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The response to the question below was authored by Marc Mitnick DPM

Cartiva implant failure and sesamoiditis after cheilectomy

by Sandy
(Washington, DC USA)

MTP Cartiva 1 mos & 3 mos Post-Op

MTP Cartiva 1 mos & 3 mos Post-Op

52 yo female with R hallux limitus. 3 mos out from a cheilectomy R MTPJ with a Cartiva implant. Surgeon also did a soft tissue release of the sesamoids. I have had continued pain in the sesamoid area since surgery. Post-op images at 1 mos while still walking in a rigid bottom post-op shoe showed the implant appeared to be in good position with decent joint space. 2 mos later I have continued pain with limited ability to bear wt thru the sesamoids, and limited ability to dorsiflex the toe with weight bearing. This pain in the 1st MTP joint is causing alterations in my gait mechanics and I am finding myself walking on the outside of my foot. Incidentally, I had an extensive medial meniscus tear with associated medial compartment articular cartilage tear requiring a significant debridement of both 3 weeks prior to the foot surgery. The inability to bear weight thru the MTP joint of the foot is impacting my ability to rehab and strengthen the knee/leg. Plus the altered gait mechanics from the foot pain is putting increased stress on the medial (injured) compartment of the knee. So getting the foot better is even more important because of the impact it is having on the knee. I am attending PT.


XR at 3 mos post-op now shows resorption of the implant and the joint space has significantly decreased. There is talk of maybe needing to re-do the implant (OMG!). DPM suggested a custom orthotic to possibly help with the sesamoid pain plus allow me to be more aggressive with my knee rehab. I will use the orthotic for at least a mos then we will re-eval pain and ROM. They scanned my foot and suggested I get an OTC dancers pad to use until the orthotic came in.

The orthotic has arrived. The orthotic has plate specifications for Device Width as Bisect 1st. Posting: Forefoot Intrinsic to casts; Posting: Rearfoot low profile, extrinsic to vertical. Padding: 1/16" padding from distal end to toes.

The left and right orthotics are made to the same specs, but the left foot is not having any issues. There is no dancers pad in the orthotic. I have been having sesamoid pain since the surgery,but not prior to it.

Shouldn't an orthotic for sesamoid pain have a dancer's pad? I have used the orthotic for a cpl days and don't feel like there is any less stress on the sesamoids. Still painful. OTC dancer's pad helped some but tended to move around on my foot requiring repositioning every few hours. Since this was caused by surgery (not a high impact trauma where we'd worry about a fx), would getting a steroid injection soon be reasonable?

Also, how common is it to need to re-do the cartiva implant? It's relatively new in the US, only approved in the middle of 2016, but I haven't come across many studies reporting problems with it. Could the hole drilled to set the implant in have been made too deep? Is it because the implant is a little crooked? If I am now almost bone on bone, could that be why I am having pain with dorsifexion? There is no longer a bone spur in the way, but could it be the actual head of the metatarsal and the prox phalanx are colliding?

Thx in advance for your feedback.


RESPONSE

Hi Sandy,

Let me start off by saying that I have no
personal experience with the Cartiva implant, but the exciting "feature" of this type of implant is that it will create a synthetic or artificial cartilage over the head of the first metatarsal bone which is something silastic and metal implants cannot do. Silastic implants tend to resorb and break down over time, and metal implants tend to wear down bone simply because metal is harder then bone.

I can see by your two x-rays that the joint space has diminished over the period of a few months. I would not be surprised if that is a common finding with this type of implant.

The purpose of implants for hallux rigidus is more to reduce pain and less for creating greater range of motion. I have no hard statistics but am willing to bet that most people who have great toe implants really do not end up with a greater range of motion, but in most cases end up with significant reduction in pain, and at the end of the day, that is what most people want.

Work was done on your sesamoids in an effort to give you further motion in the great toe joint and more then likely as a result, that is why you are having sesamoid pain. Even though you did not have blunt trauma to the sesamoids, you did have surgical trauma and there is always the possibility that there might be a fracture, although more commonly the pain is do to trauma to the ligaments that attach to the sesamoids.

An orthotic would be the advisable option here but based on your narrative I have two issues with your orthotics. 1. They were made narrow by bissecting the first metatarsal which may give you more flexibility in your shoe selection, BUT, will probably aggravate your tibial (medial) sesamoid, since making the orthotic slightly narrow will probably end up pressing into the tibial sesamoid. 2. A dancer's pad should have been built into the orthotic as the sole purpose of the orthotic with the use of the dancer's pad is to take weight off the sesamoids.

Before you consider a cortisone injection, you want to make sure that one of the sesamoids is not fractured. For that you would need a bone scan or MRI as a simple x-ray might not show a small sesamoid fracture. Assuming no fracture, a cortisone injection might not be a bad idea.

