Toe v. Thumb

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quantum7

Trad climber
Squamish
Topic Author's Original Post - Jul 27, 2018 - 09:34pm PT
Hello all,

Some of you have read my previous posts and have been very helpful. 4 months ago I lost my right thumb (dominant hand) as well as part of my middle and ring fingers in a climbing accident. I am losing the plot though trying to make a decision about whether or not to amputate my right big toe to make a thumb. My surgery is in a few months and I am almost sick trying to make the right choice.

I'm appealing to you, my peers, for opinions. I really need honest thoughts from people who understand how meaningful climbing can be in one's life.

So...if you were in this situation, would you trade your toe to create a thumb? And why or why not?

If you post a response, I will thank you now. I wouldn't post this type of thing normally, but this has really got me gripped.

Adrienne

Edit: Thus far, the prosthetics I have seen are mostly cosmetic. After much research, there are very limited options for functional thumbs. I tried one on the other day that is meant to be functional, but the stump of my thumb is not long enough to secure the device properly. I've attached a photo.

Also - climbing is a factor in this decision but not 100% the driver behind it (I also hike, scramble, do yoga, ski a bit) Life tasks in general, including my current job, are equally important in the decision.


rottingjohnny

Sport climber
Sands Motel , Las Vegas
Jul 27, 2018 - 09:47pm PT
tough question...i smacked my thumb last winter with a slngle-jack...now i have trouble picking things up due to loss of feeling in the thumb... there is , life after climbing... i sympathize with what you're experiencing...can you climb without a big toe...?
Ksolem

Trad climber
Monrovia, California
Jul 27, 2018 - 11:32pm PT
I've always though that for me, if it came down to it, I'd take the upper body injury over the lower. There's a lot you can do in mountain sports with two legs and feet that work right.

But I'm curious, are there prosthetics that can help you with any of this? For example, say you give the toe. Is there something they can attach there so your foot fills a boot and you can learn to walk normally?

It's just a terrible f'd up choice to have to make. My heart goes out to you.
skywalker1

Trad climber
co
Jul 28, 2018 - 01:41am PT
I think its hard to give straight advice, sheesh. I will respond with limited knowledge but some experience with bad injuries. I learned to get around the injury. Is it work? Yes. Will it ever be the same? No. Climbing is a fun thing but not necessarily a numbers thing or a speed thing although we have our goals. The surgery is not a now thing either (???) or shouldn't be directly tied to climbing IMO. Having climbed my brains out for 28 years I'm actually paragliding and not climbing 2 yrs now and may just climb socially. I'm 44.

I'm just thinking in terms of context. You had a horrific injury. This surgery is also going to be yet another hard injury without a certain outcome. If you are asking this with the mind set of your climbing, I think best to wait. If overall quality of life is the motivation I'd still wait and try to learn how to live in your new body.

You have been dealt a tough card no doubt but the ball will be in your court I presume for some time???

Good luck!!! Best wishes and chime in again.

S...



neebee

Social climber
calif/texas
Jul 28, 2018 - 05:10am PT
hey there, say, Adrienne ... mousefrommerced, has been climbing, without a thumb...

he could tell you more, but, he's not near on-line services, at the moment...
you could try 'paging Thocking' and see if he could get in touch with him...

perhaps he has some advice, to chip in here, too... ?


and-- what someone said, here, -- you might wish you had good solid
footing, someday, in your older age...

i've seen a LOT of older folks, in their 80's, wishing that they were more
stable on their feet... :(
nafod

Boulder climber
State college
Jul 28, 2018 - 05:29am PT
Maybe try a formal decision/risk analysis? It helps to center the thinking.

I’d start with a spreadsheet and make two sections each with two columns. Do the surgery section and the as-you-are with pluses and minuses listed. Then start listing things on one side and the other. Pluses and minuses. Hard facts.

For things you aren’t sure of, also stick on another column and estimate a probability; probable, likely, not likely, improbable.

For the minuses, many of which will be risks rather than things that are for sure, dig into them and see if they are true, and contemplate on how to mitigate those risks.

When you’ve got it all on the sheet in one place, then look at it.

I think I would elect to do the toe swap, as I am sure I would figure out how to compensate for the missing toe in all of my other stuff (hiking, skiing, kayaking, biking, climbing) and would be missing my opposable thumb, but I also know there are opinions, and there is living it, and I just have an opinion.

Best of luck!
couchmaster

climber
Jul 28, 2018 - 05:35am PT

Tommy Caldwell should answer this one. For me, I would not do it. Not just that it would be painful, but that failure could result in both a thumb an d a toe missing. Most likely you will not have feeling in the thumb as well. You can climb without a thumb, I once knew a guy who kicked ass at handball who had lost his index finger and thumb when he jumped up and grabbed a ski lift rope and got it caught under the roller. Not sure he could have played so well without a toe. Big toes in particular help with balance. I'd leave it be if it was me. Good luck on your choice!

