Need help with surgery decision

[dai3symae]

Doctor,
I had bunion/hammertoe surgery on my left foot 2 1/2 years ago.  The bunion required two screws for the repair and the rigid hammertoe had a portion of the joint removed.  I recovered from the surgery without complications except that the foot still has pain, swelling and inflamation.  There is no infection or stress fracture.  Current x-rays show that my big toe is now too short (although the joint space is good) and this has apparently shifted my weight bearing to the 2nd and 3rd toes.  The 2nd toe (which had the hammertoe repair) is now out of alignment and is not attached properly at the base joint. (doc says it comes 30-40% out of the joint).  The 2nd toe also has some bone degeneration.

There are two surgical options being offered.  The first is to fuse the big toe to create length and the second is to add an artificial bone graft to create length without fusing the joint.

I'm a 52 year old female teacher.  I'm not diabetic and my overall health is good.  I have constant pain in my foot as well as muscle spasms and some "nerve" type pain.  What, in your opinion, is the best option for me?  How much function will I lose if I choose to have the fusion of the big toe?

Thank you for taking the time to read this and for your expertise.

Sandy

[dai3symae]

Thank you for your answer.  I got a 2nd opinion today....this doc says not to fuse the big toe (he recommends doing something surgically to the tendon to gain more flexiblity).  His greatest concern was the 2nd toe.  He says it is dislocated (I stubbed it about 4 wks post surgery 2 1/2 yrs ago).  He recommends a "salvage forefoot reconstruction" and wants me to see a foot/ankle surgeon.

I want to make the right about my foot and appreciate your input.

Sandy

[Yena H Do, DPM]

Getting a bone graft to increase length of the 1st metatarsal would be beneficial and allow you to continue bending the great toe joint.  You have 33 joints in you foot and 25% of your weight pushes through that big toe joint.  If the procedure is done correctly, you should have most of your pain resolved with this procedure.  A graft taken from the calcaneus or pelvis bone increases the chance of the graft to take.  However, if you need to lengthen the bone to a greater degree, you may need an artificial graft.
If you are not active, fusion can help too.  But, you lose flexibility with certain movements.  You wouldn't be able to bend the toe and some activities may be effected:  no heels, no standing on tip toes, or other activities that require toe bending.