I do not know if I would personally recommend another Cartiva implant. From a surgical standpoint, it is not that big a deal, but if it did not work the first time, what will be different the second time?

The views you provided me in the x-ray do not give me enough information to offer any other suggestions. I would be interested in seeing a lateral view as there are certain issues that may be part of your problem.

In summary, my suggestion would be try and get the sesamoid issue in order with a proper orthotic, perhaps a cortisone injection if there is no sesamoid fracture. I would continue with physical therapy in an effort to reduce the pain in the joint.

If your surgeon suggests further surgery, definately get yourself a second opinion. You do not want to fall into the trap of having repeated surgeries on the same joint. Each subsequent surgery creates more scar tissue which can actually make matters worse in this type of situation.

Marc Mitnick DPM
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Oct 07, 2019
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by: CeilEnter Your First Name Only

Failed Cartiva implant. So upset and disappointed!
Orthropedic surgeon recommended Cartiva on my right foot, and 2 years ago I had the surgery. It has proven be a very unfortunate decision.
Within 2 months, I knew it was not right. The surgeon said to give it time. I continued to do everything the surgeon said to do post-op. About 6 months out, I noticed that my toe was turning inward. The pain is worse than before surgery.
It continued to get worse to the point where I began seeking other treatments, pt, shots, and several other doctors... because my original surgeon continued to say "just give it time."
The pain has continued to get worse not just in the toe, but in the bottom of the foot too. The seismoid and heel areas are terribly painful, my hips feel out of alignment, and my range of motion is non-existent. My big toe turns toward the 2nd toe, and doesn’t touch the floor.
I am a 64 yo who is very active, and am even active through the pain...but I just cannot continue to live in such pain!
Today I saw the 4th doctor who is "very well respected in Atlanta, GA. This doctor recommends a total toe replacement with The "Reference Toe System".
Has anyone heard of this?
I would greatly appreciate feed-back!

Sep 28, 2019
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Successful Cartiva Implants
by: Adrienne

Can someone with access to real statistics post the success versus failure rate of the Cartiva implant procedure?
I am three weeks out from Cartiva implant procedure on my right foot. The left foot was done exactly a year prior to the surgery on the right foot. Both procedures were accompanied by tenotomy on toes four and five to straighten them. The left foot with worse symptoms was done first. My DPM is adamantly opposed to having both done simultaneously. At this point the left foot feels great and I even a wear high heels but I choose not to do so on a regular basis. The right foot seems to be responding faster than the left did. I am glad I did not read this thread prior to surgery. One of the keys to success seems to be keeping the foot iced and elevated for two weeks after the procedure. I might add that I only suffered from hallux rigidus and no other foot issues.

Jul 08, 2019
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Failed Cartiva
by: Chrid

Can anyone shed light on the failure of this device and potential recall?

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A couple of points need to be made. If you read this thread, you would think the Cartiva implant is the worst procedure ever created, but keep in mind, this thread is only from people who have had failed procedures. Typically, unhappy patients research, then complain about their outcomes, compared to those who have had the procedure and are satisfied. Satisfied patients have no reason to research the procedure and comment about the outcome. Thus the "failure" rate of this procedure is skewed simply by reading this thread.

Even though the Cartiva implant is supposed to "replicate" destroyed cartilage there are a couple of shortcomings.

1. The actual implant does not cover the total cartilage area of the first metatarsal head and only a small portion of the cartilage of the phalanx (toe bone) comes in contact with the implant. That may lead to an instability in the functioning of the joint. It may also be putting too much pressure in the confined area of the implant.
2. The compressive nature of the implant may not work the same for all patients. A one size fits all device may give different size people, different function at the level of the affected joint.

I have retired from doing surgery, so I have not done any, but in speaking to my colleagues, overall, they appear to be satisfied with their results.

I think a key factor when having the procedure done, is to select a surgeon who has done quite a few Cartiva procedures and thus might be better at picking the proper candidates for this type of correction.

Marc Mitnick DPM


Jun 18, 2019
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Sept 2018 Cartiva Implant Failed by May 2019
by: Michelle

There’s nothing I can say that has not already been said in this thread.
In my 40s and thin. Salvage surgery for arthritis in 1st MTP joint 5 years ago. Cartiva implant late last year, 3 mos of relief then poof, overnight, back to pre-op level pain. Now, however, the foot is disfigured. The toe has lost an inch of length, is crooked and displaced, bends upward, is immobile and every step hurts. The pain keeps me up at night and wakes me every time a sheet touches the joint. I am passing blood from all the NSAID use I need to go about my day. My orthopedist will not use the word "failure" but recommends a fusion. This was always a last resort for me. And I can hardly afford to take off another period of time from work.
If there were some way to raise the flag on this device without alienating every doctor in this town I would do it Cartiva is a class action suit waiting to happen.
Really, it’s essentially a contact lens installed in a high impact bearing and weight bearing joint.
Michelle

Apr 23, 2019
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Failed Cartiva Implant...Now what?
by: Liz

I had the cartiva implant surgery Jan, 2019. The pain never went away, in fact, it has gotten so much worse. I went to physical therapy and had some good results, however, my big toe will no longer sit flat. Instead it sticks up in the air. Frustrated, I went back into my doctor on Good Friday, and was told the implant was no longer in place and my metatarsal has a small fracture. I'm now wearing a boot until the fracture heals, about 4 weeks. After that....my doctor wouldn't give me a definitive answer. I suspect she wants to do the fusion surgery.

