Foot Hallus Rigidus/Bunion(Complicated not Cosmetic)

marieltha

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I know that complicated (not cosmetic) bunion surgery is in my future. No cartilage left in big toe on left foot. Bone spur on the bunion/joint area. Genetic slant causing bunions. So definitely not podiatrist surgery. Trust my OS and will probably have this next year. Has anyone had experiences w this specific hallus rigidus type of bunion repair?
PS to Moderators: I also would like input re foot posterior tibial tendonitis (PTT) repair. Please advise: Separate Thread ? Other? Thanks
 
A separate thread, please, for your other topic. Sorry, I cannot offer any help with this condition, but I'll tag @Josephine for you. She may have some experience with it.
 
Has anyone had experiences w this specific hallux rigidus type of bunion repair?
Many of them. The principle means of correcting such a bunion is by osteotomy and fixation with screws or pins.

bunion.png
 
Thanks, Josephine. Ouch, but should be an improvement. My spur is well below the joint in the toe itself—on the front/top of the foot—so I think perhaps even more screws/pin/devices.

Same foot as the posterior tibial tendinitis (last August)so lots of issues. Not a tear, but deteriorated. Twelve weeks until it felt or looked at all normal. Still hurts sometimes.

Born with very high arches and insteps. Lots of trauma (toe dancing; marathon running).

Since the new PKR in March , however, the whole foot is straighter. Also got new orthotics.

I think the toe & bunion & spur will be next.

I like to have some info before the discussion w the OS. This really helps. Thanks again.
 
so I think perhaps even more screws/pins/devices.
Unlikely. They like to keep the absolute minimum of hardware in the foot!

I should also point out that this that I've described is the traditional method of dealing with this problem but there are many others in addition to which, surgeons often like to invent their own versions!
 
Helpful as always, Josephine. Thanks
 
Had MRIs yesterday of the whole foot and the whole ankle.
My OS thinks it is time for an update of what is going on in my entire foot and ankle.
The tentative plan was to fix the forefoot in 2020, not sooner, to give me time to rebuild stamina after the 2 surgeries in 2019 (4 total in 16 mos).
And then monitor the PTT.
Now, he wants to make sure there isn’t something going on that might impair my knee recovery (recoveries).
Sounds good to me.
I will update after I see him for the MRI results on August 15.
 
Update
MRI Results
August15,2019
I got my foot and ankle mri results. “Interesting.”

My forefoot issues are affected by the posterior tibial tendon arch/ankle issue.

A healthy tendon on an mri is a thick dark line, like you drew it with a magic marker. On last year’s MRI, I couldn’t even find the sprained tendon (posterior tibial). There was a blurry grey area which meant it was very “deteriorated”.

This year, there’s a lovely black line! BUT then there’s a sort of white notch in it—duh, this is where it is torn, but still hanging on by a bit. Sigh. And of course that “notch” is the exact spot where it hurts. So I have succeeded in rejuvenating it, but tears don’t heal.

So the plan is basically the same, but changed a bit.

First, recover this year from the shoulder and knee surgery, and ligament sprain. Regain stamina.

Next year, fix (fusion)the bunion which will also remove the spur on it and correct the genetic misalignment that caused the bunion.
Leave the first smaller joint in the big toe as is (no cartilage) as fusing both that in the toe and fusing the second, bigger joint below the toe with the bunion and spur would cause too much loss of range of motion. (Just as you said, @Josephine).


Then “sometime” after that, have the ankle fusion surgery (subtalar arthrodesis)to restore alignment and correct function to the foot. Tendon repairs/replacements, I’m told, only have a 38% success rate.

I will do this before the torn tendon causes a foot alignment deformity and all the resultant damage, including a limp.

Conclusion:
I’m okay with all of this. I’m walking in the pool every day now (in supportive water shoes). The ligament sprain is slowly healing.

The shoulder repair recovery is on schedule.

