Am I Facing a Permanent Disability?
Four years ago, I had an unfortunate incident where I stumbled on a step, resulting in hyperextending my right big toe. Initially, I didn’t experience any pain; it only surfaced three months later. After consulting with a physician, it was determined that no treatment was necessary at that time. For the past four years, I have dealt with mild discomfort during daily activities, limiting my ability to fully bend my foot — activities like lunges and push-ups have become impossible. Earlier this year, in February, I sought a second opinion from a new doctor who diagnosed me with a first metatarsal osteochondral defect, indicating that there was no cartilage left and a bone cyst present. Following this diagnosis, I underwent surgery where they drilled into the affected area and filled the cyst. Although my initial recovery was successful, I have since started to experience worsening symptoms. Now, bending the toe or placing any weight on the joint causes pain, and it frequently changes color to a purplish hue while remaining swollen. Unfortunately, physical therapy hasn’t provided relief. During a follow-up appointment, my doctor suggested trying shoe inserts as a potential solution. However, my problems persist. I’m left wondering if this condition is leading to permanent arthritis or if the damage is irreversible. As a 27-year-old female who has never smoked and has no previous medical issues or injuries, I am concerned about my ability to return to a normal lifestyle. Could this situation be considered irreversible?
Answers (1)
8/29/2025, 8:53:32 AM
OpenHealth AI
I'm sorry to hear about the ongoing issues you're experiencing with your toe. Based on your description, it sounds like you have been through a challenging situation, and it’s understandable to feel concerned about the long-term implications.
Main Points:
- Ongoing Symptoms Post-Surgery: You are experiencing pain, swelling, and discoloration after surgery for a metatarsal osteochondral defect.
- Concerns About Irreversibility and Arthritis: You’re worried about the potential for permanent arthritis or irreversible damage.
Explanation:
Your symptoms—pain, swelling, and color changes—suggest that there may still be underlying issues with your toe joint. The surgery you underwent aimed to address the osteochondral defect and the cyst, but it’s possible that additional complications such as inflammation or inadequate healing may be contributing to your current discomfort. The fact that you are still experiencing significant limitations suggests that further evaluation is needed.
While some damage can lead to arthritis over time, it's not possible to definitively state that your condition will become irreversible without further assessment. Early intervention can often help manage symptoms and potentially improve function.
Next Steps:
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Revisit Your Doctor: Given the worsening of your symptoms, it’s crucial to follow up with your orthopedic or podiatric physician to discuss the ongoing pain and assess if further imaging (like an MRI) is needed to evaluate the healing process and any new developments.
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Consider a Specialist’s Input: A referral to a rheumatologist might be beneficial to evaluate the possibility of inflammation or arthritis. They can recommend specific treatments to help manage pain and assess the joint structure.
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Control Symptoms: Consider using ice therapy and elevation when experiencing swelling or pain. Over-the-counter anti-inflammatory medications like ibuprofen may also help reduce discomfort (always follow the recommended dosages and consult with a healthcare provider before starting any new medication).
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Discuss Further Treatment Options: If shoe inserts haven't provided relief, ask about other supportive options, such as custom orthotics or alternative therapies such as corticosteroid injections, which may help alleviate inflammation.
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Focus on Adaptive Exercises: While traditional physical therapy hasn’t worked for you, consider working with a therapist who specializes in adaptive methods or an occupational therapist who can help develop a tailored exercise plan that accommodates your limitations while promoting mobility.
It’s vital to remain proactive about your health. Gather information, express your concerns during medical consultations, and advocate for the care you need. Your return to a normal lifestyle depends on the steps taken moving forward and how well you manage any arising issues. Stay optimistic and engaged in your healing process.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.