I'm in my late 40s, in good shape and not overweight To say I'm worried is an understatement. My current x-rays show the metatarsal completely out of line from all of my previous x-rays.

I'm not sure what to do. I want to get another opinion, but am not sure where to go.

If anyone knows of a good doctor in PA, please let me know. As well, if anyone has any advice, it would be greatly appreciated.

My email is beecann123@gmail.com

Thx, Liz


Apr 11, 2019
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Cartilage implant Pain one year after
by: sue

Had cartilage implant march2018 been in pain ever since.worse then before surgery all from my sesamoids. Had mri dec 2018 everything looked good except massive inflammation from sesmoids.ive done dancer pads, shot and good feet store orthotics.still pain and now the nerves are kicking in and makes it horrible to walk.now mt calf muscles are flaring up ...I need help I’m tired of the pain I’m passed the tear mark...help

Apr 03, 2019
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Cartiva failure
by: Reb

I had Cartiva implant Jan 2018. Its now a little over a year later and implant has receded back into the bone. I need revision surgery but not sure which way to go. Most Dr.'s recommend fusion but I have wanted to avoid except as a last resort. Perhaps this is now the last resort, but I have another surgeon recommending Arthrosurface Toe Motion implant or Sgarlato Gait Implant. Does anyone have experience with these?
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I am not a big fan of fusions, so if your surgeon feels an implant might work, I would consider going that route.

Marc Mitnick DPM

Feb 26, 2019
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Hmm, Time Is Not On My Side
by: Daniel

First I'm a 43 y/o Male in excellent health. I have been professional firefighter for 16 years and hoping to last 9 more, so I can get my full pension. That last statement is the issue. I got bilateral cartiva implants Nov 13, 2018. I did them both at the same time. It really wasn't that bad. But.... the left toe got infected and split before the stitches came out. I spent the weekend before Christmas in the hospital getting iv antibiotics and cultures of the infection. Whic⁹h surprise, the cultures didn't grow anything. I got a picc line and iv antibiotics for 6 weeks. Now its Feb 26th. I'm on light duty at work while my wound care dr gets the gapping hole closed in. It's so close now. So that's the good news. Bad news is that I still can not walk without a lot of pain in both great toes. Now granted I am limping way better then I was before the surgery. Also I do not have any pain under my toes. I am afraid that the amount of time to heal up enough to go back to wearing an air pack and dragging hose, not to mention, walking to the fire truck 30 times a day is going to be longer than the city is willing to wait. It's tough being the sole provider of ones family and facing the fact you might loose everything. But the reality is I was doomed anyways. I went from walking normal to absolutely needing surgery on both feet in 7 months. Go big or go home I guess. My surgeon says the wound needs close up first and then with some therapy I should be good. I just don't think it will heal quick enough. I just need the pain to go down by 40% I mean 50 would better. So do I consider it a failure? Not yet, not yet.
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As disappointed as you must be, complications are a normal part of surgery (hopefully this was explained to you before you consented to surgery). I agree with your surgeon, that once the wound is closed, you should be able to start therapy. Will this make you fully functional as a firefighter? Only time will tell.

Marc Mitnick DPM

Jan 10, 2019
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Update from my April 2018 post
by: Kelly

I posted in April 2018 3 months out from my implant surgery which was Feb 8th. UPDATE: 11 months later and I am in worse pain than ever before. There are very few shoes I can wear and walk in. My foot is in constant pain, top, bottom, side, area of inscission. My other 4 toes are now cramping. I wake up in the middle of every night with a stabbing pain. This surgery has ruined my quality of life. I can no longer golf, hike or even walk for very long distance. I trip to the grocery store leaves me in even more pain. With no activity my pain is around a 4, by the end of every day I am at a 9. Due to the pain, my gait has changed which is now causing pain in my knee, hip and back. DO NOT GET THIS SURGERY!

