Hallux valgus (bunion) surgery in athletes

Hi Paul,

I just had surgery on my left foot (Aug 16th) 1st MTP joint fusion. I'm a tennis player and hoping to be able to play again. I am truly inspired by Lleyton Hewitt (former #1 tennis player) who also had a 1st MTP joint fusion in 2012 and after a speedy recovery returned to the tour and played 4 more years.

Here is the article from the Australian May 26, 2012:

WHEN Lleyton Hewitt walks on to a Roland Garros court for his opening match at the French Open next week, it will be with steps rarely taken by a professional tennis player.Hewitt has undergone radical surgery to prolong his career and remove the constant pain that has accompanied his every court appearance over the past two years, with two screws and a metal plate now locking permanently into place in the big toe on his left foot.

Hewitt's toe, chronically arthritic and misshapen after years of digging into hard courts to launch his service action, is now reconstructed and irreversibly fused. Whatever cartilage there was in the first metatarsophalangeal (MPT) joint has been removed and painful bone spurs shaved off. The toe no longer moves, but nor should it give Hewitt any more grief.

For the first time that he can remember, Hewitt is without pain when he begins each day. If his luck holds, he may even start finishing tennis matches the same way.

The dramatic change in outlook has prompted Hewitt to reset his remaining career sights on a full-time return to the tour this year, a competitive campaign next year, and perhaps beyond.

Hewitt's manager David Drysdale, although reluctant to discuss the medical procedure in detail, told The Weekend Australian: "The X-rays look like something out of Bunnings."

The toe fusion surgery, performed by Melbourne foot and ankle specialist Harvinder Bedi, is common enough as a remedy for degenerative arthritic conditions but extremely rare, if not unknown, for a tennis player still trying to earn a living on the professional tour.

When Hewitt was deciding whether to undergo the procedure, he was warned there was a significant chance he might not be able to play again. The biggest unknowns were whether having the toe set in place would allow Hewitt to push up into his serve or push off hard from his forehand in a baseline rally.

Hewitt opted to go under the knife anyway, reasoning he would need it at some stage for a pain-free retirement. Such was his frustration with the time he has been forced to spend off court in recent years, he calculated it was a risk worth taking.

The pay-off for Hewitt will begin in Paris, where he will return to the circuit two weeks earlier than he had planned. Although his expectations for Roland Garros are low - he has only been on the practice court for two weeks - the success of his rehabilitation has encouraged him to dedicate the rest of this year to restoring his lowly world ranking.

"The aim is certainly to play out the rest of this year and get his ranking up again and then have a good 12 months, hopefully injury free, where he can have another crack at it," Drysdale said.

"He has played spasmodically because he has had different injuries over the last three years so in some ways, it has actually protected his body. He has had time off. If anything he might be able to play a little bit longer."

At age 31, Hewitt has spent the past two weeks practising up to three times daily against former Davis Cup teammate Todd Woodbridge on a clay court at Kooyong.

As recently as four weeks ago, Hewitt had next month's grass tournament at Queen's locked in for his return to the tour, in preparation for Wimbledon and the Olympics, which are also being played at the All England Club. In a recent interview, he explained that his better-than-expected recovery from surgery and Australia's Davis Cup draw encouraged him to push hard towards Paris.

"Once I knew that the next Davis Cup tie was going to be most likely on clay in Germany. I probably pushed the boundaries a little bit more," he said.

It normally takes between six and 12 months to make a full recovery from toe fusion surgery.

Hewitt's speedy recovery will improve his chances of making inroads at Wimbledon, the tournament he won 10 years ago. It will also bolster Australia's chances of beating Germany and returning to the Davis Cup World Group.

Robbie

Not sure if you are still on here. I wanted to know how you are doing? I had an osteotomy and chelectomy of my left big toe about 15 months ago and the pain now is worse. I am a professional coach of soccer and the pain now is making me consider the option of fusing. I have read about Leyton Hewitt, but have also heard that the funtionality will be effected. How did it effect you. I am in constant pain and i cant really demonstrate on my left side any more. The thought of kicking the ball with my left foot is off putting, and if i catch it wrong... oooch

Susan

Thanks for the info re Leyton Hewitt. I had read it, but also i have heard some more negative stories from other people. You mentioned in your original post that you had some exercises that appeared to work and ease the pain. Would it be possible to share these? Good luck with your own rehab

Hello, Paul:

what was your problem ? Hallux valgus or hallux rigidus ? You mentioned cheilectomy, which, as far as I know, is a procedure performed for hallux rigidus...My problem was hallux valgus, not hallux rigidus, with only a moderate degree of osteoarthritis due to the deformity. My surgery was performed by a very experienced orthopaedic surgeon (MD) specialized in foot and ankle surgery. He choose a technique called "Distal soft tissue realignement + basal osteotomy of the first metatarsal". Surgery went fine. I had to wear a surgical shoe for about 2 months. After 6 months I was ninety nine percent back to normal mobility: I could play tennis, started jogging  and cycling. It took me 1 whole year to return to play soccer and, despite a minor loss of dorsiflexion of the big toe, my athletic performance was not significantly  impaired by the surgery. Everything considered, I am very pleased with the outcome.

Hi, Susan: How is fusion doing these days? I have mine scheduled Jan. 3 and I'm still looking for feedback. Thanks! -- Monica

Hi.... just reading your helpful posts.   Am a tennis player (competitive but just for club) but gym and activities essential to me- as is my work .    Heading towards fusion for right foot and bunion left.  Alarming thoughts of being off my feet for months and how to manage work.   Am prob using a consultant in Nottingham but please cd you advise me details of your consultant.     Any other advice?  Thanks and hope you well.

So I play soccer as well but have no pain... thinking of delaying it until I'm older. Did you ever go through with it?