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Thread: MTP joint instability/subluxation - Anyone have any experience?

  1. #26
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    Finally got to see the ortho today. He thinks it's just a neuroma and the tendon is fine. He thinks the pop I am feeling is the nerve not the tendon, and the appearance of tendon sublux is just the enlarged nerve interfering with my toes realigning properly after my foot deloads. He said that if it really is a problem with the the tendon and something like this has occurred:

    Quote Originally Posted by Vinman View Post
    There are typically bands of tissue to hold tendons in place and maybe you tore that causing the tendon to be unstable?
    then he has never seen or heard of it in 11 years of practice and wouldn't even know what kind of surgical fix he could do for it.

    Since I was there we injected it again to see what happens. Maybe my earlier injection didn't get the right spot, who knows.
    Last edited by Dantheman; 11-28-2012 at 04:04 PM.

  2. #27
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    +++++++++++++++vibes man. I feel for ya. I hope there is a solution soon and you can get back to what you love for many more years.
    "The skis just popped me up out of the snow and I went screaming down the hill on a high better than any heroin junkie." She Ra

  3. #28
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    Thanks. The whole appointment was pretty much a long debate about why my "neuroma being a symptom of flexor tendon instability" hypothesis is wrong. The primary reasons I had for that were that a) the sports medicine guy said that "sublux" you can see in the pic was caused by the tendon and the popping I could feel was the tendon snapping back into alignment; and b) the acute onset of symptoms. Pretty much everything I had read indicated that Morton's neuroma was something chronic that developed slowly over time and not as a result of acute injury. He says that the sports medicine guy was just plain wrong about anything being wrong with the tendon, and apparently neuromas do occur as acute injuries. So, I'm deferring to his expertise for now. I hope he's right and my tendon hypothesis is wrong, because if I was right it seems I am very truly fucked.

    I'm anxious to see if this second cortisone injection does anything. I'm starting to wonder if that hike I did with Sam in June where the pain got VERY bad (easily 8+/10, barely made it back to the truck) did so much damage that the nerve is beyond saving.

  4. #29
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    No noticeable effect from the second injection. Had a follow-up scheduled for Jan. 9, but called the doc last week to see if we could do surgery before the end of the year (for tax purposes, already have a ton of medical bills from our stillbirth this summer, gonna be well over the threshold where I can deduct medical expenses). Got on the schedule for Dec. 27, let the cutting begin.

  5. #30
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    Got out of surgery about 1.5 hours ago. Doc said it wasn't the biggest neuroma he's seen but right up there. Looking forward to this nonsense being over with. Oxy is goood.

  6. #31
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    Got out of surgery about 1.5 hours ago. Doc said it wasn't the biggest neuroma he's seen but right up there. Looking forward to this nonsense being over with. Oxy is goood.
    Glad to hear you are on the road to recovery. Looking forward to TRs about epic trail runs. Careful with that oxy.


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  7. #32
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    Quote Originally Posted by Dantheman View Post
    Got out of surgery about 1.5 hours ago. Doc said it wasn't the biggest neuroma he's seen but right up there. Looking forward to this nonsense being over with. Oxy is goood.
    Nice dude! Glad they got you in finally!

  8. #33
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    Quote Originally Posted by neufox47 View Post
    Careful with that oxy.
    Won't be a problem. I get a recreational effect from opiates for the first 1-3 doses then nothing. If I take more I just itch like crazy and get hopelessly constipated. They gave me 60 pills and I bet 50 will end up in first aid kits.

  9. #34
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    Two-week post op today. Very happy to get the stitches out as they were itching like crazy. There's still a little swelling around the incision but supposedly it looks pretty typical for this point in recovery. I can go back to a regular shoe now and my mobility for day-to-day tasks is close to pre-surgery levels but I still need to minimize time on my feet for 1-2 more weeks. Got the OK to get on the spin bike and do some easy lifting.

    Apparently the neuroma was about the size of a raisin, a healthy nerve should be about 1 mm.

  10. #35
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    progress, that is awesome!
    Something about the wrinkle in your forehead tells me there's a fit about to get thrown
    And I never hear a single word you say when you tell me not to have my fun
    It's the same old shit that I ain't gonna take off anyone.
    and I never had a shortage of people tryin' to warn me about the dangers I pose to myself.

    Patterson Hood of the DBT's

  11. #36
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    good to hear DTM, dang that was a big'un
    fighting gravity on a daily basis

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  12. #37
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    Brief status update. Tried the spin bike for a couple minutes on the day of my post-op but any amount of resistance felt like too much so I bagged it. 5 days later I tried again (18 days post-op) and did about 10 minutes at low resistance and about 3 minutes at moderate resistance and pretty high RPMs. Actually worked hard enough to get my heart rate up and suck wind a bit. That felt great and my foot didn't seem to react negatively.