Both Partial Knee Replacements feel very good.

And each day, the legs feel better.

And a plan to improve the forefoot (bunion fix) sounds sensible to me.
:meow::kitty:
 
Ouch! Foot surgery is not fun! Have a good discussion with your surgeon about mobility and restrictions after your surgery and about pain management.

Great that you have a plan of action though.
 
So sorry you have had all this surgery and still have some yet to go. But sometimes that's the best route. You're doing a good job of taking things slow and keeping solid plan in place. Best of luck to you going forward.
 
Saw my foot MD today.
He went over the foot and ankle MRIs that my OS had ordered.

He sent my Rx orthotics back to be modified.
The whole foot is less swollen than a month ago. Voltaren gel and walking in the pool have helped. But the plantar fasciitis tendon (pft) on the mri showed swelling and it has hurt again (off and on/chronic, really).

He did an ultrasound that measured the swelling in the pft. Very swollen. Did an ultrasound guided cortisone injection. My first. Ordinarily I would not do that in a foot, but honestly, it hurts, and if the impending hurricane comes near us next week, the drop in barometric pressure will make my arthritis and all my recent surgical bone sites ache.

It feels much better.

CC. @Jockette
 
I’m glad your foot feel better since the first injection. :yay:

My foot hurts here and there but is much better since I’ve been wearing my sandals almost all the time.
 
E6F8A9D7-AF65-43D9-8AF1-8722B61F8318.jpeg

I will give my black cat, with her permission of course, extra hugs for all the BoneSmarties who do not have a black Nurse Cat

Foot is doing okay. Much better since the injection and using the voltaren gel 3x day and icing once (down from 3+).
Ordered new shoes: Asics GT 1000 7 in a bigger size. 10mm stability shoe designed for overpronation; has gel cushioning in the heel and the forefoot. Also waiting for my Rx orthotics to come back from being adjusted to lower the heel and make the heel softer.
Note: I like the cushioning and 10mm drop of my old Asics GT 2000 5, but they are old and the toebox is too tight and borderline too short . So I hope the 1000s, which supposedly have a bigger toebox, in a longer length will do the trick. I will let you know. I have used an exacto knife and slit the mesh in the toebox of the old ones to give the toes and bunions more room in the meantime, and moved the laces back towards the ankle (ie, not using the two holes near the toes) New ones expected tomorrow.
 
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Just got new shoes. I researched the size guides, measured my feet as directed in cm, and I found big differences in the sizes, even for the same brand. Glad I measured.

In the pic above, I’m wearing the new Asics GT 1000 7 in a 10 1/2 wide. Biggest shoe I have ever bought! 8mm drop (difference between forefoot and heel. Orthotic will raise this a bit).
In cm for length, it is the same as my very recently purchased Columbia water shoes (middle, purple, wet—just got out of the pool), which are a 9 1/2 B. 10mm drop I think; might be 8. These feel great walking in the pool. Until today, this was the biggest shoe I had ever bought.
The other is my old Asics GT 2000 5, size 9 B, which I dug out and started wearing when my Brooks Addiction (size 9 B) seemed too high in the heel, with a 12mm drop. These Asics have heavenly gel cushioning in the forefoot and the heel, and a 10 mm drop, but the toebox is too tight.

The Asics GT series are Stability shoes for Overpronators. The 1000 have bigger toe boxes and smooth mesh (no stitching over bunion).

My foot doctor advised me to go bigger to accommodate the Rx orthotics (being modified to lower the heel and make the heel softer). He also advised getting a wider width to accommodate not only the orthotics, but also my very high instep, as long as the heel fits. And I was focused on the toebox as I cannot have the bunion surgery until at least next year—have to get past the ligament sprain and far past the shoulder surgery.

I gradually break in a shoe in the house. So far, the new ones feel really good. I will update again.

Thanks to all who shared their thoughts here and in my Other threads on feet. The comments about new knees changing one’s gait seem logical.
 
