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Thursday, March 10, 2022

Hallux Rigidus: Surgery, No Surgery, or In Between

Here is the right big toe joint of someone whom has some minor DJD
(Degenerative Joint Disease AKA Wear and Tear)

Here is the left big toe joint of the same person with significant DJD

     Hallux Rigidus for many is a painful arthritic big toe joint. Patients can present with pain for many years or recent. Typically, like any sore joint, you can use common sense and get the joint comfortable. You may be just holding off the inevitable, the surgical knife, but who says that this is not worthwhile. 
Surgery is not without its problems. Most surgeries last 10-15 years and then have to be redone. If you fuse the big toe joint, you may not have big toe joint pain again, but you have totally messed up the normal pattern of movement. Our body must compensate for limping in pain, and it must compensate when a major joint is locked up permanently. 
     There are so many thoughts that run through my mind with this patient. One concerns why is the left side more broken down. We could discuss this for hours. Commonly, the left foot in our predominately right handed society gets beat up more. It is our support foot or support side that always takes more load in some way or another. Yet, podiatrists love to look for the nuisances to a pain syndrome like this. What also may put more pressure on the left big toe joint? Asymmetrical pronation is one, where the pronation or arch collapse places incredible stress on the big toe joint. Tight achilles and hamstrings, long leg syndrome, bone structural differences between the two sides, etc, all can place more force on the big toe joint which slowly and gradually collapses under this pressure. 
     Having been in a sports medicine and biomechanics practice my whole life, I have come to appreciate a non-rush attitude into surgery. Get more than one surgical opinion, and do not tell one surgeon what the other said. Find out if anyone can treat your problem conservatively. It is great to find out if there are mechanics that aggravate the stress at the injury that can be reversed. It is also great just to calm down the inflammation and relax any irritable nerves. 
     The last point today: treat the patient, not the xray. 


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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.