Jan 03, 2019
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Just adding another failure to this site.
by: PAM

Like the rest of you i also have a failed Cartiva implant. Im now having a fusion. My cartiva implant was on 9/21/17. I waited a year to see if the pain would go away, well no and in some respect its worse. What's really wierd is it seems to be getting worse and have alot of body pain. I believe its the body trying to heal something it cant,that Cartiva hole. To anyone reading this that is afraid of fusion please go to the hullux ridigus support group on facebook. Ive got alot of good information there. The stiff toe is not as bad as it may sound. Just want to get on with my life at this point. But i agree cartiva was approved too quickly by the FDA. The research may have been incorrect, it was too small a group to make a judgement. I did not sign on to be a text subject. Maybe the FDA should take some responsiblity for this. Oh but that will never happen, its a goverment program.

Dec 27, 2018
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Arthrosurface
by: Laurie

I have a consultation with a doctor near LA to remove my Cartiva and replace with the Arthrosurface implant. Anyone have that procedure yet?
I am 11 months out from my surgery with pain, swelling and extremely limited range of motion.

Dec 26, 2018
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Failed Cartiva
by: Denise

I had the cartiva implant surgery June 7, 2018. I was willing to follow all the instructions for a complete recovery and not push rushing to get back on my feet. I was hopeful but now almost 7 months out, I have more pain than I did before. More surgery and possible fusion is not an option. I had a CT done (My surgeon said he was concerned that my bone was "reacting" to the material. That spells FAIL for me). My follow up is Jan 11 to find out the results of the CT scan. What responsibility does the manufacturer have in all this? The recovery for this surgery and subsequent pain was worse than major surgery on my hip and femur after a major accident.

Dec 13, 2018
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I want to sue Cartiva and my doctor. Who’s in?
by: Lauren

Same as most people here, I was in way more pain after the Cartiva surgery, including awful sesamoid pain. I just had a fusion today. The doc told me today, right AFTER the fusion, that the attachment of the fusion plate may be at risk because of the hole in the bone from previous Cartiva surgery. And what does this mean for the sesamoids, will that pain miraculously go away now? I doubt it. This is my third surgery on this toe, it’s been 4 years since I could walk without pain. If this fusion doesn’t work I’m going to jump off a bridge, but not before I sue the shit out of Cartiva!

Oct 16, 2018
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Upcoming Cartiva Surgery
by: Steve

Hello

My brother has surgery scheduled for end of the year. His Orthopedic Surgeon wants to use the Cartiva Implant on his Right big toe to correct the arthritis.

Mark Had surgery 12 Years on Left Toe and same Doctor did a fusion. The incision area became infected and he ended up in Hospital for 4 Days and on IV Antibiotics for 8 weeks.

The family is concerned since Doctor will not talk about last time and says chance of another infection is a Billion to one.

My brother's infection started 3 weeks after the last surgery and they never figured out what happened.

Should he get second opinion? Mark is worried but feels like Doctor should not Challenged.

Would like some imput
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Hi Steve,

A second opinion is never a bad idea, particularly when your surgeon somehow thinks he is not obligated to answer questions.

Marc Mitnick DPM



Sep 12, 2018
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Cartiva Failed!
by: Lori

I had a cartiva implanted Feb 1 2018. Everything was great for about 3 weeks. In fact, it was awesome for 3 weeks! I was walking pain free with normal ROM in my toe. But during week 4 my foot began to swell.

The swelling has increased ever since and now (7 1/2 months later) my foot is also swollen and painful. My podiatrist did a bone biopsy to make sure it wasn't infection (negative biopsy).

So now I have a pathological displaced fracture of my great toe! My podiatrist has not experienced this with any other patients. I will be scheduled for a joint fusion soon. So much for retaining normal ROM!!

Sep 05, 2018
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Cartiva failure
by: David

I had the Cartiva implant March 2018. Pain is worse than ever. Saw a NEW Doctor today. Appears fusion is my only option now. Like many others, I was excited to have this procedure done to end my pain. Total failed procedure. I need this pain to end. DO NOT GET THE CARTIVA IMPLANT.

Sep 03, 2018
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Cartiva Nightmare
by: Laurie

Phyllis,
I could have written that post you put up on August 30. Exactly what I am dealing with. Burning pain on the bottom of my foot and I cannot walk more than a block. Went to a specialist who said the implant appears to have not worked Bone on bone and my only option is a fusion, too. So pissed.
We may be a small sampling, but how many people do not even know sites like this exist? My guess is there are more that are unhappy. More importantly, my entire lifestyle has changed because the only exercise I can do is swimming. I have invested hundreds of dollars in shoes, orthotics, compression socks, etc, not to mention pain meds which I refuse to take anymore - they are opioids - then anti-inflammatories. I just cannot ice everyday anymore. Extremely frustrated and doing my research about the fusion. I live near LA and the one recommended specialist charges $1200 just for a consult. I feel your pain, literally! And I would never recommend this surgery to anyone.

