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Saturday, June 30, 2012

Hallux Limitus/Rigidus Post Op Email Advice

Dear Dr. Blake, I am an active (swim, pilates, yoga, circuit train, walk) 52-year old female with severe arthritis in hands and feet. Three years ago I had cheilectomy with osteotomy on left big toe.
Dr Blake's comment: The cheilectomy is a joint clean out of bone spurs and scar tissue and the osteotomy is to shorten the first metatarsal taking pressure off the joint.
 This relieved pain for nearly two years. I wear MBT shoes most of the day, avoid heels over 2 inches, take NSAIDs, etc. Now having severe stomach issues. No more NSAIDs. Discomfort is near-constant.
Dr Blake's comment: Switch to topical Flector patches or Voltaren gel for the top of the joint. And try to lay an ice pack 2-3 times daily on top of the joint for 10 minutes to keep the inflammation under control. You can go to PT and get 5 iontophoresis treatments with topical cortisone (dexamethasone phosphate). 
 I will try the taping procedure you recommend. Here is my question: I am scheduled for surgery July 18. Was leaning toward joint fusion, but wonder about joint replacement.
Dr Blake's comment: This type of surgery is no difference than knee cartilage tears. 5-10 years of a good result is considered normal response. Even joint fusions have 15-20% poor outcomes, and you can not do much about. I can only give you my bias, but I prefer possibly a second clean out, or partial implant (like the knee), as your next choice. Before surgery, perfect the taping, make sure your orthotics are great, and calm the joint down with a removable boot for 3 months with PT if need be. You may be very surprised how well you do. Calming the joint down will definitely help you make a clear headed decision about the next surgery. If you decide on fusion, consider occasional cortisone injections into the joint first to at least cool the inflammation down while you get some opinions.
 My doc will do either, but cautions that I will likely wear out the joint replacement in fewer than ten years, possibly a few as 5. I will then need another surgery. This makes me hesitate.
Dr Blake's comment: Do not use possible future surgery as a reason to do a more permanent procedure. The KISS principle still applies here. Think of the possible stress on other body parts if you have the big toe joint fused. Nothing is easy. Go one surgery at a time.
 Please offer your opinion. on Taping Supplies: Nexcare Product Stronger Than Kinesiotape for Foot Injuries

Additional Info: Also had Morton's Neuroma removed. No cartilage remaining. Several bone spurs and cysts. Bone on bone with severe degradation in head of metatarsal.
Dr Blake's comment: Can you send a photo of the same image from your MRI that I have placed here so I can look at it and it may change some of my thoughts?

Side view of First Metatarsal showing great bone across the joint of a T2 weighted MRI.

Hoping your taping procedure will save my right foot, which is several years behind the left! on Taping Supplies: Nexcare Product Stronger Than Kinesiotape for Foot Injuries

Dr Blake's comments: I hope this helps. Rich

1 comment:

  1. Thank you! Extremely helpful advice. I do not have a copy of my MRI, but will attempt to access. I will immediately start the patches and icing to calm the joint, as I am no longer a candidate for cortisone injections.

    I have put off action on this, to avoid another surgery. Now my ankle and knee are inflamed, including a Baker's cyst behind the knee. Already doing PT suggested stretches and exercises in pool for remediation and strengthening.

    Have scheduled a time to discuss details with my doctor and will get more information about the partial implant. I am very appreciative of your willingness to share your knowledge and expertise. Thank you!


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.