My wife had that surgery in both feet about eight years ago. She has pins in both and alternates biking and running to allow her feet to rest on the biking days. Too many runs in a row can put too much pressure on her feet and cause potential fractures. She isn’t competitive and wants to just stay in good shape in her mid 60s. She runs and bikes about 45 to 60 minutes per day. She looks for running and hiking shoes with a little stiffer bottom that has good support.

Can’t offer info, just wanting to say I am sorry you are in this position, making this choice, and I wish you well. Keep us updated.

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Thanks for that. My surgeon does his fusions with a plate and screws, and so maybe there isn't the fracture risk that there might be with only screws. It's great to hear that she is able to do some running, though.

Thanks Dr Tigerchik. :)

X-rays may exaggerate the bony changes.
Before considering joint fusion I would recommend:

Injection therapy, regardless of what’s been said
PT
Custom foot orthoses
A hemi-implant if conservative treatment is ineffective.

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Dr Jay
http://www.Tri-Pod.net

Thanks for your thoughts, although they don't answer my question in any way, and I wasn't looking for a debate on alternative options. I have done enough research this year to be pretty confident that there are no other long term solutions.

But to your points specifically:

Cortisone is known to work until it doesn't and provides, at best, a temporary fix. The only situation I can see where it is worth trying is to mask an injury just prior to an A race, by eliminating the inflammation, to get you through it. It is also known to break down your cartilage, so what's there is likely to get damaged further. My sports doc offered it to me as an option but agreed that it would only delay the inevitable and noted, in response to my concerns about damaging the cartilage, that there was barely any there to destroy. My GP, when referring me to the surgeon, told me not to waste my money on it (without any prompting from me) and my surgeon also did not believe cortisone would offer any relief.

PRP is another injectable and I received one of those injections last year for plantar fasciitis, and it worked well. However there is no literature to support the use of PRP in toe joints. And, in fact, I wouldn't expect PRP to be beneficial. PRP works by using your own highly concentrated platelets to accelerate repair, but in this case there's nothing to repair. But if you're aware of any research that does indicate a long term benefit then do share.

PT - had plenty of that last year and the beginning of this year. As you'll appreciate, arthritis is a degenerative disease and so PT isn't going to reverse or "heal" this.

Custom foot orthoses - again, tried that last year with no real benefit. I currently have a carbon inner sole from my podiatrist which does provide some relief but, again, it's not a permanent solution - instead of walking in pain with every step the carbon inner sole gives me relief for around 30 minutes of walking before the joint starts to flare up.

Implants - I've not found any research to indicate reliable long term success with implants and the research does still seem to report fusion of the joint as being the current gold standard in treatment. Indeed my surgeon has steered me away from considering any implant (his overriding view is that "joint replacement has not been successful in the big toe") and my own research these past 9 months has given me no reason to disagree with him. If you have any research that points to long term success in active patients then feel free to share. But, quite frankly, it seems that there's a good chance you'd end up having to have a fusion anyway.

Cheilectomy surgery in 2021 for me ... I can now run a lot more with less pain. Be fore my surgery I had to run with stiff shoes (Hoka) and with a carbon insole to make sure that my toe won't move. It was a painfull procedure but in the end I would have done it wat way way before. I'm planning a comeback in Hawaii in two years.

That’s great to hear - good luck with the comeback. I did canvas a chielectomy with my medical “team” (and I’m including my GP, Physio, podiatrist, sports doc and surgeon in the group!) but the consensus seemed to be that my joint is too far gone for that option.

It seems I was able to ignore or manage it well through all the early stages of the arthritis development and it’s the end stage that has finally stopped me in my tracks.

I am in the same place after being told 18 years ago I needed fusion surgery; however, that surgeon told me I would never run over 5K again. Needless to say, I walked away from him and proceeded to run multiple marathons and complete triathlons. Now after chipping my big toe in two places last month, I've reached the point where I can't ignore it any longer. Of course, I just signed up for Eagleman and Ironman MD 2024. I haven't made a decision as to when I'm having surgery since I"m waiting to see how the bone chips heal and if I can run with them floating around well enough to get through Sept 2024 and then have the surgery. If I can't, I can defer to 2025. Wishing you the best of luck and please keep us posted on how you're doing post-op.

Good luck with the healing - you’ve done well lasting 18 years! My toe fusion surgery is now booked for early December. It’s going to be a very quiet Christmas, but I’m looking forward to getting it done and seeing what I’m dealing with on the other side.

Sorry about your bone chips :( keep us updated on you too.

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

My experience with arthritis may be similar.

I was diagnosed with arthritis in one toe several years ago and have had to be careful about mileage ever since. Mine has caused the bone to considerably enlarge at the joint (1st metatarsal, both ends) so that there is a noticeable difference in size ( lump) between one foot and the other. It makes lacing up a very different affair between the two.

I have found that changing the lacing pattern can reduce the pressure on the affected toe. As most running shoes start the lacing right over that joint. I have gone so far as the wear different shoes to accommodate (same shoe newer model, different fit) as one model started the lacing above that joint.

After reading about a rather famous actors experience with arthritis and their use of MSN I tried it and found that it reduced some effects. Then after cycling through a myriad of running shoes I gambled on a carbon plated shoe on the basis that they are very cushioned and do not bend, so maybe less stress on the toe from bending while running..


The carbon shoe experiment worked well enough that I can train without pain. I'll never make Boston, but then I never did before..:0)

Considering the boomers are getting old and developing strange lumps and bumps it would do the manufacturers some good to design a few shoes around that.

I thought I’d bump this thread and give you an update on my surgery, in case it provides any useful info for people finding this in the future.