Aug 30, 2018
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Cartiva implant should not have passed FDA!
by: Phyllis

This is so discouraging to read so many people have had failed implants. My doctor only had great things to say about Cartiva, I am 8 months post op and like the other comments, I’m in the worse condition now than I had before surgery. My pain level today is 7 and 9 on the days I have to walk more than 1500 steps. I wonder why we have the burning pain on the bottom pad. My dr kept telling me to give it time (1 year) and every time I would see him to complain about the pain he NEVER took an X-ray after surgery...so I finally went to another dr. last week & he did an X-ray ... to our surprise it looks as though the implant was never done! Now it’s bone on bone and it’s too late now for a metal implant. Only a fusion will help now and I’m skeptical because of the bottom toe pad being painful/burning if I’ll still have problems after surgery. I feel like we need to file a class action suit. I’m so upset! This has affected our lives in a major way!
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Indeed, there are a number of dissatisfied patients who have posted on this site, but it is a small sampling and there is no way to know how many "happy" patients there are out there after having the Cartiva procedure.
Your decision to have a fusion really rests on how much pain you are presently in. I would certainly wait until the one year anniversary of your procedure before deciding on further surgery. If you are still having substantial pain, then having a fusion seems to be a simple decision (in my mind). If your pain has begun to diminish then you could certainly hold off for a while longer and see what happens.

Marc Mitnick DPM

Aug 28, 2018
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7 weeks out
by: unknown

I am only 7 weeks out from surgery but have limited upwards motion and i am limping in a running shoe. There is swelling and redness. I only have about 20 degrees of upward flex (dorsiflexion?) on my right foot compared to 45 degrees with my normal left with lots of pain, swelling and redness at the top. No pain at the ball / bottom of foot. Is this normal? I could walk normally pre surgery but only for short distances...less than 2 miles.

Jul 18, 2018
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Failed Bunion surgery
by: Karen M

I was hoping this implant would be the answer to all my pain through over shortening of my big toe due to bunion surgery. But it seems the number of failed surgeries resulting in the same pain I already have leaves me not knowing what to do.
I have hallux rigidus with a bone cyst the distal phalange is now lose as it over compensates for the rigidus where the original problem was.
I’ve had two ops on this site as after the first I had excruciating sharp pain.
Like most people I don’t know what to do there has been mention of fusing my toe but that again isn’t without problems
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If you were hoping that the Cartiva implant would act as a "spacer" and make your big toe appear longer, that may just be wishful thinking. It is very hard to "stretch" a joint that has contracted particularly if is shortened from previous bone removal.
Although obviously I have not examined your foot or even seen x-rays, in general it would appear to me that your only viable options would be a conventional implant or a fusion.
If you have spent any time on this site, you know I am not a fan of first metatarsal-phalangeal fusions, but sometimes there are just no other options, particularly if you are in a lot of pain.

Marc Mitnick DPM

Jul 06, 2018
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Cartiva Nightmare
by: Laurie

Had surgery on 2/27/18 - implant in right big toe joint for bunion. Pain is almost unmanageable - after one cortisone shot, 12 PT sessions plus stretching at home, pain meds, icing. Had MRI - told all normal. Got the graphite hard orthotic and it made it worse. Bottom of foot under big toe extremely painful - way worse than pre surgery - never had pain there. Still have to use walking shoe for part of the day and only wear a wide running shoe. I have narrow feet, but now the surgery foot is half a size longer. At my wits end. Dr. keeps telling me to be patient. I am 61, in great health, very active - or used to be - but now I cannot even walk my dog. Extremely disappointed and looking for options.
Pre-surgery, it was not decided if I was getting the implant or a pin - Dr said she would decide when she opened up my foot if I was a candidate. Have the pin in the left toe, no issues, great recovery(8 years ago). Searching for options because I refuse to be immobile due to this disaster.

Jul 05, 2018
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Alternative to Cartiva
by: Ry

Has anyone with one of these failed implants looked into the Arthrosurface procedure? My doctor recommended for a failed Cartiva procedure. It is a metal implant but has been around for over 13 years with very good results. My doctor has revised several failed Cartivas to the Arthrosurface with excellent results (according to him). Wanted to know if anyone has heard anything similar.

Jun 27, 2018
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Failed implant
by: K

I’ve had pain to first MTP joint for 4 years, been wearing custom orthotics for 3 years. No injury, just years of walking for my job. Pain was getting worse so I had cartiva implant surgery in February 2018. First set of X-rays joint space looked great. As the joint is healing I was always in pain, gradually the swelling started to go down somewhat. At 2 months post op the joint was still swollen and very stiff. Dr ordered more X-rays and at that time I find out the implant failed. Why?? I was elevating my foot, icing it and was limited weight bearing (slowly weaning myself off crutches). It’s been over 4 1/2 months and that joint still hurts with no improvement in range of motion. Dr made me new orthotics which help but I am still in more pain now than prior to my surgery. I am so disheartened by this entire process. I never would have had the cartiva implant inserted if this was a possibility. Everything I read before surgery was how great this implant was. I would NEVER recommend this surgery to anyone.



