Tell me about your toe fusion

I'm 41 yo. I have Hallux rigidus of right big toe, but not as far advanced as yours. My story, as of now, is one of near-complete rehab, from not being able to climb at all.

18 months ago I returned from a five-week climbing trip that involved a lot of hanging belays. I could hardly walk, and had to stop climbing.  I had 35 degrees flexion and an x-ray showed, according to my ortho, arthritis of 3-4 on a scale of 1-10. I had another work/climbing trip coming up in a week. Doc gave me a cortisone shot right into the joint. It immediately exacerbated the pain, and by the time I got on a plane a few days later, I had to be wheel chaired through the airport. At my destination I bought a pair of too-large Astromans, took a ton of naproxen sodium. For about a week I could only belay, but then managed to follow my son around on easy North Wales multi-pitch, though still with a ton of pain. By the end of the trip, though, the cortisone shot was starting to have a positive effect. Within a month, most pain was gone in daily life, and I could manage to climb routes at my previous level, though still with pain.

Meanwhile, I went to physical therapy with the PT for the local professional ballet company. She gave me a few exercises to strengthen the muscles around the joint, and prescribed a toe-spacer to help my alignment. I haven't been religious about the exercises for a year, but I do them somewhat regularly and am aware of growing strength and mobility in those muscles. I also got orthopedic shoe inserts with serious arch support. (The orthoticist made an insert with a stiff toe bar, but that exacerbated the pain, and I went back to the over-the-counter inserts.) On the advice of a friend at the gym, I started taking a glucosamine-msm-condroitin supplement, and have been taking it daily for a year now.

By the start of this past summer, I had been climbing regularly for a few months without cortisone. I started to get a flare-up from a long day of slab climbing in soft shoes. Before our big summer trip, I got another cortisone shot, and that allowed me to climb pain-free all summer. I haven't had a shot since June, and have not had any more flare-ups. My toe alignment is improving even without the toe spacers, and I can spend a session on small footholds without any pain. I'm optimistic that I will be able to slow the deterioration of the cartilege and to support the joint with improved alignment and muscle tone.

I have no doubt that fusion surgery is in my future, but it's looking much more distant than it was a year ago. I hope this helps anybody with moderate arthritis looking for some therapeutic solutions.

Cool, this is starting to get good.

Hallux Rigidus, from my understanding is the PIP joint, aka the big joint where your toe bends. https://www.foothealthfacts.org/conditions/hallux-rigidus

My painful joint is the one distal to that. The little tiny and kinda useless one. The DIP

I think I'm around 3-4 shots of cortisone in it. This smaller joint is just harder to work on. PIP even have little tiny joint replacement, it looks like a total knee but little. I'll mention the osteotomy to my doc but my gut feeling is that it's just too small of a joint with too much cartilage missing to make it effective.

Coming from the inside of the industry, listening to doctor complaints, orthopedic rep sales pitch, as well as seeing who is happy and recovering has also shaped my opinion.

Poor reading comprehension on my part.  I thought yours was hallux rigidus as well, my bad.  I guess it's worth mentioning oseotomy but you're probably right.  Sounds like you've done your due diligence researching outcomes.

Ryan, I've gone through about the same progression for the most part it sounds like, just a few years ahead maybe.  Over the last few years I've had probably 5, maybe 6 cortisone injections.  I've altered my footwear completely except for running (did switch to Hoka which was great), and climbing.  Where at first I thought I was going to get surgery immediately, I probably bought myself about 3 years of hard/maximal climbing and running.  The cortisone has worked for as long as 1+ years for one shot, but it's slowly having less effect.  Now I'm going through with the surgery, just a tough call when I can still do everything, just with varying levels of pain and discomfort, so it's hard to say when enough is enough.  Not sure if that's any help but figured I'd add it.

ahparker wrote: Poor reading comprehension on my part.  I thought yours was hallux rigidus as well, my bad.  I guess it's worth mentioning oseotomy but you're probably right.  Sounds like you've done your due diligence researching outcomes.

Ryan, I've gone through about the same progression for the most part it sounds like, just a few years ahead maybe.  Over the last few years I've had probably 5, maybe 6 cortisone injections.  I've altered my footwear completely except for running (did switch to Hoka which was great), and climbing.  Where at first I thought I was going to get surgery immediately, I probably bought myself about 3 years of hard/maximal climbing and running.  The cortisone has worked for as long as 1+ years for one shot, but it's slowly having less effect.  Now I'm going through with the surgery, just a tough call when I can still do everything, just with varying levels of pain and discomfort, so it's hard to say when enough is enough.  Not sure if that's any help but figured I'd add it.

Thanks, that is a help. Interesting to hear that you found the cortisone lasting up to a year. I wonder if I'm still riding the benefits of that. Good motivation to keep doing my toe mobility exercises even when it feels OK!

I am so glad that I found your question, so THANK YOU for posting! I would love to hear an update.

I have been recommended for the same surgery to fuse both of big toes. I have severe damage from Rheumatoid Arthritis. I was shocked when I found climbing, but maybe you relate, climbing seems to really help my pain and my mobility, as unlikely as that may seem for someone who can barely stand on her toes and who is always in severe pain after hiking for more than several miles. It old my surgeon that my primary concern as far as wanting to have this surgery is to be able to do MORE. Most of my toes are like jelly... and my metatarsals are damaged too. I want to make sure that the lack of movement in my big toes won't make it impossible for me climb and do yoga. I am a yoga instructor, and I climb for fun.

Personally, I believe that the nervous system might be where my RA "lives" and that having chronic tension in my toes and feet causes tension, numbness, and tingling to spread throughout the rest of my body... so i am also hoping that, while it will suck in some ways, maybe fusing the big toes into proper place will help to prevent ongoing inflammation in the rest of the body?