So I had my surgery this morning and so far it seems to have been really straightforward. I was in theatre for an hour, plus an hour in recovery before my husband got the all clear to come and collect me and I walked out.

The fusion was performed on my right big toe, so no driving for 6 weeks. I took some crutches into hospital with me and was glad to have them for extra stability when I left hospital. My foot was still numb from the nerve block and so it was pretty unnerving walking on it. I’m in a small surgical shoe which prevents load bearing on the toe joint but does allow me to walk.

My surgeon has said I can walk up to 1-2hrs a day, so the advice is to keep mobile but don’t do anything strenuous, keep the foot elevated (above the heart) and iced. I’ve set a timer and am doing a lap around our apartment (with the crutches) at least once per hour as well as ankle rotations any time I think about it.

The foot was completely numb for about 5 hours post-surgery and has now transitioned to pins and needles, so I’m guessing the nerve block is starting to fade. No real pain yet, though. But I’m waiting for it! I’m taking Panadol at the moment, although haven’t felt I need it, but have stronger pain meds on standby if I need them.

As I mentioned, I’ll post updates as I go, and happy to answer any questions.

Just adding in a 6 week update for anyone who is watching this thread.

After my last update I had about a day where the opioid painkillers I had been prescribed were needed, and took those on a strict 4 hourly cycle throughout the day. The following day I was back down to Panadol for a day then needed nothing after that.

At 2 weeks I went back to my surgeon to have the stitches out and he was happy with progress. He used a suturing method that is used in cosmetic surgery and which only leaves a single thin line scar. The “stitches” actually just looked like a single ripcord! Instructions for that visit were to massage the scar with Vitamin E cream for 5 minutes each day and I could increase my standing/walking around the house to 3-4 hours per day. But no swimming or biking of any sort (including very easy spinning on the wind trainer!).

Yesterday I had my 6 week check with x-rays to check if the fusion had worked. The joint was pronounced solid and the x-rays confirmed the fusion has happened exactly as it should. I’ve shared a picture of the hardware below - a plate and 5 screws were used.

Interestingly, over the last couple of weeks it’s dawned on me how much pain I was tolerating pre-surgery, as suddenly now I’m realising there is zero pain in the joint. As I relayed that, and my satisfaction, to my surgeon he confirmed that this outcome is exactly what they are looking to achieve with the procedure and the biggest challenge he has is to convince women to go through with it. It seems we are too attached to our high heels and would rather suffer through the pain. Well I can now tell you all first hand that losing high heels from my life is a small price to pay.

There’s some minor sensitivity across the top of the plate, but I’m told this is normal and will settle down over the coming weeks. Also some slight numbness and tingling around the big toe. Again, that’ll take a bit longer to return to normal.

I’ve been cleared now to
- ditch the surgical shoe
- wear sandals and running shoes
- swim (no fins), bike and walk
- drive.

After six weeks of inactivity it’s going to be great to get this creaky body moving again. Easy does it to begin with and there will be some swelling and irritation as the foot adjusts. But elevation and ice continue to be my friend.

Walking around yesterday in regular sandals felt great. I seem to be rolling over my toe reasonably well using the bend in the 2nd MTP joint instead.

A final check up in another 6 weeks and at that point my surgeon will entertain a conversation with me about running.

Hey IG101
Good updates on progress. Position of the toe and metalwork looks great.
Don't be surprised if you start to get some cramping in the sole of the foot at times as the intrinsic muscles re-awaken after being in such a stiff surgical shoe/sandal. Don't throw away the surgical shoe just yet as it's handy on days where the foot needs a break.

Work on self mobilising all the other joints by rolling foot over a tennis ball, gripping the toes around it and maximising the IP joint movement. If the scar area is sensitive then alternate massaging the skin either side of the scar, and giving it different stimulation to either de-sensitise or re-sensitise the area. Things like using an exfoliating glove to give a prickly sensation or a vibrating toothbrush. The sensitive or numb areas need to start to know what different sensations fells like. Hot cold, rough, smooth, vibration..All that stuff.

Oh and stay positive about the progress. If you have done this well by 6 weeks then imagine what it can be like in another 6, or 12 as you add exercise that is both mentally and physically stimulating.

I have had a stiff big toe that has progressed to little to no mobility over 20 years. It never really bothered me unless I banged it into something and I assumed that I would eventually require fusion. I have probably averaged 30 km/wk over the last 10 years down from 160km/wk back in my running days, I also do speed golf in summer 2x week. I have found that the new carbon plated shoes have been a miracle for me and allow me to run as much as I want including speed work and I am on my way to finally get back in running shape and a hopeful to try and break 18min for 5k at age 57. Good with your recovery.

Thanks for those suggestions! Yes, was told I could start massaging the scar area more firmly now to help with the desensitisation, but good idea to add in the different textures.

And I’m feeling really positive about it. My walking gait is feeling remarkably normal - much better than I was preparing myself for. Looking forward to seeing what the next few weeks brings.

Good luck with the carbon plated shoes - I hope they continue working for you.

Looking back I can see now that I had been dealing with mine for a number of years, also with a loss of mobility. I remember going to my physio in May 2022 with what turned out to be plantar fasciitis and he honed in almost straight away on the lack of dorsiflexion in my big toe joint. But it didn’t hurt and I so I was “yeah, it’s been like that for ages….shrug”. It was only when the pain started, and I had to give up running because of that pain that I finally took it seriously. By that stage carbon soled shoes and every other “fix” were of no help and fusion was my only option.

I have heard of many other people who have had a fusion and said they wish they had done it sooner. Well now I can see why. There were times prior to surgery when I wondered if I was being too hasty and whether it was bad enough to get it done so soon. But now I’m on the other side I have absolutely no regrets - super glad I didn’t put it off.