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Sunday, March 10, 2013

Hallux Rigidus: Wonderful Review of Surgical Options

I practice in an area where many of the top surgeons prefer fusing an arthritic big toe joint called Hallux Rigidus. But, there are options out there that I hope these 2 links give you some reference point. I am not a surgeon, but in the hundreds and hundreds of Hallux Rigidus cases I have seen, most patients are avoiding surgery. Those who need surgery have to look for a recommended 3 surgeons to honestly discuss cheilectomy (joint clean out), shortening osteotomy of the first metatarsal, joint replacement, intra-positional arthroplasty, and joint fusion (arthrodesis). There are definite camps of preferences. You need a surgeon who is skilled in all of these and knows the subtle differences and where your joint fits into this schema. You don't want to hear "I always do it this way".   I do try to live in that ideal world. Fantasy???


  1. Thank you for sharing this. I am particularly interested in Interpositional arthroplasty. I am 41 years old, and moderately active. About 6 months ago I was diagnosed with Hallux Rigidus, Stage III.

    The podiatrist who diagnosed me said that it was likely the result of 2 "trip and fall" injuries to my big toes, spread 5 years apart. That makes me bitter considering that I saw a podiatrist after the first injury didn't heal as fast as I expected, and she said it would just take time - without even x-raying. And I got the same response from a GP after the second injury. But there's nothing to do for that.

    So, at Stage III, my podiatrist says that cheilectomy would be futile. And at my age, he doesn't advise joint replacement because it won't last and will make fusion more difficult down the road. He predicts that I'm 2 years or less from being in chronic pain requiring joint fusion. But he didn't mention Interpositional arthroplasty.

    I really don't want joint fusion. I haven't read any good stories about it, and it scares me. I teach Pilates and losing all motion in that joint would be very limiting. I don't need a huge range, but at least being able to get into "plank" position, as for a push up, is important.

    I feel lost. I've never had an injury that couldn't be healed. Since diagnosis, I've given up heels and my barefoot shoes. I primarily wear Danskos and other shoes that limit my ability to roll through the joint. I gave up my plan to start running; instead I swim and plan to start biking. I'm fine with that.

    With all of that, I've been almost completely pain free. But am I kidding myself that this is buying me time? Is my podiatrist correct that no matter what I'm going to have fusion in 2 years?

    I've read other posts of yours that talk about the joint being self-fusing, and that for some the pain of that process is manageable. But am I correct that it would also leave me with a completely immobile joint?

    Would early intervention to possibly preserve ROM be an option? I'm loathe to start down a surgical route, but I don't see many options.

    1. Jordan, so sorry for the delay in my response. I was on vacation, and needed some down time. Stage III is a good time normally to create motion and desensitize the joint. Since you are so young, definitely would try to get this joint moving, but it needs to be done without eliciting the pain response. Have a good physical therapist measure the joint range of motion every 3 months. Keep your pain down as you have been doing, and 3 times a day do the Self Mobilization described in the blog. Gently move the joint several times a day through a circular range of motion to reshape the cartilage. Check out what physical therapist in your area is known for manual work to increase range of motion. Learn how to make dancer's pads and perform spica taping. Ice for 10 minutes 3 times a day to the top of the joint whether you think you need to or not. I hope this you get moving. Do not think about surgery for the next year unless the pain gets out of control, and you can not control it. Rich


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.