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Friday, January 2, 2015

Hallux Rigidus: Email Advice

Hi there Doctor  Rich..... you earned it and I feel I need to address you appropriately),

Today, I just returned from yet one more podiatrist visit.  And now...I am thoroughly confused.  Let me back up a bit....I had been searching for foot help on the internet.  That's how I found your blog.  I also found Dr. Huppen of Seattle, WA.  You both have very extensive sites with great information.  Regarding Dr. Huppen who I found first...well, his site was so amazing and helpful about orthotics and showing foot anatomy and what happens when a flat foot walks without support that I actually called his office for a reference.  He publishes articles and speaks at conferences and I thought in his travels he might know someone in the Milwaukee area.  He did refer me to a Dr. Brant McCarten who was familiar with Dr. Huppen.  And then ....I found your blog which was so helpful. But I can't fly to Seattle or San Francisco, so I went to visit Dr. McCarten hoping that all I needed were the right orthotics and appropriate shoes and my hallux rigidus would stabalize and I could live without a chielectomy.

So my plan right now is this....I am having orthotics made with support under the middle of my foot to alleviate pressure on big toe and support my flat feet.  This orthotic...it will not be under my big toe...Dr M. wants my toe to move somewhat as that is what it is meant to do,so it will end before it hits the base of my toes.   But Dr. M outlined how he could very easily help my problem....do a cheilectomy.  

Why I am writing to you....I would like to hear your thoughts about the chilectomy procedure and it's ability to alleviate hallux rigidus. I have heard that having the cheilectomy is a slippery slope which ultimately leads to the fusion surgery.   I truly don't want to have the surgery that fuses it.  Can't wrap my head around that right now. I have read about folks that were very happy with the results after having the chilectomy.  I have also read about those that were unhappy with the results.  This doc has done many of these procedures....he works with lots of athletes.  

I have been very athletic ...for the past 33 yrs...running (which I stopped 14 yrs ago) biking, inline skating, cardio/stepping....racquetball.  And now my life is whittled down....mostly doing pool work....swimming into a stream (I don't know the exact name of it), and other water aerobics.  A little bit of inside biking and elliptical...but my heels are starting to hurt recently.    I have to walk very slowly in the orthotics that I have so my joint doesn't hurt...so I am even moving slower these days.  It's getting to me emotionally, I regret to say.  I know I have to wait till these orthotics come in and see if they need adjustment...then I have to wean into them.

And as I sit here...I can feel my heels talking to me....not sure if it's cause the Xelero sneakers which are new...and possibly are too dense and don't give enough.  I have been on a never ending search for comfortable work shoes (I am an elementary school teacher...walking on hard stone tiles all day).  

So Doc, I would appreciate your thoughts.  And suggestions for shoes.  I have very narrow feet as well.  

With respect,

Jenna (name changed due to witness protection)

Dear Jenna, 
     Thank you so very much for the wonderful email. Cheilectomy is a wonderful procedure, but can go wrong even in the best surgeon's hands. They need to have a feel on how much bone and good cartilage to remove from the top of the joint (typically as little as possible but still get the job done). Lack of pre-op MRIs are one of the major causes of poor results. The MRI should point to where all of the bone spurs to be removed are, and if removing them will lead to joint restrictions post op. The MRI will also tell the surgeon if there are significant cartilage damage deep within the joint that may warrant a joint replacement in the future, or at least micro fracture surgery at the same time of the cheilectomy. The standing AP foot x-rays should tell the surgeon if the first metatarsal also should be shortened at the time of the surgery with an osteotomy (surgical bone break with screw fixation). So, I am not afraid of cheilectomies. They work best with mainly medial and lateral spurring, and least with major dorsal (top) spurring with absence of dorsal cartilage. The more the dorsal bone needs to be removed, the more post op physical therapy is needed to attempt to get the range of motion back, and probably the more luck is needed. From 2 weeks, when the stitches come out, to 12 weeks, physical therapy is crucial in a lot of instances when the dreaded frozen toe syndrome is expected. Golden Rule of Foot: Go into a cheilectomy with Plan B as a joint replacement, not fusion. I hope this helps. I will have to discuss narrow work shoes at another time. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.