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Thursday, August 9, 2012

Early Signs of Hallux Limitus: Email Advice

Hi Dr. Blake,
I am so glad that I found this site! I have been diagnosed with Hallux Limitus - very mild with a small spur just beginning to develop on the top of the joint. I didn't even notice stiffness in the joint until the dr. pointed it out to me.
Dr Blake's comment: Hallux Limitus means limitation of joint motion across the big toe joint. I find that the average patient understands when there is pain in the joint, but are not aware of the subtle reductions in lose of motion. Hallux Limitus is less than 60 degrees of motion, Hallux Rigidus less than 30 degrees. Normal Big Toe Joint Dorsiflexion is 80 to 90 degrees. Walking needs approximately 60 degrees, so limitus is less than this amount. 

I simply noticed the bump when I tried on a pair of heeled sandals with a strap across the bump. So I went to have it checked out and was diagnosed. The doctor suggested surgery "at some point, but not yet."
Dr Blake's comment: Golden Rule of Foot: The disability from surgery should be equal to the disability of the problem before surgery. What does that really mean? You must be quite limited in your life to undergo an elective surgery that hopefully temporarily is quite restrictive to your life. I definitely do not see that in your life. And I do not buy into preventative surgery, surgery to prevent the joint from getting worse, since all surgeries weaken joints, and have the potential of permanent disability via complications. Listen to your body. When the treatment option is a surprise to you, it is probably not right at that time. 

 I was pretty disappointed with the suggestion because it seemed so vague, but that's for another day. My real question is this: I've read that Platelet-Rich Plasma injections can help with certain arthritic joints and have been replacing cortisone injections recently. . . is there any evidence that PRP could work for Hallux Limitus?
Dr Blake's comment: I have no experience with PRP, but it makes sense in situations of chronic tears ligaments or tendons. It may be important with arthritic joints, but I am just not convinced yet. 

 At this point, I'd be happy with just maintaining my current condition and not allowing it to progress or worsen. I currently only have pain when wearing shoes that touch the bump, and occasional aching/stiffness, but no real pain. Thanks for any info you could give me on PRP in the big toe.

Hey Cristi, To me the doctor had no place to bring up surgery in this scenario. What is the purpose in a non painful joint? I have so many patients I have treated for the last 30 years who have a bump, have some limitation in motion, but that is all. You need to see someone who is an expert in conservative care of Hallux Limitus, who can examine you, and decide what conservative measures you should do to help the joint. If you read all of the posts on Hallux Limitus, they mainly deal with reducing pain. But you have no pain. For now, do not worry, find shoes that make you feel comfortable. Read a little, but not too much, on Hallux Limitus. And Listen to your Body! Hope this helps.  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.