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quantum7
Trad climber
Squamish
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Topic Author's Original Post - Apr 26, 2018 - 01:02pm PT
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Have any climbers out there had this surgery done? I recently lost my thumb and partially two fingers on my dominant hand in a climbing accident. The surgeon has suggested a transfer of the big toe to the thumb area as it is the option that results in the best mobility/function of the hand afterwards. Looking to talk to anyone who has had this done to see how it impacted their lives (both climbing and non-climbing related parts of life).
Thanks
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C4/1971
Trad climber
Depends on the day...
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Apr 26, 2018 - 03:23pm PT
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A physician named Ralph Bunke from Stanford pioneered that surgery in the 1970's. It was a miracle for a lot of folks that had lost thumbs for some reason or another.
You never miss your thumb until you don't have it.
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Crazy Bat
Sport climber
Birmingham, AL & Seweanee, TN
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Apr 26, 2018 - 07:14pm PT
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I met a guy who had had it done. They took his middle toe. He was greatful to have a thumb and had full mobility for normal activities. I think he had a little numbness around the base of the digit. I only noticed because it was a little undersized. Loosing a big toe to have a beefy thumb might not be worth it.
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quantum7
Trad climber
Squamish
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Topic Author's Reply - Apr 26, 2018 - 07:53pm PT
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I fell while leading. I was trying to clip a draw and was having trouble reaching. Because I was trying to clip there was a lot of slack out, and when I fell I think my brain thought I was going to hit the ground and so I instinctively reached out and grabbed the rope. I don't believe it was a conscious decision because I know full well not to grab the rope or draws. My thumb was instantly severed by the rope
And my middle and ring fingers were damaged beyond repair . They were amputated below the upper knuckle. And there you have it.
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skywalker1
Trad climber
co
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Apr 26, 2018 - 10:07pm PT
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God damn quantum7!!!! I will quickly point out I have zero experience in this. Maybe trying to get a hold of Hugh Herr and/or his associates? I believe he does a lot of work in amputees/ prosthetics and maybe can lend you advice. The big toe was not intuitive to me but second...still never heard of this. Yikes!
Good Luck!
S....
Edit: Just googled his name and he's all over the front page.
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neebee
Social climber
calif/texas
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Apr 26, 2018 - 10:08pm PT
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hey there say, ... mousefromnerced, might chip in and share about
getting onward, without a thumb...
hope you get some good advice here... :)
:( sorry you had the loss, :(
prayers for you to find a 'good trail' with all this 'search for info' ...
:)
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DAN DUANE
climber
SAN FRANCISCO, CA
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Apr 27, 2018 - 06:21am PT
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I once sat next to a fit-looking man at a dinner table who'd had this done. His hand caught my eye, but I just thought, Wow, that guy has an incredibly powerful-looking hand, and a prominent scar along the base of his thumb. As a climber, I think, you get an eye for unusually strong hands and it makes you curious: climber? carpenter? After we'd been talking for a while, I asked if he worked with hands or what. He asked what I meant. I said, "Oh, I don't know. Your hands look like they've done some work, that's all." He pointed to his foot. He was wearing Teva sandals and even then I had to look for a moment to figure out what I was supposed to see. His other four toes had rearranged themselves and grown stronger in a way that made the absence of the big toe unnoticeable until I really looked.
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Oplopanax
Mountain climber
The Deep Woods
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Apr 27, 2018 - 09:59am PT
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One of the MScs in my geology department had this done. His new "thumb" looked a little weird but it was the kind of thing you didn't really notice until he told you about it. He could swing a rock hammer and hold a coffee cup in that hand, he didn't climb though so I have no idea if it will get you up a 5.14 or not.
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wayne w
Trad climber
the nw
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Apr 27, 2018 - 03:20pm PT
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The Toe Off, made for those who have lost a toe, is is a very effective orthotic that could make your transition much easier. It may even be something that you continue to use as you find healing moving forward. You can purchase one at Allardusa.com
Wishing you the best of luck as you find healing and make your way back to climbing. I contracted Paralytic Polio when I was 9 months old, and have faced many big challenges additionally, but am planning my 40th big wall ascent soon.
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thebravecowboy
climber
The Good Places
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Apr 27, 2018 - 11:48pm PT
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the wonders of modern science. werner say all he do about the science-dog-g0d but, yes, I'd trade a(ny) toe for a thumb.
thanks for sharing your story Q7. that hurts
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quantum7
Trad climber
Squamish
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Topic Author's Reply - Apr 28, 2018 - 10:46am PT
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Thanks everyone. This is a huge challenge for me. Climbing and also my job are both out of the question right now. As far as the transfer goes, most often the big toe is used because it is most like the thumb and also will give the best mobility and function. Strangely enough, it sort of morphs into what looks like a thumb over the course of several years, where the other toes remain looking like toes. Re: balance, I was told by the surgeons that the metatarsals are key for balance and those would remain intact.
I am of course exploring other options because I don't really want to trade one body part for another. The choices are limited though - a cosmetic prosthetic has almost no value in terms of function. There are some mechanical type thumbs that could help. The thumb is responsible for 50% of a hand's function and I am realizing that truth very quickly. There are so many basic things I cannot do now. Doesn't help being right hand dominant.
I did contact Hugh Herr a week or so ago, but havent heard back. Maybe in a few years I'll just 3D print a damn thumb.
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Off White
climber
Tenino, WA
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Apr 28, 2018 - 11:33am PT
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Wow, what a thing, thanks for telling us about it. Please bump this thread now and then as you progress in figuring this out, it's super interesting. I hope for nothing but the best outcome for you whatever route you go.
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neebee
Social climber
calif/texas
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Apr 28, 2018 - 03:11pm PT
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hey there say, quantum7...
wow, as to this quote:
The thumb is responsible for 50% of a hand's function and I am realizing that truth very quickly.
one of my older friends, wrenched her neck so back, that she lost use of
a large part of her hand... by the time she got it fixed, it is still not
too good... and-- she can't use her thumb at all, :O
i am going to share this with her, as 'general interest stuff to know' ...
and yep, she is seeing that, right now... :(
*good to know the rest of her hand is getting a bit better... i just wish she would do therapy, :(
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justthemaid
climber
Jim Henson's Basement
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Apr 28, 2018 - 04:20pm PT
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Wow- sorry you had such a terrible accident.
Personally- I'd do it. I don't know how long the recovery is, but I need my hands to make a living on top of climbing- so the decision to swap body parts to keep something resembling normal functionality would be a no-brainer. I've climbed with frost bite victims who lost big toes and could still climb, so it's a skill that can be learned.
...that or I'd go full metal bird claw.
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strawberry rhubarb
Trad climber
Squamish, BC
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Apr 30, 2018 - 09:47pm PT
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Hi Quantum7. So much respect to you for telling your story on this forum and for getting busy with finding solutions to this huge challenge. I wanted to offer a connection for you. In November I did a Physio student placement at the Glenrose Rehab Hospital (Edmonton) and I worked with a woman who has been running pediatric limb difference clinics for many years. She has seen all the different prosthetic and surgical options out there for limb loss and limb differences. She and also works with a team of orthopedic surgeons, physiatrists, OT's, and other PT's and follows the patients every year until they no longer need care. Im sure she would be willing to chat with you about the different options and what she's seen for outcomes. Does this interest you?
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quantum7
Trad climber
Squamish
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Topic Author's Reply - Jul 6, 2018 - 07:01pm PT
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Thought I would bump this post as I am struggling with my decision to amputate my toe.
Wondering if there is anyone who has had a big toe amputation and if so, how did it affect your gait, balance, and of course your climbing.
Any help is appreciated. I hate not having a thumb but I still don't know if I can take my toe off to replace it.
Thanks
Adrienne
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Sierra Ledge Rat
Mountain climber
Old and Broken Down in Appalachia
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I have a friend who had toe to thumb surgery.
Back in the 1970s we were on the West Rib of Denali, he had a bad fall and we couldn't rescue him for a long time. (Two others died.) He lost all of his fingers and toes to frostbite except one index finger and one great toe.
I think for him, the decision to have the surgery was easy.
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micronut
Trad climber
Fresno/Clovis, ca
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Hey Adrienne,
No lie, one of my good friends had this exact surgery done and has lived a very normal and athletic life. His was a wake-boarding accident with the ski rope momentarilty going slack, looping around his thumb, then tightening instantly.....snipping his thumb off at the base.
He adapted quickly after the surgery....now nearly twenty years ago. He has no balance issues (the big toe doesnt do all that much in walking actually) walks barefoot all the time and still plays sports, including waterpolo. He jokes about his "thumb" all the time when asked and it actually is surprisingly un-noticeable. He has a crushing handshake and a great testimony about the whole thing.
I'd put you in touch with him if you're interested. I'd say go for it without a hesitation man, but you should talk to him!
Scott
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Gnome Ofthe Diabase
climber
Out Of Bed
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micronut..... We never interact? Greased,by,monkey,I,Be? oh,well, to bad,for,me, but you ARE A HERO!
(the system here hasn't worked for evah(ekat) So hows a person to reach out to you?)
I love you guyz & the few Galz who we do keep:=)
as we grow apart it is a good thing when the experts here weigh in
Thank You All!
The same thread/OP @ MntProj, where contact / communication can be made,
http://www.mountainproject.com/forum/topic/114562022/big-toe-amputation
YEEHA!a RARE POST FROM, altelis
AND YET ANOTHER HERO EMERGES
V V V V V
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altelis
Mountain climber
NM
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Quantum7, I just finished up my Ortho residency at the University of New Mexico. One of our attending surgeons there did a few of those pollicization reconstructions.
We have a lot of cowboy roping accidents (in fact, one of our other attendings has published many papers on thumb amputations from roping accidents).
I've taken care of many patients with thumb and/or hand amputations, and discussed with them getting back to manual labor type jobs (roping, ranching, and carpentry for the most part) with both myoelectric prosthetics as well as with pollicization reconstruction.
The few carpenters who've had isolated thumb or thumb/index amputations and had pollicization really like the end result. Depending on the level of amputation it can be a very functional thumb.
The young cowboy's we've had who've needed myoelectric prostheses (typically for more hand based, rather than finger based, amputations) have been overall happy with their prostheses and ability to get back to a lot/most of their jobs. But pretty sure all would trade them in for a more functional and durable thumb.
Its not a surgery that's done frequently, so if it is a possibility for you I would strongly recommend finding a hand surgeon at a center that has a lot of experience with these injuries.
If I can be a resource at all for you, I'd love to help however I can.
a l te l is at gmail dot com
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altelis
Mountain climber
NM
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Haha Gnome- this is where I come when the long days and weeks prevent me from getting into the mountains as much as I'd like.
Plus, while I can go on forever when I feel like I have some level of experience to add to the conversation, in this community my climbing experience (while certainly not negligible) is dwarfed by you all. I read and enjoy and try to learn. But when on occasion something orthopedic comes up, I like being able to pretend like I have something to offer ;)
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altelis
Mountain climber
NM
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The big toe actually has a very important role in walking.
That being said, your thumb, especially if you rely on your hands for work or pleasure or both, plays a much more important role.
There are relatively easy additions to shoes (e.g. carbon fiber shank with morton's extension) that can help make up for the loss of a big toe. There are not very good easy additions to make up for a lost thumb.
Certainly you won't need an actual prosthesis, and depending on the stiffness of your shoe, may not even need anything in your shoes.
My hunch is the biggest thing that will be noticed with a great toe amputation for climbing is the lack of sensitivity/feeling. Most of us use our big toe as the point of maximum feedback and purchase while climbing.
I'm sure you'd be able to find an orthotist who likes to climb that would work with you to make a custom orthotic for a climbing shoe. I'd guess moving toward a slightly stiffer climbing shoe with a more symmetric toe box (e.g. less reliant on all your weight being on your great toe) would be what you'd want.
But overall those are going to be minor and easy things to overcome compared to the possibly massive advantages of having a functional thumb again.
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nafod
Boulder climber
State college
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Years ago there was an F14 pilot, call sign Hoser, who lost his thumb. Had the surgery and was able to return to flight status (with new callsign = Toser). Pretty stringent requirements on reach and mobility required to satisfy the docs, as you can imagine.
Best of luck...
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quantum7
Trad climber
Squamish
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Topic Author's Reply - Jul 7, 2018 - 07:56am PT
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Thanks again for the responses. Scott and Strawberry Rhubarb, sent you both PMs. Altelis, I have some Qs for you as well, but need to gather my thoughts. I tried climbing a week ago (on TR) with my hand in a glove. It's not easy, but I tried. Big problems are: can't clean gear (let alone place it) with my right hand; belaying is not smooth (trying to learn to use the gri gri with my left hand as I am not comfortable with the ATC); fingers are still way too sensitive to place in crack or crimp.
But, in three and a half months I have definitely seen improvement in every day life tasks, which is why I am questioning the toe transfer. I have surgery booked in the fall, so still time to change my mind. My job definitely requires a working hand as does climbing, but so much fear that my foot will be compromised or that the transfer will fail (small possibility) and I could be thumbless and toeless.
Thought I would include a picture so you have a sense of what I am talking about.
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altelis
Mountain climber
NM
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Keep using it! A lot of that sensitivity will go away with use. And I totally agree, figuring out the bounds of what you can do as is will really help you decide if pollicization is worth the sacrifice to your feet.
I can't tell from the picture, were they able to salvage the base of the 1st metacarpal? As in, do you still have a thumb basal joint (the 1st CMC joint)? If so, and there may be other options to give you a slightly longer stump without sacrificing a toe. The longer stump wouldn't have the ability to flex at the IP joint, but if the thumb basal joint is still working then you may be able to retain opposition and abduction which could give you a good in between option.
Happy to answer any questions whenever you are able to get your thoughts together.
And biggest thing I would suggest is make sure you are seeing an experienced hand surgeon who has experience doing post-traumatic hand reconstructions. If that's not your current surgeon, ask for a referral for a second opinion. Any good surgeon should be happy to help find you a second opinion.
We do a lot of hand surgery and reconstruction during my residency, but we have hand fellows and they get most of the actual (excuse the pun) hands on surgical time during those cases, and not the residents. I'm going to be in LA starting next month doing a trauma fellowship, so while this isn't going to be my speciality, I definitely understand the concepts fairly well and can either ask my mentors from residency and/or refer you to any resources available if I don't know the answer myself.
~Alex
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nafod
Boulder climber
State college
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Ok, found the link. On Hoser. You can see the right hand has 3 fingers and a big toe. Plenty of tactile action required to fly.
https://m.youtube.com/watch?v=6aILfg1KRcg
[Click to View YouTube Video]
https://www.facebook.com/120434031325043/posts/%22in-the-smoke-'till-i/3798057326364/
Around 1986 Hoser "procured" a 20MM barrel from the F-14 Gatling gun. He attached a breach and fashioned himself a rather formidable weapon. One day the breach blew up, took off his index finger and right thumb. That would not stop Hoser, he had them take off his right big toe and attach it to his right hand....now he had three fingers and a big toe...looked a bit like a lobster. He proved he could operate the trim button on the stick and back on flight status he went...oh and with a new call sign, "Toeser"....you just can't make this stuff up.
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spectreman
Trad climber
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I'm an outpatient physical therapist of 30 years. I've seen several patients with amputated big toes. They all compensated very well and were able to walk normally. It took some time and some work but they all did very well.
Good luck to you!
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the Fet
climber
Tu-Tok-A-Nu-La
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Maybe you could put some athletic tape under the toe over the top, over the top of the foot and back around the ankle to pull the toe up hyperextended to get a feel of what it would be like without it.
If I were in your situation I’d likely do it. Except my big toe is monstrous so it would be really freaky. I have a friend where they used a pinky to replace a thumb. It works well for writing etc but I’d prefer the strength of the big toe for climbing etc.
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quantum7
Trad climber
Squamish
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Topic Author's Reply - Jul 8, 2018 - 06:51am PT
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@Alex - |I have my MCP joint intact, thankfully.
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micronut
Trad climber
Fresno/Clovis, ca
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I'll definitely defer to the orthopods here, but my quote about the big toe not being all that necessary for walking comes from three personal friends who dont have one. I know that's not much of a sample size, but each of them seems to have little to no issue.
So I should have said....."None of the three friends of mine without a big toe said it cauuses much trouble walking without it."
The whole point was to offer some encouragement from personal direct experience.
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altelis
Mountain climber
NM
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Micronut- sorry if that came out too much as a disagreement with your friends' experiences.
Absolutely, I would agree that most people will eventually get along just fine without a big toe.
But it does serve some sort of purpose, and there are definitely activities that are easier with one.
And while the pollicization is generally very successful, its not 100%, and the new thumb does have limitations.
Quantum is clearly torn, and I just didn't want to (overly) minimize the loss of a fully functioning body part nor (overly) sell on the benefits of the surgery.
I think he's in the right place- trying to really get a good sense for what his current hand can do, and really understand the pros/cons of the surgery.
The honest answer- I'd defer most to folks personal experience with the surgery, loss of a big toe, and the therapists on the board who have experience treating patients who've either had this surgery or are without a big toe.
~Alex
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High Fructose Corn Spirit
Gym climber
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I've been following this thread.
As an outside third party, I just want to thank Altelis for posting up and sharing his expertise. Thanks to the two or three others too who did so as well - and thank you too, Micronut. I always find your posts in these medical and health matters accurate/informative.
Good luck, quantum7. See you in the mountains and crags!
https://en.wikipedia.org/wiki/Pollicization
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micronut
Trad climber
Fresno/Clovis, ca
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Alex no problem at all! I appreciate your wisdom and would trust you over most of us who have no experience with these kind of things. Glad you are on here for your insight and experience. I hope he gets some good intel from credible sources.
As a surgeon myself (gums and jaw and sinus though......I know nothin' bout toes!), I agree that trading a totally viable limb for a surgery that is not guaranteed is a decision only he can make. Hopefully he is able to surround himself with a good medical team that can help with this decision.
Good luck and keep us in the loop Quantum!
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micronut
Trad climber
Fresno/Clovis, ca
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I have reached out to my buddy Curtis and he is going to send me some photos of his foot and his hand. I will also have him chime in with his direct experience.
Scott
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Gimp
Trad climber
Missoula, MT & "Pourland", OR
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Given the deficits shown toe transfer would be preferable to pollicization IMO. I have done both operations multiple times over my career and while all patients are fearful of the morbidity of toe loss I (despite believing you should rarely if ever say always and never in medicine) all my patients ultimately were happy about their decision for toe transfer.
I stopped doing toes 5 years ago as I began to move out of trauma and into a more age appropriate elective hand practice so would not claim to be totally up to date on the all the various modifications of great toe transfer currently available. But a trimmed toe looks like the most likely choice for you given the level of your amputation. Busy centers usually have patients who have had the procedure who are willing to discuss their experience you may want to ask about this.
I concur with prior comments regarding going to a volume microsurgery center for this procedure. The Bunke clinic in San Francisco is now run by the late Harry Bunke's son Greg and the clinic is very focused on microsurgery and has excellent outcomes. In Canada Toronto used to be the center for all things microsurgical but suspect there are many well trained people at many sites throughout the country now.
Good luck with your decision making. Get more than one opinion and realize you have time to make this decision.
Steve
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Gunkie
Trad climber
Valles Marineris
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quantum7, sorry for your accident. I hope things work out for you. With that said, I am continually amazed at the depth of knowledge, experience and competency displayed on ST.
Carry on.
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Gnome Ofthe Diabase
climber
Out Of Bed
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Hmmm I spoke to mouse, he is readin; Kraus, my mentor & so much more.
Hans had the 1st family,to attend to, for JFK's back, complicated by Addison's, so recuperation was in doubt.
Thats the un-known, how do you think you will heal? and is running close to your heart, the controller of .... all that running is, (to many)
long distance or any running becomes , for some, a near daily need
As in, is to be able to run, a must?
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altelis
Mountain climber
NM
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Steve, thanks for the input.
Looking back at my posts, I had meant to initially talk a second about pollicization and then continue recommending toe transfer. But realized I kept using pollicization in my discussion.
I'm a little dazed from studying for Boards this Thursday.
I fully agree, given his amputation (both thumb and other digits) and desired functionality if he goes forward with surgical reconstruction, toe-transfer is the way to go.
Sorry to any who I confused with continued use of the term pollicization.
Steve, are you still working in Missoula?
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High Fructose Corn Spirit
Gym climber
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“Appearance itself is part of function...”
Beautiful!
https://www.theatlantic.com/health/archive/2014/10/the-surgeons-who-make-toes-into-thumbs/381362/
On looking up pollicization, I did wonder why not use the second toe instead of the big toe? as it's also similar in size and perhaps not so critical as the big toe? But experience, I guess, shows otherwise?
"sometimes surgeons transfer the second toe, typically they opt to use the great toe"
"the procedure has come a long way since that first 1966 monkey job."
...
or you might wait a few years to let the art and science catch up? or research the current state of the art and proactively, clinically participate? in the spirit if Hugh Herr.
Spiess thinks that regular use of cadaveric parts is not so far off. “The field has evolved immensely in the last 10 years,” he said, “and I can see maybe within the next 10 years it becoming a routine art.”
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micronut
Trad climber
Fresno/Clovis, ca
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Adrienne,
My buddy Curtis finally got back to me with some photos. One of my earliest memories right after he had the surgery was that he told me the hardest part was that he had rear-ended at least one person while learning to drive again. He would often drive barefoot in his jeep and he found that without his big toe he would just barely miss the brake pedal when pulling up behind a line of cars. Thump! I think he had to buy a bumper or two over the years.
He is on a road trip up north right now but said you could call him any time. The Supertopo email function is a mess. Email me at
Tripolehq@yahoodotcom if you want me to get you his intel. Great guy with a wild story who still plays hard.
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quantum7
Trad climber
Squamish
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Topic Author's Reply - Jul 9, 2018 - 11:14am PT
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Great responses from all of you - thank you! By the way,
the he is a she : ) Although, some days I wish I was a dude because maybe the thought of having a giant, weird looking thumb wouldn't be so bad.
@Gimp (Steve) I've read the chapter in Harry Buncke's Microsurgery "bible" on great toe transfer several times now and it's pretty wild. I wish I could afford to go straight to his clinic, but it is not possible. My surgeon has done over 100 of these transfers throughout his career and comes highly recommended, so I have to trust in that.
@High Fructose - read the Atlantic article recently, and that picture you posted is one I have seen before and only can hope mine would come out like that. For some reason my surgeon doesn't seem really keen on shaping the toe after the surgery. I'm not sure why, as plastic surgeons strive for good aesthetics in most surgeries. I wonder if it is because his patients are almost always men, and perhaps they aren't as concerned with appearance of the thumb? I do not have the nicest toes (years of climbing) so it would be nice not to have this bulbous thumb as the end result! But, I know function is more important than form in this case.
@Micronut - will email you
@Gnome - not a runner, but a hiker so I don't want to lose that
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donini
Trad climber
Ouray, Colorado
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I want to say that you seem to be an extremely clear thinking person and I commend you on the way you are approaching this issue...my very best wishes for a great outcome!
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micronut
Trad climber
Fresno/Clovis, ca
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By the way Adrienne, I thought you were a dude too!! Not sure why, probably just the fact that Supertopo is so full of old mangy alpha males. So funny, Adrienne is a far prettier name for a gal than a bro any way!
Glad to be part of your journey and I look forward to watching it unfold.
Stay brave,
Scott
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the Fet
climber
Tu-Tok-A-Nu-La
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some days I wish I was a dude because maybe the thought of having a giant, weird looking thumb wouldn't be so bad.
But then you might have a toe like this.
Megan Fox has brachydactyly, clubbed thumbs, I don’t think any red blooded guy cares.
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