My doctor is considering doing a lateral column fusion on my right foot. We have tried just about every conservative technique under the sun or at least I think we have. I have tried various braces and supports. We have done three rounds of x-ray guided steroid injections that relieve the pain but for a limited time (1-2 hours), physical therapy and here today hee sent me to a Chiropractor. He informed me there are several techniques that can be used instead of the fusion but he did not elaborate. Does anyone know of different procedures for the lateral column besides fusion? The pros/cons of having this done, or have a few links they can throw my way? I have looked for quite some time and have not really found any information that was helpful regarding the fusion of the lateral column. Any help would be greatly appreciated.

Hi Heath and welcome.

First, can you tell me a bit about yourself? Age, weight, occupation and general health?

What brought about the need for the lateral column fusion? Can you describe your symptoms a bit for me?

Jeff

Well I am a 26yo male, 6' 180lbs. I am an active duty Marinel, in excellent condition and at the moment due to my medical situation I am working in an office enviroment.

This past May I was playing around with some friends and I ended up severely spraining my foot. The swelling went down at around the 4 week mark and I was able to walk decently around 6 weeks. The pain stayed the same throughout this entire time. It is a strong shooting pain throughout the range of motion on the outboard side of my right foot that spreads up and over the top of my foot. My foot would periodically go numb and the first doctor I seen diagnosed me with Peroneal nerve palsy and I was placed in an AFO. I wore the AFO for 12 weeks and it helped with the numbness and being able to control my foot while walking. After the AFO was taken off the pain on the outboard side of my foot was still present. After talking to him I received my first steroid injection which did not help in the least with the pain and really only made it worse for the day. After a week I went back to him he wanted to do another shot and I requested a different physician.

With my present doctor I had an MRI and Bone scan performed and both showed that the cartilidge in my foot had deteriorated to the point that at the present I am almost to the point that it is bone to bone. After this the new physician did a x-ray guided (cant remember what he called it Flora?)steroid injection into the joint and the pain was relieved for 1-2 hours. After that time had elapsed the same symptoms reaccured and i went back for another round of steroid injections using the same technique. The steroid injections did not help but both relieved the pain for a short period of time so he was certain the injection were in the correct place. He then sent me to physical therapy for whatever reason if not to waste more time and this did not help either. Presently he sent me to a Chiropractor to try and relieve some pressure on the joint and after the first day i could barely walk the pain was so bad. I returned from the Chiropractor again this morning and have had my foot imobolized, elevated and on ice all day to try and relieve some of the pain that this is causing but to no avail.

My current doctor is a little aprehensive about doing any sort of surgery for the sole fact of my age, and everytime i see him which is about every 2 weeks now he touches here and there about fusion and then sends me to yet another conservative technique that ends in failure, and for pain its always Ice, elevate and take a motrin which is not helping after these visits to the chiro.

Not sure what else to say really if you need more specific information I can try to answer them to the best of my ability.

Thanks for the warm welcome and Happy Holidays to you.

Heath,

I'd tend to agree with your doctor's apprehension. Although your problem is specific to the CC joint (calcaneocuboid joint), the CC joint works in conjunction with the stj (subtalar joint) and TN (talo-navicular) joints. Between the three of them, the work to control a lot of the motion in the foot. Here's a couple of x-ray views to get you oriented....





Now an isolated stj fusion seems to do well and would work in a guy your age. An isolated TN joint fusion would work but I find that the younger the patient the more the problem with the fused TN joint inhibiting the motion of the other two joints. Follow? But for some reason, the stj does better.

An isolated CC joint fusion never seems to work well. I'm sorry. I know that's not what you want to hear, but I just want to warn you about it before you go off and have it done and have problems. We've got another isolated CC fusion patient in the forum called me2. You might want to track down her posts.

Unfortunately, the only solution I've found with an isolated CC joint problem is to fuse all three joints. It's a procedure called a triple arthrodesis. Many doctors are going to be reluctant to do a triple in a 26 y/o patient. The reluctance is due to the load put on the adjacent joints. For instance, it's not uncommon to see a young triple arthrodesis patient have ankle arthritis later in life. Why? Well, the lack of range of motion in the foot is taken up by the ankle. And as such, the wear is just too great and the ankle wears out early.

Sorry to be the bearer of bad news, but I'm glad you're here and we can talk about it.

Jeff

Thank you very much for the informative reply. This has been my biggest fear with having anything done to something that I am dependent on to do the things that I love doing so much. Given the circumstances is there anything you would recommend that maybe I could put a bug in my doctors ear about? He was telling me about an alternative procedure that instead of fusing the joint they insert spheres into the joint? Then on another occasion he mentioned taking soft tissue from somewhere and placing that inside the joint. Are these options that would maybe be beneficial in the long run?