Curious, how did the accident occur?

justthemaid

climber
Jim Henson's Basement
Jul 28, 2018 - 05:51am PT
There were 50 excellent replies in your last thread. http://www.supertopo.com/climbing/thread.php?topic_id=3082497&msg=3103405#msg3103405

If you are waffling this much maybe you should just cancel the surgury? The toe-bank isn't going anywhere .

Me- I need my dominant thumb to pay the bills - so my toe would have been forfeit the day the accident happened- but that's my situation. Your is different.
the Fet

climber
Tu-Tok-A-Nu-La
Jul 28, 2018 - 09:11am PT
I think you have been getting some excellent replies. Not just if someone would do it or not, but the rational behind their decision, that's what really helps because it will help inform your decision, and that's what it really is, your decision, it will come down to the pluses and minuses for you. I really like the analysis is excel idea above. (Edit: just re-read your post at the start and saw that's exactly what you asked for- smart)

As mentioned there's no rush. I wouldn't do it unless I was fairly confident the decision was the right one for me.

Personally I think I'd be 99% likely to do it. There's so many things I do that require two thumbs. While I think I'd get used to the missing toe and it wouldn't prevent me from doing anything. Climbing is just one small factor for me, there's many other things that are just as important or more important (eg skiing) and again overall I think two thumbs would be more important to me, and worth the risk of losing both. I would want to know what is the chance it would fail and what are the factors that can cause a failure. Personally I know my body heals very well (cuts, breaks, sprains) so I'd guess that would help me have a successful procedure, but I'd want to do more research on that. It's your dominant hand so that would be a big factor in favor for me.

I would probably also be agonizing over the decision though too. It's a huge decision and one not to be taken lightly. I think you are being smart, so try not to stress over it and appreciate that you are doing your due diligence. IMO Your subconscious probably knows you need to go through this difficult decision process so embrace it and try not to be sick about it.

I hope I didn't come across as flippant on the other thread. I think it's good to try to maintain some sense of humor about the whole thing. The appearance of your thumb is such a minor thing compared to function in my opinion. And I'd rather see my toe there than nothing. If anyone thinks it's ugly that's not someone you want to be around anyway. If I met a woman who did the procedure and I knew the story I'd think "that chick is rad". I think I'd look at mine and mainly think I'm happy I live in this day and age where we have the technology to do this procedure. And I have a huge big toe. Come to think of it my toe is so big I don't know if I'd even have the option because the diameter is much bigger. If they could do it I would because even though it would look so strange I'd dominate in thumb wars. :-)

Good luck and I'd like to hear what you ultimately decide.
sempervirens

climber
Jul 28, 2018 - 09:33am PT
I'd keep the big toe where it is. As said above, it might not function well as a thumb. As a toe it still serves an important purpose in climbing and so many other endeavors.

Do you have phantom pain in the missing thumb? Is it possible that you'd get phantom pain in the amputated big toe?

Is a thumb more important to climbing than a big toe? That's a tough question. But if yes, consider that climbing might become less important to you over time. I've had to replace climbing with other sports at various times in life due to life's circumstances. And I found martial arts classes, trail running, skiing to be as satisfying. Well, almost as satisfying, nothing can replace all what climbing offers, IMO. But still, considering all things, climbing might fade as time passes.

Sorry, you're in this position, count yer blessings and all that...
Thought provoking discussion.
Good luck.
MikeL

Social climber
Southern Arizona
Jul 28, 2018 - 09:38am PT
Wow, climbing must be *really* important to you.
sempervirens

climber
Jul 28, 2018 - 09:46am PT
Wow, climbing must be *really* important to you.

whatcha mean Mike?
tradmanclimbs

Ice climber
Pomfert VT
Jul 28, 2018 - 03:17pm PT
Foot work and foot comfort more important than hand strength..
quantum7

Trad climber
Squamish
Topic Author's Reply - Jul 28, 2018 - 09:49pm PT
Thanks everyone. I really do appreciate hearing your thoughts.

@Ksolem - there are options to fill the toe via orthotics and toe fillers. I spoke with a podiatrist last week who said orthotics would be key in preventing damage to my other toes as they try to compensate for the missing big toe

@skywalker1 - very valid points about waiting. the thought of another amputation after just having 3 is not pleasant. I am 45, so the numbers in climbing are less important each year. It's more the feeling it brings me being out there on the rock

@neebee- i have definitely thought about aging with a potentially problematic foot : (

@nafod - I love me a good spreadsheet and I definitely analyze the sh#t out of everything, so your suggestion would probably be a very good exercise for me. I always feel better when I have something concrete to refer to.

