Hi Walt,
If I were you, I'd go for the cheilectomy with an orthopedic surgeon. I
have hallux rigidus too, in both feet, and waited too long. By the time
I told my surgeon I was ready for surgery, my joints had deteriorated to
the point that cheilectomy was no longer an option. I wish I hadn't
waited. (FWIW, I had the arthritis for more than 20 years before
reaching the stage where moderate treatments (i.e., orthotics, pain
meds) no longer worked.)
I did not want fusion (I was only 43, for heaven's sake!), so I opted
for arthroplasty, which involves grinding off the osteophytes that cause
the bump common in hallux rigidus. Then they insert an implant that
resembles a bolt into the joint capsule to replace the end bit that's
been ground off and stitch you up. I had general anaesthesia and an
overnight stay in the hospital. One foot was done in October 2005, and
the other in April 2006. I stayed home for a month each time before
returning to work.
There are pros and cons to this type of surgery:
Pros: easier shoe fitting (no bumps to collide with the toe box); you
will still have some range of motion; if you're not happy with the
result, fusion is still an option for the future
Cons: since it's not a full joint replacement, the arthritis doesn't go
away, and you can still experience some discomfort when walking
General advice: regardless of the surgical route you decide to take,ask
them to give you lots of local freezing at the surgical site while
you're asleep so that you don't hit a wall of pain when you wake up.
When they tell you to keep your foot elevated for a week, do it. You
will have to deal with post-operative swelling and your shoes won't fit
for a long time. Invest in a good pair of sandals with two adjustable
straps (I have Birkenstocks) so that you'll be able to wear something
besides a cast shoe. When you go home from your surgery, you will need
crutches for the first couple of days until you can put more weight on
your heel and switch to a cane. Aluminum crutches are lightweight and
easy to adjust.
One more thing: there is always the risk of infection/rejection. I have
just returned to work after having the first foot done again. The
implant didn't ossify and we couldn't figure out why, so we decided to
try a different type that is glued in. While I was asleep, they took a
culture and discovered infection in the joint. That surprised us, since
the only sympton I had was unexplainable pain and a shadow in the X-ray
around the implant--no redness, no swelling, no skin tenderness, no fever.
In the end, I have no regrets about taking this option when it was too
late for a cheilectomy. They are always making advances in orthopaedic
surgery. Maybe in the next 10-20 years they'll develop a complete joint
replacement for the great toe. If I had gone for fusion I don't think
this would be an option for me.
Hope this helps. If you have any more questions, feel free to email me
directly. Just remove the NOSPAM from my email addy.
Cheers,
Maureen
walt_wankel@yahoo.com wrote:
> I have lurked here for awhile after being diagnosed with arthritis at
> the base of my right big toe about two years ago. About a year ago,
> it developed in my left big toe and the pain has gotten bad in both
> feet. I haven't noticed any deformity or swelling.
>
> Went to a highly recommended podiatrist yesterday. He gave me four
> options:
>
> - cheilectomy,
> - A Keller procedure,
> - fusing the joint,
> - implants
>
> I'm not satisfied that the Keller procedure would be the best option
> and implants seem to be overkill.
>
> That leaves cheillectomy vs. fusion. Cheilectomy is the most
> appealing to me, as it seems to be the least traumatic. The only
> thing that concerns me is will it last? The doc recommended fusion
> but it seems weird to think that I would lose ALL mobility in the
> joint if I had a fusion.
>
> The podiatrist ordered Celebrex and that is doing the trick so far as
> managing the pain. However, I realize I am facing surgery and I want
> to have it done within a year. I want to get a second opinion and
> will do so from an orthopedic surgeon where I work (Johns Hopkins
> hospital).
>
> I would appreciate any feedback re: cheillectomy versus fusion for
> hallux rigidus. Also, are there any advantages to having a podiatrist
> do the procedure as opposed to an orthopod?
>
> Thanks!
>
> W
> 
Cheillectomy vs. fusion, podiatrist vs. orthopedic surgeon for hallux rigidus 
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