Jun 05, 2018
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Still Not Sure
by: ANON

I had my Cartiva in March 2018, I am 36yo and almost 3 months out from surgery. I was super excited about this procedure and the expectations of recovery time and was tired of getting 1-2 shots a week in the joint, which also became very costly. Being active, the day of surgery I was hitting golf balls in the yard while wearing immobilization boot with no issues. By the end of the first week I had already went to a loose tennis shoe around the house to get mobility back and the boot when leaving the house. By the second week mostly in a tennis shoe along with a lot of ice and elevation. End of second week stitches removed and back to work on the third week of course walking with a limp and having to go home a few days through week 4 and 5 with pain and to take meds. Developed extremely painful sesamoid issues and back to the Dr. for shots. After the last shot being placed in the bottom of my foot at the sesamoids where I asked was immediate breath taking relief and have been able to walk somewhat normal again. Custom expensive orthotic insoles have helped. Swelling stayed down for the most part but due to random on and off swelling, redness and pain it was suspected of gout from the trauma of surgery. I was returning to the gym but could not do any cardio other than a bike and just weights. Still not able to run or hike, climbing and down hill does not hurt but walking on a sideways angle is impossible. Around week 7 had MRI just showing extreme tendonitis. X-rays were still looking good but still in bone pain. Yes ROM was decreased so I still pushed it to regain as much as possible. Still having some bone pain now and finding out around week 11-12 looks like the implant is not taking and the cavity that was drilled has increased in size so the implant is most likely moving and my body has rejected it. Also in the last 2 weeks developed painful bunion that is obvious and was not there before surgery. Looks like scheduling to have the Cartiva removed but considering other options. Myself and the Dr. are against fusion due to my age and activity level. I still think it just needs time, like 6 to 8 months to get somewhat normal again but the Dr. wants to remove it. Thinking about waiting another month or two but i'm still not sure about this implant.

May 21, 2018
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Cartiva implant
by: Maudie

I had a cheilectomy with cartiva implant 2/12/2018. I have great range of motion in both directions. I do still have some swelling in the joint, but that is to be expected and eventually will get back to normal, about six months to a year. I do have pain in the joint and ball of my foot from time to time, especially when I overdo it. I am an avid hiker, walk and runner, I am pretty active. I was told not to engage in hiking on uneven terrain for at least six months and not to use the treadmill to walk for the same amount of time, but to walk on a track. I don't like sitting still, so I have been using my treadmill and tend to overdo it, causing pain. I am now limited again due to a torn retina. I am 58.

May 17, 2018
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Do not have Cartiva implant!
by: Kimberly

Had Cheilectomy performed on 4/10/18, 5 weeks post op today, had bone spurs removed with Cartiva omplant to replace cartilage, can’t move toe at all, on the rare occasion I can bend my toe down it freezes! I had Cheilectomy in Oct of 16 on right toe with no implant, it did great and has continued to do so. Dr is having to go back in on 5/22/18 to redo because X-ray I had two days ago shows implant failure along with the pain, inflammation and loss of movement in toe. I will tell him not to put implant back in, I hated I had it done, don’t know how he will repair the hole but I’m not getting the implant put back in! I will not get a fusion either! If you are considering the Cartiva implant, don’t do it!

May 01, 2018
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Don't get the implant
by: Chris

Coming up on 6 months after surgery. Limited range of motion, extreme pain. Implant is wearing away the bone according to xray. Cannot walk normally on the foot, joint still swollen. 30 sessions of PT with limited minimal improvement. I wish I'd never gotten the implant. I still had some space in the joint before, now there is none. Implant ruined my active life and I'm very depressed. Not going to get fusion, that will only make things worse. I wish I'd known I had a choice not to get this.
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Hi Chris,
In 99% percent of the cases, bunion surgery is an elective procedure meaning you can decide not to have anything done. Hopefully, your surgeon presented it to you that way.
If you are still in so much discomfort you might inquire whether or not a conventional implant can be inserted to replace the Cartiva substance. Not sure if that can be done or not since I have not performed the Cartiva procedure and have no actual experience with it.

Marc Mitnick DPM

Apr 27, 2018
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Cartiva
by: Gerry

I had the cartiva implant on 2/15/18. I am 11 weeks out and still in pain. I am still trying to get the toe to move both ways but it will move forward but then locks up on the return. I heard so.
Many good reports about this procedure and 98 percent good rains after 4 to 6 weeks. My doctor says give it time but it feels the same way now as it did 5 days after surgery. He said he used a 10 mm on me instead of the 8. I didn’t know they came in different sizes. I has a carbon filter graphite orthotic inserted into my shoe. Helpers somewhat but I would have rather taken shots that I had for 2 1/2 years before this surgery. The shot was not a cortisone shot but was a powerful anti inflammatory shot that started with depo medrol which lasted 9 months and then
when I would aggravate the toe, I had to
get another shot..roughly every six months. If I had to do it over,I would have continued with the shots. My foot doctor states give it time to heal because the foot is weight bearing but I am so disgusted at this point that I am ready to have the toe amputated,