@couchmaster - I was lucky enough to have a very encouraging email from TC. His injury is different from mine as I have lost opposition and grasp. As far as what happened - the rope severed everything when I fell. If you check my recent posts I have written in more detail about what happened. It sucked.

@justthemaid - I am definitely considering cancelling or postponing the surgery. My dominant hand pays the bills too, so I may have to consider a career change

@theFet - not flippant at all. loved the toe pic (mine is big too) and had no idea about megan fox. I dont have a face like hers to make up for wacky hands, but you are right - if someone doesn't like how my thumb looks they can get stuffed

@sempervirens - I have less phantom pain now than a few months ago. I'm not sure what would happen as far as phantom pain goes in the big toe. I imagine there would be some. I've been replacing climbing this summer with hiking. I used to loathe hiking but now it has helped me stay sane and I've seen some incredible places that I've always wanted to see, but was too busy climbing : )

@MikeL - climbing is really important to me, but that is far from the only consideration


nah000

climber
now/here
Jul 28, 2018 - 10:14pm PT
damn. that’s a devil’s bargain if i ever heard one.

if it was my particular siteeation, climbing wouldn’t play a role in the decision. whether i had my thumb or not, i’m past my prime so whether or not i had my thumb would just result in a personal game being played with differing sets of personal limitations.

and so the question would come down to work and other day to day tasks... i’d probably only be interested in input from both those who had lost a big toe and those who had had this surgery before i made the decision.

but in the end the question would come down to if it didn’t work out and i lost my toe and the surgery was not successful, would i still wake up two years from now satisfied with the decision i had made?

while i’m not in your situation and haven’t talked to folks in the two situations above [and so accepting that what follows is useful only for the point of conversation], still, i can’t imagine choosing to take on the risks involved by taking on this surgery...

but as jtm said: that’s just my siteeation...



and so best of luck and heartfelt sympathies being sent your way: somebody must have stayed up late dreaming up this conundrum to have you be faced with...
the Fet

climber
Tu-Tok-A-Nu-La
Jul 29, 2018 - 08:22am PT
What is the small possibility that the transfer will fail? Eg 1 in 100, 1 in 1,000?

Are there any common factors contributing to failure? Eg amputation below the second joint?
Gnome Ofthe Diabase

climber
Out Of Bed
Aug 15, 2018 - 11:30am PT
mfm-bumpin' - this is the 2nd of 2 threads













A new thumb, how's that?
Even if a cadaver/donor body part where to be applied it could/would have to be fresh to avoid rejection?
The complexities of harvesting?
of the micro-surgery to preserve any chance of a working replacement seems like it would be a low 5/10?
then going forward what is a happy result vs the sum gains...
& if said organ donation were a thing to sign up for,
- how to fund that?
Russ Walling

Social climber
from Poofters Froth, Wyoming
Aug 15, 2018 - 01:07pm PT
Easy choice if it was me.... get the new thumb
Gnome Ofthe Diabase

climber
Out Of Bed
Aug 15, 2018 - 01:32pm PT
? well,. . I do still covet what is the most versatile pack on the
market,
& its a huge market,
but I don't agree with my harsh critic -

SAVE YOUR IN-TACT PARTS

What I'm saying is that on balance,

if you are 45 years old & female,
with a slight build,
with more need, going forward,
for ease & comfortable MOBILITY
(& not knowing if the outcome will be a good one.)

I had a severe crushing injury & (at, 32yrs old, 5'3'/ 130#s)
I did, & think you should/need to be seen by a pediatric specialist.

ask directly:
-& there are significant unknowable potential complications-
What is your realistic ability to heal?
(will you be given humane growth hormones?, Stem Cell therapies - cost$)

Which, from the multiple medical issues that might follow,
Are known to be hard to come back from. What are the types of procedures & if those surgeries and rehab have a history of Failure/success.

What percent of return to full physical activity, and how long before, (if ever) can you get back to high levels of activity?


(also, to be honest I would have to know if the family tree had longevity going for it, before I weighed in more deeply)

But 3 years of healing? and then more to master what is the new normal,
& a need to try to return to peak physical condition to compensate?

I would be worried that if the rigors of approaches aren't disqualifying, cold temperatures will be.

I have thought about this, I have been sure to ask the thumb-less one. He, I think, would concur.
That:
When the finger of fate chooses
to rend one from one's thumb & fingers, it's a terrible thing
Still, the need to walk, with full ability,
(too, climb, i'd want that toe)
out strips the loss of ability to grasp,
which given time, the mind will re-boot to change the lesser,
so while right-handed your left will rise in competence, the route of Compensate. . .
yosemite 5.9

climber
santa cruz
Aug 15, 2018 - 05:46pm PT
Absolutely do not give up your big toe. It is much more important than a thumb. You can adapt to losing a thumb. You can't adapt to losing a big toe. It is far too important for walking and for climbing. Break your big toe first if you want to find out important it is. I wish you the best.
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