The right diagnosis and fusing the toe info

by Kris
(Washington State)

Hi,

I am a 37 years old and was a very active female. My podiatrist recommended fusing my big toe after seeing a 30-40% joint deterioration in my big toe joint via an MRI. My symptoms are burning and pain on the ball of my foot just under the 2nd metatarsal (like a stick is shoved up the metatarsal area and it greatly irritates me when I walk and rest) which also radiates down towards the heal. Other than the second cortisone shot with provided some relief, ice and massage seem to relieve my pain. Back in February, my podiatrist thought the cause was a longer leg, then in July I was told that orthotics will solve the problem – which helped some, but now I am beginning to feel pain in the my other foot.

How can I be sure that the ‘bad toe’ joint is the cause of my pain? I am seriously considering the surgery, but what if this is not the right diagnosis? How can I be sure? Won’t fusing the toe affect my gait and potentially cause more problems?

Thanks!

Hi Kris,
Although fusing the big toe joint is a common procedure I do not particularly like it, especially in young active people. The bigger issue I have is that you state the pain is under your second metatarsal, so I do not know what surgery on the great toe is going to do to help you (other than perhaps you have what is known as a hypermobile first ray and the doctor hopes to stabilize the first metatarsal in order to reduce pain in the second metatarsal).
If that is the goal I would get a second opinion as overall, unless I am missing something here, the proposed treatment does not really fit the disease.
Additionally, if you are as active as you state I am not surprised that your great toe joint has deteriorated 30-40 percent at age 37, rather I think that is to be expected and it is certainly not enough to warrant fusing the joint. Keep in mind, when you fuse a joint, that puts added pressure on the adjacent joints which may lead to deterioration of those joints.
Marc Mitnick DPM