Surgery for arthritic toes can leave patients with a lifelong limp. Film director Kenny Rye, 39, from Worthing, West Sussex, underwent a pioneering technique using technology borrowed from contact lenses, which avoids these problems.
He tells DAVID HURST about the experience, and his surgeon explains the procedure...
THE PATIENT
Sport has always been a big part of my life, especially cycling and jogging, and I was a competitive body builder when I was younger. But at the age of 20, I skidded on my motorbike on a wet road, and feared my sporting days were over.
The bike was a write-off and I was in agony. For a minute I thought I was paralysed. Then slowly I started to move. By now, cars had stopped and someone must have called an ambulance. There was no visible damage, but I had a severe pain in my foot.
I was taken to the local hospital, where doctors said I'd broken a couple of joints in my foot, including my big toe - hence the terrible pain.
They wanted to put my foot in a plaster cast for a month, but in those days bodybuilding meant the world to me and I had an important to me and I had an important competition in six weeks. So I told them not to, but to bandage it instead.
The doctors reluctantly agreed, but warned I might have problems later on, such as an ache in my foot from time to time.
For 16 years it didn't give me any more cause for concern. However, three years ago I noticed the joint in my big toe looked swollen and became really painful if I walked for more than five minutes - like a sledgehammer had been bashed over my foot.
My GP thought it was a bunion, but advised against surgery because the procedure can be extremely painful and I would not be able to walk for six weeks afterwards.
Earlier this year, a friend of mine asked why I was limping so badly. When I told her, she said she'd heard of a doctor called Dieter Nollau in her home country of Germany who was doing operations on people with painful toes.
I got in touch with Dr Nollau this summer and he agreed to come to Worthing. When I saw him for the initial consultation, he took my toes in his hands, bent them a few times and said I had osteoarthritis.
I was shocked - I associated osteoarthritis with older people, but he explained it can happen to younger people too, especially if they've suffered trauma to the affected joint.
He said that within a year the joint would fuse together and I wouldn't be able to walk at all. When I told him about my motorbike accident, he was certain that was why my big toe joint was defective.
This meant that my cartilage, the protective tissue which should have ensured smooth movement, was being pushed out by the bone, causing friction and pain.
He told me that with conventional surgery I'd have the toe joint fused together using wires and metal plates. This would stop the pain, but would leave the toe rigid - and with the possibility of painful symptoms recurring.
However, he said he had a new procedure - I would be the first person in the UK to have it - which was not only less painful, but longer-lasting and would bring back total mobility to the toe.
I had the operation in August - when I woke up I was told I'd be able to walk home from the hospital in an hour, without limping. Sure enough I did. I did feel nauseous from the anaesthetic and a tenderness on my toe joint but within a week I was jogging on the treadmill at my gym.
Now I'm in training for a triathlon. I can run and walk, because the surgery has taken the pain away, and I have got my quality of life back.
THE SURGEON
Dr Dieter Nollau is a consultant orthopaedic surgeon at BMI Goring Hall Hospital, Worthing, and medical director of the European Foot Institute.
As soon as I examined Kenny it was clear that he had osteoarthritis in his toe. An X-ray showed a small piece of cartilage had been pushed out by the friction between his joints. Something needed to be done because his pain was only going to get worse.
Osteoarthritis is usually something we associate with age, but it is becoming a greater problem in younger people as a result of activities such as jogging and squash. This puts pressure on the toe joints and wears away at the cartilage.
The cartilage gradually loses its elasticity, becomes brittle, splinters and is destroyed, resulting in complete loss of motion. The small joints of the foot are often the first to be affected. The same effect is caused by accidental damage to the toe.
Up to 20 per cent of adults in the UK have osteoarthritis in their big toe joints. It can happen at any age, but is most common from the age of 40.
Conventional surgery involves fusing bones using plates and wires to hold the joint together. It doesn't work well and takes months of painful healing. It also leaves people with a lifelong limp due to their stiff toe.
Often, due to this incorrect walking, it will lead to ankle, knee and finally hip problems.
A few years ago I heard about a gel-like material called SaluCartilage, developed in America. It's made from a similar substance to that used to make soft contact lenses. Even under pressure and friction it does not wear at all.
In December 2002, I used it to operate on my best friend, who suffered from osteoarthritis in his foot, at the German Podiatry Institute in Munich.
I'm pleased to say he's walking well, and is still my best friend! Since then, I've performed 117 operations in Germany, all with excellent results. Now I'm training surgeons all over the world.
During Kenny's operation I made a 4cm incision on the top of his big toe joint, so I could see the defective cartilage causing the pain.
Next, I cut this cartilage debris with a plier-type instrument; using a drill, I created a hole in the toe bone. This is similar to when you drill a hole in a tooth before a filling - it ensures all the 'bad' pieces you are replacing are removed.
I then inserted a 1cm-diameter cylinder of SaluCartilage directly into the hole where his cartilage should have been. It plugs in securely and we make certain by pushing it down with a small hammer.
Five stitches sealed the incision and after a small dressing was put on it, Kenny was taken to a ward until the anaesthetic wore off. The operation took 25 minutes. Two hours later he was walking home.
Two days after the operation Kenny was given physio, mostly traction - pulling and stretching - to improve flexibility. His stitches were removed ten days after that and he was already able to go to the gym by then.
The speed of the surgery, the pain-free healing period and the fact that the patient can put weight on the joint immediately as well as recover mobility are all great positives for this operation.
The procedure costs £2,000 privately and should be available on the NHS next year.
• European Foot Institute, 01903 261 593; footinstitute@aol.com
Source: http://www.dailymail.co.uk/pages/live/articles/health/myoperation.html?in_article_id=506577&in_page_id=1989
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