Update after Followup with OS

My followup was primarily for my RCR shoulder, but that, the recent PKRs, and ligament sprain are all intertwined with my ongoing foot issues.

Great news on the shoulder progress, so my balance while walking should continue to improve.

He said the foot (PTT and bunion) are the same, of course. Left foot over-pronating, so I need to be wearing the firm arch supports as much as I can. Now that I have bigger, more comfortable shoes, I am working on that.

>>Bunion restricts normal forefoot motion, but I have to be well past the shoulder recovery before scheduling that surgery. Stamina is better overall, but shoulder stamina and strength are only 4 months into a year+
recovery.

The sprained knee ligament has healed but my gait is off, so I am to practice walking with a longer stride. I had shortened it, he thinks, in response to the pain. So he wants me to work on the gait and stride to see if these are, in fact, aggravating the knee/ligament/leg. Tried this walking in the pool yesterday and the gait is less stiff this am.

At my request, he added an Rx for lidocaine gel5% . I have been using 4% OTC. The voltaren helps the foot quite a bit (now using it on the ligament sprain knee also).

So :kitty:but with a longer stride....
 
378281D2-012B-4993-BCA8-29A8E9EEBA51.jpeg DF7A66AA-96BE-4316-8FDF-0EBE2DDCB427.jpeg
Monday, Sept 30, 2019 Rx Orthotics Redo Update:

My foot MD sent my Rx orthotics back for a major redo after seeing my foot MRI.
Here’s the redo:
-The arch is still firm, but
-There is an additional layer of thicker, cushy foam over the arch, under the top layer, and
-There is a different, cushier layer of foam over the whole foot, and
-The additional hard heel has been removed, and
-The whole forefoot is now soft cushion and it bends at a better place for the mechanics of my feet.

Directions:
- I am to do a much more gradual break-in period for three weeks before returning to see him:
-One hour a day (not exercising) for Week One;
-One hour one day alternating with two hours (or >1, but <2) the next day for Week Two;
-Either repeat Week Two or increase the time on some days for Week 3.
Caveats: Go slowly. Decrease time if needed. Do not rush.

If before the next visit or by then, I feel like the heels are still too hard, then he will send them back and have gel foam spot cushions inserted into the heel.

Today, I wore them for the hour as directed in the new Asics shoes and they felt pretty good. Much better. My bunions are even happier.

Note: All adjustments are at no additional cost.

PS to @Jockette My doc uses PAL for custom Rx orthotics. You can open their catalog online. Saw several options for nerve issues. Also, I looked up your sandals and they are very attractive as well as supportive. Thanks.
 
@Crumbly and @Josephine (when you return)
I’m new to this forum, but not to Osteoarthritis. I have had: Spine fusion (L5-S1), both thumb joints removed, right big toe fused, left big toe knuckle joint spacers

What is a big toe joint spacer? I have no cartilage left in my left big toe joint and a genetic complicated bunion with a spur in the big joint below it. I’m planning the fusion surgery for the complicated bunion and the OS said to leave the big toe itself as is because to do both would be too many screws (as @ Josephine had said before I discussed specifics with my OS).
 
I have had the orthotics revised again for a gel spot in the heel (imbedded under the top layer) and for an adjustment to the right one (my right leg is ever ever so slightly shorter than the left) to make my legs even when I stand or walk. Hips and glutes seem happier.

Now doing a very gradual break-in, but this version felt very good right away. Supportive and cushioned, but not squishy. They feel like they spring energy back to you, the way the gel and foam in expensive running shoes feel.

A 10mm shoe seems my perfect height. The new 8mm shoes seemed to make my calves ache, but with the revised orthotics in them, they feel good. Overall, the old GT2000 5 Asics is a more cushioned supportive shoe, especially in the forefoot, but the 1000 7 has the toebox that the bunions like.
 

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