1st MTP (Big Toe) Joint Fusion?

[bg10459]

I smashed my right foot pretty badly at an enduro almost 4 weeks ago. I dislocated the 1st MTP, fractured 1st, 2nd and 3rd metatarsal heads (mild or non displaced) and fractured the anterior calcaneus (comminuted, mild to moderate displacement). I had emergency surgery to re-set and pin the big toe (ORIF) and then had surgery last week to plate the calcaneus. My biggest concern is the MTP, though. I have a bunion and previous injury to that area of my foot, as well as mild pain for about a year before this accident. I was told I have little or no cartilage left in the joint and fusion was recommended by the emergency doctors and by the surgeon who repaired my heel (entirely different facilities).

I'm 42, in decent shape and fairly active. I ride or mtn bike most weekends throughout the spring, summer and fall and the Tough Mudder is on my bucket list. Needless to say, I'm hesitant to have my toe fused. Has anyone had this done who can either ease my mind with positive results or further convince me to avoid it with negative?

Has anyone had a MTP joint replacement (arthroplasty)?

Dr Mark, can you offer your opinion on a biologic interpositional arthroplasty or any other alternative to arthrodesis ?

Huge thanks in advance for any help or info.

[DrMark]

_{An interpositonal arthroplasty is a reasonable thing.  I have done many successfully.  Post the X-ray.}

[bg10459]

I have the studies and reports on disc.  I'm not sure how to print them.  Here are some post reduction pics from my computer screen

 

 

[DrMark]

• The dislocation is not reduced.  I hope its in better position now.

[bg10459]

Actually, I'm realizing that this image must have been after they tried unsuccessfully to reduce it by hand. I don't have any X-ray of the post ORIF yet. I'll try to get one when I see the new Dr on Thursday.

Thanks again.

[bg10459]

Finally, here's some good pics of my current condition.....

Edited May 30, 2014 by bg10459

[DrMark]

its still not reduced and the joint is completely disorganized. Fusion is the right plan.

[bg10459]

Thank you. That's what 4 docs have told me. I didn't want it to be the case, but I've accepted it. Things certainly could be worse.

Do you have any opinion on the optimal angle of dorsiflexion to set the toe? I understand there's a balance between running and walking functionality. I feel like more would allow for a longer gait and be better for running. What's the downside of a greater angle?

[DrMark]

Ten degrees of valgus and ten degrees of dorsiflexion works best. Don't get crazy ideas about what YOU want. You will be sorry.

Buy designer jeans or neat stuff for your bike. That is a better way to express your individuality.