Apr 18, 2018
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All Too Familiar
by: Steven

I had a Cartiva implant in October of 2017. After only 2 weeks, and no weight-bearing at all, I was told that the implant failed...back to bone on bone. My pain is 10 times worse than before the procedure. I am extremely active and now many of my activities are limited. It could be the operator or perhaps this is just a stop gap and not a great product. I got a second opinion from another surgeon and he is not favorable toward the Cartiva implant at all. The local rep was not able to address some of his concerns. There are strength in numbers. I am going to be reaching out to the manufacturer directly. All the best.

Apr 17, 2018
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Failed Cartiva Implant
by: Kelly

I wish I had found these comments BEFORE my surgery. I had surgery Feb 8, 2018. I have less range of motion and more pain and swelling than before. I walk with a limp on the outside of my foot as any pressure hurts the bottom of my foot. I can only wear one pair of shoes that are slip on and wide fit. My toe does not bend at either joint in any direction. I had done 4 weeks of Physical therapy but stopped going after not seeing any results. At the last appointment with my doctor, she was basically stumped, did an xray and blood work with no negative results. She recommended an MRI which I have put off, because I have already taken too much time off work and can't afford another co-pay at this time!

Apr 14, 2018
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Cartiva Failure
by: William B

My implant lasted only 4 months. Never was able to walk without pain and had significant inflammation the entire post op time. X-ray revealed that the implant was beginning to cause severe irritation to the Metatarsal head. Appeared to be a reaction to the implant.

At 5 months post op had implant removed and performed a Cheilectomy. Significant bone graft had to be performed to repair damage caused by the implant. Now 3 months post op from second surgery and about 50 percent to full recovery which will probably be another 6 months.

Personally I can not see how the Cartiva was approved by the FDA.

Apr 09, 2018
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Another failed captiva surgery
by: Paul

I have arthritis throughout my body which generated substantial pain in my right side big toe and bone on bone in my right hip. Had a failed captiva implant 2-10-17 followed by a successful total hip replacement. Second opinions confirmed the failed toe implant and I was given the same options as the rest of you folks with one additional option: Diclofenac sodium gel, slathered on my entire foot 4 times a day provides 50% relief of the pain on the bottom of my foot and on the failed implant areas. Another surgery after the hip replacement and 3 failed back surgery’s makes no sense. The gel allows me to golf and walk short distances I hope it provides relief for other sufferers of these types of problems. You might want to ask your dr why this min invasive option was not suggested. It can’t get deep enough to provide 100% relief but it provides some relief, enough to allow me to enjoy life.

Mar 31, 2018
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Also failing...
by: Celeb

I am in a set similar situation to several other posters, in which I had this implant placed on Jan 10th, 2018, but discovered that within a month the joint space had quickly diminished and it was deemed a "failed procedure". My 2 options for repair are 1) Remive the implant, backfill part of the hole with a bone graft and then reimplant the Cartiva or 2) An interpositional arthroplasty.

I have no idea what to decide. How long does an arthroplasty last? I am fairly active, and am on my feet all day at work.

What to do?

Celeb
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Speaking from a position of never having examined you, I would be inclined to not have another Cartiva procedure. If it failed the first time, what are the odds of it being successful the second time, particularly with a bone graft? Yes, a bone graft will fill part of the "hole", but the graft would have to be a perfect fit in order to be successful and that is rarely the case.
I do not know your age, but it would seem your two options are either an arthroplasty or a fusion of the joint.
You might consider getting another opinion from a foot surgeon in your area before making any decisions.

Marc Mitnick DPM

Mar 21, 2018
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Cartiva Failure and Sesamoiditis
by: Brad

Hello Sandy,
I hate to say it, but i'm glad i'm not the only one with these symptoms. I had a bilateral Chielectomy which provided no relief. I then had a bilateral Cartiva implant and am having the same issues with severe sesamoid pain and increased pain in both 1st metatarsal joints. I am a year post op and wish i would have never had either type of surgery. Both results have been worse than the initial pain from hallux limitus. I don't really know where to go from here... Please keep me updated on your journey and let me know if you find any type of relief.

BTW: 34 YO Male, Good Health.