I appreciate all climbers' thoughts, and anyone's experience who is dealing with deformed feet or chronic pain during climbing. It means a lot. While ALL your thoughts are valid, before you post, if you don't know anything about R.A. or chronic pain..... maybe just don't say anything about it. Thanks.     One thing that I can promise you is that us people with disabilities and chronic pain will keep defying logic and finding ways to climb in ways you'd never expect! Good luck to you 'high altitude'. 

I don't have any real advice but a word of caution. RA attacks the joints, some worse than others depending on the person. I'd love to tell you that removing two joints that probably don't work anymore will have a bottom to top transformation and leave you inflammation free. It doesn't work that way. This surgery will help you with the pain from the offending joints, which may motivate you to be more active. Probably nothing more. There are astonishingly few real silver bullets in medicine.

Ryan McDermott wrote: 

Meanwhile, I went to physical therapy with the PT for the local professional ballet company. She gave me a few exercises to strengthen the muscles around the joint, and prescribed a toe-spacer to help my alignment. 

Hey Ryan, would you mind posting up some of the exercises you do or a link to a site that describes them? Thanks.

John Goodlander wrote:
Hey Ryan, would you mind posting up some of the exercises you do or a link to a site that describes them? Thanks.

The PT had me holding my four toes steady with a hand and just trying to move the big toe laterally away from them, in several sets of several reps, depending on what you can do. She also had me doing circles with the big toe. But I've found the same principles applied, with more extensive options, in KinStretch mobility classes taught at my climbing gym. You can google Kinstretch toe mobility or toe CARS for videos. If you want a full mobility suite, I'd recommend ClaytonMoves.com. 

So, just to clarify, neither of you have actually gone through with the surgery? Have you gotten any advice as far as how a toe fusion would affect your climbing?

Debbie Higgs wrote: So, just to clarify, neither of you have actually gone through with the surgery? Have you gotten any advice as far as how a toe fusion would affect your climbing?

We haven't. It's an information gathering session.

I've got mine on Dec 6. The pain while climbing is so much lately that even if I never get my foot totally back, almost anything would be an improvement. I don't ride the struggle bus but I've been stuck behind the toe truck for a long time.

My pre-op appointment is next week. I'll certainly be asking a lot of questions. 

Good luck. I've been thinking about this all week, debating my own decision. I think if you've found a way to climb through pain, you'l find a way to climb with a fused toe. What do you think?

Ryan McDermott wrote:

The PT had me holding my four toes steady with a hand and just trying to move the big toe laterally away from them, in several sets of several reps, depending on what you can do. She also had me doing circles with the big toe. But I've found the same principles applied, with more extensive options, in KinStretch mobility classes taught at my climbing gym. You can google Kinstretch toe mobility or toe CARS for videos. If you want a full mobility suite, I'd recommend ClaytonMoves.com. 

Thanks, very useful. I will try these out. 

I'm about 3 hours post op currently. In time I'll be able to report on the efficacy of the procedure.

I am thinking of you and sending you well-wishes! I am a Reiki master. So, I don't know if that's your type of perspective, but... in my opinion there's no more powerful time than right now for intentions, prayers, and channeling inward... all the strength that you've used in climbing and other activities... you can use it now to heal. <3 

Just a side note for those that may consider this. There are a lot of nerves in the foot. Once the nerve block wore off, about 5am today, it unleashed an unholy floodgate of pain. Pretty much maxing out my Percocet dosage now.

There is a device called On-q that is essentially a pain pump but uses local anesthetic (lidocaine, marcain, ropivicaine) instead of narcs. I wish that I had one. It would have been so much better to keep my foot numb for a few days instead of this constant stream of narcs I'm on.

Anyway, for now I'm ok and am really looking forward to seeing the difference.

Colace

This is great, I'm psyched you're following up on all this!

Yeah, you gotta stay in front of the pain.  Once you get behind it, it takes so much more medication to get the pain back down.  Different doctors use different amounts of local during the procedure.  Do you mind me asking who your doctor is?

Jorge Pantalones wrote: This is great, I'm psyched you're following up on all this!

Yeah, you gotta stay in front of the pain.  Once you get behind it, it takes so much more medication to get the pain back down.  Different doctors use different amounts of local during the procedure.  Do you mind me asking who your doctor is?

He used a ton of local. I was done by 1pm and it didn't start hurting until 5am. That's why I got behind, I slept well last night. I probably should have started on the percs yesterday. In my defense, I work in surgery, never post-op.

I'll PM you my docs info.

highaltitudeflatulentexpulsion wrote: I'm about 3 hours post op currently. In time I'll be able to report on the efficacy of the procedure.

GOOD LUCK.  You're going through the hardest part of the injury/surgery/rehab curve, and while you've got some hurting left to do, sounds like a steady march up from here.  I really do hope you have some sick sends ahead of you.  

It's not hurting nearly as much now. Still not able to watch my kids though. So now boredom has set in.

I've been binging Forged in Fire and now I've ordered 3 blade blanks. Getting handles on them should keep me busy.

highaltitudeflatulentexpulsion wrote: Just a side note for those that may consider this. There are a lot of nerves in the foot. Once the nerve block wore off, about 5am today, it unleashed an unholy floodgate of pain. Pretty much maxing out my Percocet dosage now.

Colace

Yep, this! Good luck!! I'm not a fan of opiates so I would usually fall behind... one night I sat straight up in bed and threw my bedside lamp against the wall then promptly fell back asleep. My wife told me all about it the next day :D 

And good on you for finding a new hobby to stave off the boredom. I didn't play bass guitar... until I had foot surgery.