Background

My name is Steven and I am a 47 year old male, very active, living in Leeds, West Yorkshire with my partner, dog, cat and two chickens.

Having searched online for similar blogs regarding this condition, I have found relatively few, and none that are still active.  I am running this in order to share my experience, so that it might help others come to terms with the condition and maybe help where I have gone wrong (or right!).

For about ten years now I have noticed gradual deterioration of movement in the big toe joint of both feet, especially the left one.

My background is made up of jobs that typically involved standing up all day (and all night too in some cases!), my initial career choice being catering, followed by promotional work and, more recently gardening.

22 January 2014
 I was cleaning the car park for a commercial customer of mine, and very unusually made the decision not to wear steel toe cap boots (I was jet washing so Wellies seemed a much more practical proposition for keeping my feet dry).

During the course of jet washing the car park, the drain became blocked and needed freeing up so that I could continue.  There was a very heavy cast iron grate cover which I could hardly lift, suffice to say I did get it out, but slipped and dropped it on my left foot, just where the swollen big toe joint was, and onto a soft wellie, instead of a steel toe boot.

Agony.  sheer agony and I thought I must have crushed it pretty badly, however I was on my own, so decided to crack on and get the job done.

I hobbled around until it was time to go home.

Next day I could hardly walk and decided I should really get an x-ray in order to assess the damage.
I went down to A&E at St James Hospital in Leeds, and after several hours I had some x-rays which revealed a sprain to the first MTP joint of the left big toe.  What was more interesting was that the nurse showed me the bigger picture and explained that there was major deterioration of the joint in terms of wear and tear, no cartilage left in the joint and new bone-like deposits had grown around the joint (I later found out these are called osteophites).  The nurse suggested I have the joint looked at by an orthopaedic surgeon, with a view to possible surgery.

I went home with a course of pain killers and anti-inflammatories and waited for the pain to subside.

Throughout the 2014 season, the pain and lack of movement in that joint became worse and worse, the start of the week having rested was ok, but by the end of the first couple of days working, my joint was red raw and screaming with pain, getting to the end of the week was a major challenge.

By late summer, I decided to go to my GP and try to do something about the situation.

I was referred to go to Chapel Alerton Hospital or Spire Hospital Leeds in Roundhay, and decided to opt for Spire (ok I was maybe being slightly elitist thinking that a private hospital might have more cutting edge equipment and better surgeons than the NHS one, although I would be treated under the NHS funding).

11th August 2014
At the first consultation with the surgeon, he examined my feet and tried to move the joint, which was more or less completely stiff, and oversized from the osteophites surrounding it.  He knew immediately that this was osteoarthritis caused by a gradual wearing out of the joint.  He explained that this is a degenerative condition and that surgery was the only way forward.  X-rays were taken and an appointment made for a month later.

8th September 2014
At the second consultation I was shown x-rays of both feet, and I could see that on the x-ray it looked like a snow storm around the first big toe joint on both feet, however the left one was far worse than the right.  Also the surgeon showed the difference between the gaps between the joints on the healthy toes in comparison to the big toe joint, indicating the fact that there was no cartillage in that joint and it was "bone on bone".  He explained that my body was trying to fuse these two bones together and that fusion was getting broken every time I rested for a period of time and then went back to flexing the joint.  The surgery he suggested was to fuse the two bones together using a plate and screws (called athrodesis), the result being no more pain, but also no movement of that joint ever again.

I had done quite a bit of research myself on the subject and was anxious to explore alternatives to fusion, indeed what I really wanted was increased mobility and not a decrease.  I looked into other options such as a mechanical joint implant, and another (which seemed more feasible) which involved implanting a piece of pva the size of a wine gum that would effectively replace the lost cartilage.

With my internet knowledge (!) I quizzed the surgeon about alternatives, but unfortunately he told me that I was in the latest stage of the condition with severe joint deterioration, and other methods may work for a short time, but the long term prognosis was athrodesis or fusion of the joints.

He explained that recovery was not fast, 6-8 weeks minimum, with most of that time non-weight bearing which means crutches.

Now even for someone who is employed, this might be a problem.  That fact that I am self-employed as a gardener was an even more scary proposition, no work equals no income for me.

Decision time then.  It's the right time of year, he said he could do the operation in November which is when our garden maintenance basically slows down substantially until February or March.  Do I bite the bullet and do it now and hope for a pain free 2015 gardening season?

I should say that I also started a course in Garden Design at the beginning of the year, which I have only got halfway through because the season has been so busy...I could finish that whilst out of action, rest up during the bad weather and have the lad that works for me tick over the business until I recover.

Next year I might need to have the other foot done too!

After a whole lot of soul searching I decided to take the plunge and asked the surgeon to put me on the list for November, that way we could do all of the leaf clearance and autumn clear ups and my assistant would have minimal work to do on his own, until I had recovered, hopefully early January.