My biggest problem now after reading up on Me2 posts is that I do not want to have this done. Right now all that I care about is that I can get along with my normal daily routine as soon as possible without having to deal with the pain while I am walking or doing anything else that requires me to move my foot. The only thing that seems to help is to completely immobilize the foot and that only decreases the pain.

Are there any alternatives to the isiolated cc fusion or the triple arthodesis you mentioned? I appreciate all the information and Happy Holidays to you.

Heath

Hi Heath,

Not to my knowledge. I don't think that there is an alternative. The only thing that does come to mind would be to debride the joint in an attempt to try to restore the surface cartilage to the joint.

Can you described for me a little bit more the injury and problem? So the MRI indicated the joint was pretty well gone?

The cc joint is the Rodney Dangerfield of foot joints. It gets no respect until it's damaged. Then you come to realize how significant of a load bearing joint it really is.

Jeff

When I sprained my foot (not the ankle) there was a couple of audible pops. My toes went straight down into the ground and bent upwards as I fell forward so it was like I tried (well not on purpose) to fold my foot in half. Every since then there is significant pain on the outside of my right foot. It shoots down the side from around the joint and down toward my toes, over the top of my foot, and there is a constant burn there in the joint that gets worse if I rotate the foot or move it from side to side.

The MRI showed that the joint was all but gone. Like I said earlier I received so many different opinions about what was going on from my normal doctor and two different podiatrists. The first was Peroneal Nerve Palsy. The doctor wouldn't understand when I told him the only reason I don't lift my foot up that far or push down hard was because it hurt so badly. My new doctor took me out of the AFO and the only thing I can tell that was even partially helpful was the fact that with it on I didn't have to worry about stepping wrong and going off the side of my foot.

My only concern is that if I don't get this fixed now it will be like prolonging the inevitable and will keep me from doing things I enjoy doing. I just want to be able to walk around and not deal with the pain, or cutting an outing short because I can't walk comfortably.

What kind of limitations are there with the fusion? Will I still be able to run after it is fully healed? Are there certain things in everday life that will give you problems doing?

I appreciate your input on this and hope everyone had a happy holidays.

Hi Heath,

I read your post and have to admit from the very first post I thought you sound like me 2-3 years ago

So sorry my posts scared you. Honestly. Two years ago shortly before the surgery I wouldn't have wanted to read something like my story....

But maybe it helps if I can sketch you some of my experiences as a summary of the last two years.
On the whole - even though it went badly wrong and I encountered a lot of complications - I actually never regretted the surgery. I still think it was the right decision and it was worth every try.
I was walking so badly prior to surgery and deteriorating that I couldn't honestly say I'd be better off now without it. It's just not likely.

I was 27 when I had the first surgery (so pretty much your age). Now I'm 29 and moving on to a triple. My doctor was reluctant to do that at first but it's still better even at a young age than constantly crutching around and taking loads of painkillers.

There is one important difference between you and me though, that you should bear in mind. I suffer from psoriatic arthritis as an underlying disease and that is blamed for a lot of the complications. After my first surgery I went into an arthritis flare that continued almost unnoticed for 2 years as my bloods were okay (apparently happens sometimes). So there is a good chance that this is the cause of my TN joint giving up and having to move onto the triple.

After my last surgery I could appreciate the effects of the cc-fusion. The joint is almost painfree (now that it's finally healed) and that leaves me quite optimistic for the overall outcome once I go on to the triple).

Nobody will be able to make that decision for you... And it's a really tough one. Just try to be as comfortable with the decision as possible. I was sure I'd made the right decision and that helped me a lot through the last years

I hope I could put things a little into perspective for you. If you have any more questions or want to chat about it feel free to contact me .

me2

Hi guys,

Run? Probably not. The goal would be to get you to a point where you could get through daily activities pain free.

Jeff

Thank you for all the information. It has helped out alot here over the past few weeks. Now I am just waiting on my surgery consult on Jan 15th to find out exactly what we are doing and when we are doing it. I guess I was a little optimistic about what I would be capable of doing after I had this done. As it stands now I can get through the pain with most activities as long as I dnot misplace a step or twist in any way. I want this pain to go away but I am not sure I want to sacrifice some of the activities that I love doing. Are there any experimental procedures out there dealing with a CC fusion? Could it be more beneficial to wait as long as I can to have this done in hopes that a different procedure could fix the problem that I am having?

Thanks
Heath