    4 days later (22 days post-op) I got back on the spin bike again. Did 10 minutes at moderate resistance then mod-hard intervals for 15 minutes. GLORY GLORY HALLELUJAH REAL EXERCISE!!!! Felt great during and immediately after, but within an hour I started to feel some swelling setting in. Soon there was enough swelling around the incision that it was very sensitive to touch and I had trouble walking. Four days later now and it still hasn't calmed all the way back down to where it was before the spin workout. Pretty discouraged right now. I really want to be able to ski with my 3 y.o. and do easy tours by march so I'm going to wait at least another 7 days before I try anything remotely taxing, maybe even wait until after my 6-week post-op on 2/6.

    I swear I feel physically ill from lack of exercise. My only consolation is that the air in SLC is so bad right now that not exercising is probably better for my health in the long run.

  13. #38
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    You arent working with a pt for recovery / rehab?

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  14. #39
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    No. My surgeon told me just to ease back into day-to-day activities and low/no-impact exercise as able.

  15. #40
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    Is that typical for this kind of injury? You ask a pt? I know that's kinda like asking a car salesman if you should buy a car, but that seems like something that you'd rehab, no? Im no expert, but that seems like a major injury to just "ease" back into. Especially with your background, id think prof. Rehab for the first 6 weeks would be prudent. It's not like you are returning to a lifestyle of walking to the mailbox for your exercise.

    Sent from my ADR6425LVW using TGR Forums

  16. #41
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    It seems pretty standard. My surgeon has done a lot of these and knows my athletic background so I think he would have brought it up. Googling turns up nothing but stuff like picking up a pencil with your toes and toe spreads, I don't need a pt for that.

  17. #42
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    DTM, if you were my patient, I'd tell you to wait a bit more than 3 weeks to begin low impact exercises. I'd likely tell you to wait 1-2 more weeks before trying much of anything that stresses the toe. Then start a slow progression of partial weighbearing activity.

    Again if you were my patient I'd say do all the leg machines you want but just not bearing wt., leg EXT/curls etc. some stationary bike but easy, easier than you describe.

    Let this thing heal up then try to progress. at 3 weeks the stuff he cut is still healing. Listen to your body, if it causes increased pain and swelling it is too much right now.
    fighting gravity on a daily basis

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  18. #43
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    Yeah Vin, it's glaringly obvious that it wasn't ready for what I did on Friday. I'm not doing shit on my feet for at least 7 days and probably longer. No gym membership so leg extensions, etc. aren't happening. I've been chipping away at a front lever for awhile now and going to stick to that.

  19. #44
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    So after my last post things were progressing well until about 35 days post-op when the incision swelled back up a bunch out of nowhere. Saw the doc a week later and he said I most likely had some stitch abscesses from the internal stitches not dissolving properly. So, onto antibiotics for the next seven days. It started feeling better within 1-2 days and improved substantially over the course of the treatment. Started hitting the spin bike again and doing some longer walking with no ill effects. Eight-week follow-up was wednesday and was told I'm now good to go. I did some light squatting and a few minutes of easy running yesterday and it felt fine then and today. Time to get back in shape....

  20. #45
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    Skied the bird for about 5 hours yesterday and no issues with the foot whatsoever. Stoked!

  21. #46
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    Quote Originally Posted by Dantheman View Post
    Skied the bird for about 5 hours yesterday and no issues with the foot whatsoever. Stoked!
    That's hudge! Get it!
    Something about the wrinkle in your forehead tells me there's a fit about to get thrown
    And I never hear a single word you say when you tell me not to have my fun
    It's the same old shit that I ain't gonna take off anyone.
    and I never had a shortage of people tryin' to warn me about the dangers I pose to myself.

    Patterson Hood of the DBT's

  22. #47
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    So I basically had two stitch abscesses, one at the distal end of the incision and one at the proximal end. At my appointment last week the proximal one was completely gone but the distal one was still there a little bit. We decided to give it some time and see what happened. It pretty much stayed the same through tuesday and then started to swell back up tuesday night. So, as much as it pains me to do so I'm back on antibiotics for a while.

  23. #48
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    5 month follow-up:

    Did a 10.5 mile, 1,800 ft techy trail run in 91 minutes at a mellow pace last weekend. No issues with the foot whatsoever on the run. Pretty much back at my old lifting PRs too and feeling really strong on my bike. I'm almost exactly a year out from the original injury that started this nonsense and could not be happier that I seem to have finally put it behind me.

    No IT band issues either, but that only ever presented itself going for >2 hours though so that remains to be seen somewhat. Honestly though, I think the main cause of my IT band issues was all the flat road miles I ran last winter training for Salt Flats. Screw that shit, never again, unless it's intervals I'm only running high vert mountain trails for the rest of my life.

  24. #49
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    Glad to hear it DTM.
    fighting gravity on a daily basis

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  25. #50
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    Follow up

    [QUOTE=Dantheman;3998629]5 month follow-up:

    I just finished reading your thread and am afraid I have the same issue you describe, although not as bad - yet. Symptoms started last winter skiing / hiking in WY & MT and was brutal making turns. Pain went away in summer but still "clicking" sensation in 4th toe. Pain came back this summer while skiing / hiking in Chile and now seems worse as weather is getting colder. Did you find temp. a problem for your issue? Did you learn of any preventative ways to cure before geeting to your point of surgery?

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