Thanks,
Brad

Mar 19, 2018
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Cartiva nightmare
by: Monica

I had a Cartiva implant in May of 2017 to supposedly fix the problems created by a cheilectomy done in June of 2016. I woke up from surgery with an external fixator (this meant no weight-bearing for three months) that had to be surgically removed in August of 2017. So, three surgeries, followed by four months of PT. It is now March of 2018 and I am in more pain than I was before I had the first surgery. I am now facing a fourth surgery to remove the Cartiva and replace it with bone harvested from my heel. I am terrified to have yet another surgery after everything I have been through. Has anyone else had the Cartiva removed without having the joint fused? My surgeon is going to try to save the joint by lowering my metatarsal, which he did on my other foot in 2012. That foot is doing well. For anyone considering Cartiva and thinking that
it's the answer to your prayers, please reconsider. I read all the research and reviews beforehand, but this has been an absolute nightmare for me. I was a very active person who once ran and walked and hiked on a daily basis - I am now in pain every day and unable to do the activities I once loved. DON'T DO IT.

Mar 14, 2018
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Another failed Cartiva Implant
by: anon.

I am also having difficulties with a Cartiva implant. The procedure was performed in mid December and I have been on a slow decline since. The joint has continued to lose range of motion during the recovery and the pain has increased. I am now having issues with seismoids as well. I am going in next week to have another procedure where I will be sedated and the surgeon will try to manually break up the scar tissue by wrenching on my toe. I was told that if this is unsuccessful then I am headed for a fusion. I feel like I am entirely too young and active to be dealing with these problems and the pain is having a real impact on my career which requires significant walking. Furthermore, my altered gait seems to be wrecking my hips.

Mar 11, 2018
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Increased Pain 10 months after Cartiva
by: Your First Name

I had a Cartiva implant by an Orthopedic foot and ankle surgeon in May 2017. I am now experiencing increased pain in the first MTP joint, in the second toe and along the side of the big toe. I cannot walk normally. I subsequently had to have a big toe fusion on my other foot due to a failed metal implant, so neither foot is working for me now. I will be following up with my surgeon shortly and will be requesting an xray of the Cartiva joint. I note the DPM opinion on this page recommending an MRI to diagnose fracture as I too feel like a cortisone injection might relieve some pain. I am greatly disappointed in the results as I had read the Cartiva study prior to agreeing to the surgery.

Mar 10, 2018
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worried
by: Terri

I had an implant done on January 10, 2018, and the most pain I have still (and have had since surgery) is under my foot where the implant is. I am hoping that this will go away in time, but right now I am in more pain than I was before the surgery. My Dr. recommended the implant so I would have more range of motion instead of fuseing the joint. Right now, it is behaveing as if it had been fused, and I am very upset. I am hoping that this will go away and it is just too soon to tell, but I did not expect this pain under my foot, where I had none before! All of the pain was on top and in the joint from a bone spur and cartiledge filling in the joint. I really hope to go back to work soon, but I can't as it is!
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Have you gone for physical therapy; it should be helpful in increasing range of motion.
Additionally, ask your surgeon for some kind of insert to put in your shoes to take pressure off the bottom of your foot.

Marc Mitnick DPM

Jan 21, 2018
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Failed Cartiva
by: anon.

I too underwent Cartiva implant surgery to increase range of motion. I'm four months post procedure and have reduced range of motion and increased pain. I definitely would not have had the procedure knowing this would be the outcome.

Jan 15, 2018
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Exploring options - Cartiva or Fusion?
by: Brian

I read your comments about the failure of the cartiva implant. I have excruciating pain in both toe joints. My doctor recommends fusion but I am an avid backpacker and don't want to lose any range of motion that I currently have.

I've done a bunch of research and your experience is an exception to what I'm finding. I would really like to read more from your experience.

Did you read the study before having the implants?

https://www.cartiva.net/assets/docs/Foot%20Ankle%20Int-2016-Baumhauer-1071100716635560.pdf


When did you have your implant?
How are you now?

Thank you for any information as I don't want to experience what you have.

Brian

Jan 01, 2018
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Failed Cartiva Implant
by: Anonymous

Interesting response. I had this implant put in in August and have also been told it did not work and I already have calcification starting in the joint. I primarily did this to get increased range of motion in my joint. I'm left with less range of motion and increased pain. I'm not sure what to do. I'm an active 45 year old. I'm so discouraged and worried about the future of my foot and activities...

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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center





MY PRODUCT RECOMMENDATIONS
(items I prescribe in the office)


Orthotics for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


Orthotics for heel and arch pain for those who must wear dress shoes
click link below


redithotics


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Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

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NY
I am really, really impressed with your plain-speak explanations for the various conditions.

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NJ
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Fla
A well organized site containing much information written in a manner that the average reader can comprehend.

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Ontario, Canada
I found your website and articles most interesting.

Andrew

Fla.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York
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Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN
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Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa


You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT


First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA


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All the best,

Victoria

Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


Thank you for your very interesting and informative site!

Anonymous




Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN


Thanks very much for the wonderful informative site.

Catherine

New Zealand


Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. https://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location


...Thanks for your fantastic service.

Gary

Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA


Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown


Great insights! Thanks Doc, you're the best.

Glen

location unknown


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Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland




Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA


I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown




Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown




Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA




Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown




Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown




Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown