Hi Mottom - I replied to your message but figured I’ll post it here as an update for anyone else searching this thread.
I’ve been able to run after surgery and have been really happy with the outcome. No pain and walking, running aren’t awkward at all. (Hokas are the best!) Post surgery, once my surgeon cleared me to try running again I got up to doing 5km runs and didn’t have any problem with the toe. For other reasons, though, I stopped running at that point and have shifted my focus onto other activities. However I’ve done 15km weighted walks, again with no issues with the toe.
As far as running another marathon/ironman, I’m not sure I’ll aim for that again. My surgeon has mixed feelings on it - he said originally that he doesn’t recommend running post-fusion but has also told me that he has colleagues with patients who have returned to running marathons. So it can definitely be done. I think the hesitation stems from the caution he gave me that if I start getting the 2nd MTP joint upset then that’s a much more complicated issue to fix. The 1st MTP joint is fused at a slight angle and there is some flex in the 2nd MTP joint, so function isn’t too limited. I guess ultimately there’s probably not enough long term data to conclude how risk-free running is.
I hope that answers your questions. Whether or not you can run again afterwards I’d still encourage you to have the surgery, simply for the pain relief it offers. I hadn’t appreciated how much pain I had been tolerating for so long and I was really worried about the limitations I might have with a fused toe, and so was quite apprehensive about getting it done. But the surgery has completely eliminated all my pain and the loss of functionality has been minimal. I can’t wear high heels now, and there are some gym movements that I can’t really do on it, like lunges and planks, but that’s no real loss. I was never much of a high heels wearer and there are plenty of alternative gym movements to compensate. The fusion was absolutely the best thing I did and I’m glad I didn’t put it off any longer.
All the best with your surgery, I hope it goes well and you are as happy with the outcome as I am.