the last two decades. From a business standpoint, you can take a medical screw or plate made in China for $5 and sell it for $1000 or more. Given those profit margins, there is an entire army of orthopedic sales reps who sell this hardware to surgeons and hospitals. Hence, given the business plan, it’s not surprising that fusion surgery has become so popular.

I always tell my patients that a fusion is a dog with fleas. Meaning that while the surgery can sometimes help one problem by making it not move, it usually causes others. In the spine, there’s a name for this problem: adjacent segment disease, or ASD. This diagnosis means that once you fuse two vertebrae solid, the forces that should have been handled by that area get shunted to others, which break down more quickly. I don’t know what’s more medically screwed up, that we are aware that fusing one area can hurt others or that it’s so common that we had to create a medical diagnosis for the problem.

My Patient This Week

The woman I saw this week was actually in to have her low back treated. During that visit, she mentioned that her right ankle was hurting. She also recounted how a big toe fusion recovery that she endured was awful in that it took a full year before she felt somewhat normal. She also stated that a few months after her big-toe fusion, the ankle began to hurt. Her ankle was tender and so was her big toe, despite the fusion. So I explained what I have drawn in the picture above. That fusion of the big-toe joint was transmitting forces up the kinetic chain to the ankle, so it wasn’t surprising that her ankle now hurt. Given that there is no way to undo the big toe fusion surgery, outside of treating her ankle to keep it hanging in there, there was no solution to that issue.

The upshot? Big toe fusion recovery often includes new places that crop up with pain. Not all patients put two and two together, and in this patient’s case, her surgeon came up with an explanation for her ankle that avoided the obvious. However, when you fuse the big toe, that energy has to go someplace. Also, this alters your gait in ways that can’t easily be fixed. Hence, don’t immediately buy in when a fusion is recommended, and get lots of opinions. While there are a few medical problems that truly need a fusion, based on my experience, this surgery should never be used as a way to commonly treat pain with surgery.

 

 

    *DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
    Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.

    comments

    Sheri says

    What is the recommended way of treating hallux rigidus? My MTP joint needs help!

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    Chris Centeno says

    Sheri,
    For treatment for the most common cause of hallux rigidus, please see: http://www.regenexx.com/big-toe-surgery-recovery/ If you'd like to see if you'd be a Candidate for a procedure, and what type of procedure would be needed in your particular case, please submit the Candidate form.

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    Jed Blaich says

    Would a PRP or Stem Cell injection help with big toe arthritis and if so what is the outcome ?

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    Chris Centeno says

    Jed,
    Yes, that's how we treat big toe arthritis. It's also important to determine why you have arthritis in your big toe, and not other toes, or your ankle, etc...and treat that as well. The average LEFS score (which is lower extremity functional score) for men is around 60 out of a possible 80.

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    Linda Cormany says

    I had big toe fusion 2 years ago. While I have nor experienced a lot of ankel pain, I am now having a probelm with the smaller big toe joint above the one that was fused. It is taking all the "heat". I have tried prolo and platelet injections without success. One thing that does help is regular PT and manipulation with a therapist that really specialized in feet which is hard to find. I go at least monthly and it is keeping it calmed down for the meantime. I also tape it anytime I hike or walk or use a treadmill or elliptical.

    I hope this is helpful.

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    Cheri Murphy says

    So what DO you recommend for extreme toe joint pain?

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    Chris Centeno says

    Cheri,
    So many of the problems we see are as a result of the type of care people have received, as the strucural paradigm of modern Medicine looks at the body as disperate unrelated parts. So identifying the actual cause or causes of the extreme toe joint pain and treating those issues using precise image guided injections of your own stem cells and or platelets to repair the problems, rather than creating additional ones, is what we'd recommend. Please see: http://www.regenexx.com/big-toe-surgery-recovery/ and http://www.regenexx.com/the-regenexx-procedures/ankle-surgery-alternative/

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    Mike Davis says

    I had my ankle treated by you in Grand Cayman about a year ago and the subsequent improvement has allowed me to resume some pretty rigorous hiking in the steep hills around my home, but now that I'm hiking more the ankle improvement has slowed or maybe plateaued. After reading about the big toe connection I'm thinking that maybe treating my big toe arthritis could help my ankle continue to improve. I've not had a toe fusion but it it stiff and turned to the side due to a bunion. Can stem cells help the bunion and the big toe flexibility? I still have cells stored at the Cayman facility.
    Mike

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    Chris Centeno says

    Mike,
    You're likely right. One of the major causes of bunions is an issue with S1 in the back. Do you have an MRI? Please see: http://www.regenexx.com/how-your-back-is-causing-your-bunions/ and http://www.regenexx.com/bunion-removal-without-surgery/ Important to address before it creates additional problems.

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    Linda Alsdorf says

    I have had bilateral big toe titanium implants in my big toes. By xray, the implants look fine, but the first toes are about 3/4 to one inch shorter than the second toes. The result is metatarsalgia in toes 2 through 5. Is there anything you can do to help stop the pain?

    Thanks very much

    replies

    Chris Centeno says

    Linda,
    We can certainly treat the other toes, but would want to also figure why they’re hurting as well.

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    Linda Alsdorf says

    The doctors now want to take a bone from my hip or cadaver and put it on my big toes and fuse it, and then put in some of my stem cells to help heal it. Currently, my lower back, pelvis, hip, and medial gluteus maximus are killing me because of the short first toes. Isn't there anything else that can help? I am in alot of pain. Do you guys take insurance?

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    Chris Centeno says

    Linda,
    Many people have short big toes and are not in any pain, so the source of your problem is likely elsewhere, often the low back. The very invasive surgery you mentioned is not likely to fix the problem as it is addressing the symptom rather than the cause. We'd be glad to take a look through the Candidacy process to see what's going on in your case and the best way to actually address both the cause and the symptom, non-surgically. Unfortunately, these procedures are not covered by health Insurance, yet. If you would like to begin that process, please submit the Are You a Candidate Form, here, or let us know and we can assist. Please see: https://www.regenexx.com/how-your-back-is-causing-your-bunions/ and https://www.regenexx.com/toe-joint-fusion-recovery/ and https://www.regenexx.com/bent-big-toe/ and

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    Michelle Lombardo says

    I think your column is misleading there are those of us who's big toe joint is destroyed and the only option is fusion. Orthotics, shots those are just bandaids. I am a letter carrier on my feet 10+ hrs a day and an endurance athlete. I tried every option available and nothing worked this was the last ditch effort. I have heard positive things about the fusion even a return to running for some. You may be right in that searching for causes of hallux may be helpful, but you also know they it's hereditary, and searching and finding imbalances will not always help. The body is full of them. Anyways my 2 cents

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    Chris Centeno says

    Michelle,
    Thanks for your 2 Cents- hoping it works really well for you! When we talk about surgeries not working we're not talking about individual cases. What we're saying is that looking on the magnitude of a thousand cases the risks or complications outweigh the benefits. Additionally in so many cases of fusion or joint replacement less invasive treatment that would have solved the problem was not tried first.

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    Holly says

    I am curious what you would recommend when the arthritis at the MTP joint arthritis is caused by an elongated metatarsal in both feet. My range of motion is about 8 degrees with cortisone shots. The cartilage is almost completely gone and will soon be bone on bone. A fusion has been recommended because there are little other effective long term options for me. I am only 36.

    replies

    Chris Centeno says

    Holly,
    Unfortunately, cortisone shots breakdown cartilage and are lethal to the local stem cells within the joint so they make the situation much worse. We'd need more information through the Candidacy process to see if we can help. If you'd like to do that, please submit the Are You a Candidate form to the right of the Blog.

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    Daniel Field says

    My doctor has recommend fusion of the right toe big joint. I am almost 62 years, and the joint has no cartilage left, only bone on bone. It's so bad right now, I am screaming in pain most of the time. The pain meds make me sick, I can't walk without aggravating the pain much more. My back is screwed up since I was 19 years. The big toe x-ray was pretty graphic, no cartilage left at all. I have had both big toes relieved by taking piece of bone out and screwing the bones together. The right foot was the first in the 1990's and the left was done early 2000's. I believe the left toe is going to need fusion too. I really don't know what to do now. In reading this article, I am now suspicious. My surgery is scheduled for 6 April 2018. What do you think?

    replies

    Chris Centeno says

    Daniel,
    Generally, the type of problems you describe originate in the low back. We'd need to examine you (back to feet) to see if there is anything we can do, which would require your surgery to be postponed. If you'd like to do that, please submit the candidate form to the right of the Blog, and let us know so we can get the ball rolling.

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    Maureen Morgan says

    I hadsurgery on both of my big toes for “Hallux Rigidus. “. The right one done in 2010 and the left done in 2012. I am having EXTREME PAIN in the right toe and unbelievable swelling. Yet the left toe, by Xray shows broken screw/screws. I went back to my surgeon and was given GABAPENTON. This is a joke. I don’t know where to turn. I am a caregiver for my husband and I am a CNA in a Retirement Home. I need to walk. Please if you can help or refer me to someone who can help me, I’d be so grateful. I only have medical insurance through the state.

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    Chris Centeno says

    Maureen,
    We'd love to help, but unfortunately without examining you, we can't offer any direction, other than to say that you should have your toe evaluated by a Physicain. The closest Regenexx location to you would be Pittsburgh. Interestingly, Gabapentin can cause lower extremity swelling.

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    Kay Steed says

    I had spurs removed and mpj clean up of my right big toe on Apr 2017. Also had extra bone removed from in side of right ankle. I am still having lots of pain in right big toe and 2 podiatrists, including the one who did my surgery, suggested fusion or hemi-implant or cartiva implant. I am in quite a bit of pain and shots only lasted a couple of weeks. My diagnosis is hallux rigidus. I am constantly limping and walk holding my big toe raised from the floor. Suggestions please...

    replies

    Chris Centeno says

    Kay,

    We'd need more information and to see your images through a candidacy review to make suggestions. To do that, please submit the Candidate form, or call 855 622 7838 for assistance.

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    Judith BLAND says

    I had a bi-lateral arthrodesis done about 2 years ago. After everything settled down it seemed like the perfect solution, however, now (due to both big toes not touching the ground), my feet are turning out to the sides and it is causing problems with my feet, knees, hips etc. I feel that instead of walking normally, I now plod along because me feel are always turning outward. I'm wishing I'd known more before undertaking the surgery.

    replies

    Regenexx Team says

    Hi Judith,
    Very sorry to hear that, but sadly not surprised as arthrodesis does not address the problem.

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    Laurie Hurley says

    I had a Cartiva implant a year ago, which receded into my bone and had to be removed 9 days ago. A right big-toe fusion occurred. My doctor gives a very different story than yours and much better hopes for recovery. He used my stem cells from my heel and cadaver bone. So far, no pain, even post surgery, xray looks great and I get my cast off in 12 days and go into a boot. I am hopeful I will be able to resume hiking, walking and exercise. The Cartiva was a disaster.

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    Regenexx Team says

    Hi Laurie,
    Glad to hear you're doing well! For future reference, we can usually treat this issue without surgery. Please see: https://www.regenexx.com/blog/bent-big-toe/

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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