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hallux limitus/rigidus

Posted by john h on 2/22/01 at 10:46 (039637)

i know kay and judy and myself have this prombem. following are several URL's to provide further info:
http://www.orthopedicsosa.com/pt info...
http://www.straws.com/a_valent.htm
http://www.medmedia.com/oo3/160.htm
http://www.wheeless.belgianorthoweb.be/a4

Re: hallux limitus/rigidus

john h on 2/22/01 at 10:48 (039638)

two of the above urls will not work for somereason. wheeless of course is the orthopedic bible so you should be able to get to the wheeless book of orthopedics without much trouble.

Re: hallux limitus/rigidus

salina on 2/22/01 at 13:06 (039652)

Hi John,
I tried to read the info about this. But am still confused. I blame this on my watching way too many disney movies with the kiddies over the years, its as if my brain power is now limited to elementary homework and the Animal Planet channel.
You have this, so could you try to explain what it feels like? Symptoms?
I am interested, because I may have this, or something similar, in my right foot.
And have you had any surgeries or anything to get rid of it?
How has yours been treated?
thanks

Re: hallux limitus/rigidus

Dr. Zuckerman on 2/22/01 at 14:08 (039657)

I have used the Valenti procedure for the past ten years with very good results. It is my procedure of choice before I consider an implant of the human foot. I now looking into the new titanium implant which many show some promise. I still like to use and repair the joint that the man upstairs gave us. It is amazing what type of joint you can construct with the soft tissue that remains afte the osteotomy procedure with the valenti.

In addition there is no destruction to the very important flexor tendons that are below this joint and play a very important role in the gait cycle.

Re: hallux limitus/rigidus

john h on 2/22/01 at 14:21 (039658)

judy i think is considering the titanium implant dr z. from all i read one should try the cheilectomy first and if that does not work then try the implant-right? why would a titanium implant be more successful than any other. are the failures the result of the material used for the implant or the stress put on the hallux joint - especially an active person?

Re: hallux limitus/rigidus

john h on 2/22/01 at 14:24 (039660)

salina there is no mistaken hallux limitus/rigidus. if you develop a big bump on top of the second joint of the great toe and it becomes painful an x-ray will quickly show the problem. spurs develop in the joint space and there is deterioration of the cartlidge. very common with women because of tight/high heeled shoes.

Re: hallux limitus/rigidus

Dr. Zuckerman on 2/22/01 at 16:38 (039666)

It is the stress of the implant. The silicone implant can wear out and can cause inflamatory reaction and there have been cases where the silcone material has traveled into the lymphatic system. Yes this is rare but true and no one wants to talk about this. I agree that the cheilectomy is the first choice but when you are in surgery and you find that the joint is well there is a very very bad joint then a titanium implant could be your choice instead of the keller arthroplasty. There is a big difference between the cheilectomy and the valenti. The Valenti is about as close to the keller as you are going to get without doing the keller . Now the keller has its own set of problems. I like the keller in patients that are older and lack what is called a toe off with the big toe joint in the gait cycle.

Re: hallux limitus/rigidus

Dr. Zuckerman on 2/22/01 at 16:45 (039668)

Very common in injury, long first metatarsal bone, bad shoes, (tight).
Rheumatoid Arthritis, Osteoarthritis. Gouty arthritis
When it is both feet then it is probaby a biomechanical problem as opposed to an injury. I find alot of patients having both feet big toe joint problems with injury to one starting the pain. So the problem or structure was there but the injury started the pain with additional damage.

Re: hallux limitus/rigidus

Kay S on 2/22/01 at 18:46 (039676)

Dr.Z--For the record, is this something that I really need to be paying attention to, or is my condition going to be 'handled' by these new orthotics? That's ALL I need now, to be planning for another big major horrible lousy crummy unneeded foot problem, along with what I am already dealing with! Since my big toes really don't hurt, can I just ignore them?
(except to discuss them with JohnH and Richard from time to time)
Honestly, I feel like I am becoming paranoid about anything remotely connected to my feet and their various problems. If I ever get to the point where I don't think about my feet at least once in a day, it will be a true miracle.
Kay

Re: hallux limitus/rigidus

Dr. Zuckerman on 2/22/01 at 20:24 (039685)

Tbe orthosis is the best treatment and only treatment to help prevent any pain or additional stress to these joints. So don't think about the big toe joints. You are and have done everything that a human being can do.

Time is going to help your feet. I have a very good feeling about the future of your foot problems.

Re: hallux limitus/rigidus

wendyn on 2/23/01 at 07:48 (039714)

I have a dorsal bunion on my right foot. I had it operated on when I was 22 but it's slowly coming back. BELIEVE ME - you will know if it's there. You will have a big bump that's basically bone and it may or may not hurt. I know people who have very large bunions that don't hurt them at all - mine used to keep me awake at night. Glad I had it operated on - but the surgery was most painful.

Re: hallux limitus/rigidus

john h on 2/23/01 at 10:24 (039720)

kay from all i have read if it does not bother you much leave it alone. recommended shoes for hallux limitus/rigidus is shoes with a stiff sole and a rocker. many labs can build a rocker into your existing shoes. they are standard on the New Balance 852,853 and other New Balance shoes. My right foot also has hallux limitus and i have not had surger on it and it does not bother me much. If i were running i bet it would bother me a lot.

Re: hallux limitus/rigidus

john h on 2/23/01 at 10:32 (039721)

when one has a chelictomy for hallux limitus it is very important to start moving the joint as soon as possible so as to keep the range of motion achieved by surgery. i used a small rope within a few day to start pulling up on the toe (i called it the torture rope). if you do not actively move this toe up and down as soon as you can tolerate it you will have very little range of motion. my doctor (female) had a cheilectomy herself and she told me the day after surgery she would sit and put her foot against some object like a wall and bend the devil out of her toe. that will cause some major pain but as she said it would likely do no damage. she is tough as nails and swims with the sharks in south american and climbs mountains.

Re: hallux limitus/rigidus

Barbara TX on 2/23/01 at 12:22 (039733)

Wow! That is some he-woman podiatrist! I also had treatment by an extremities chiropractor who worked on my hallux limitus with trigger point/myofascial release therary. I now have very good range of motion in my big toe. If you have a mild case, maybe this is worthy of being tried. John - if you landed on the ground running in Laos, NO WONDER you have pf! Such are the spoils of war. B.

Re: hallux limitus/rigidus

salina on 2/23/01 at 13:04 (039735)

After reading about this, I am more than positive that I have this problem on my right foot.
I am so upset, because I have repeatedly asked my doctor about the problems I have with this toe, and asked why it looks the way it does, and actually demonstrated how I can't use it to toe off properly.
And all I get is a mumble about some pf jargon. I give up. I am sick of going to doctors and explaining my symptoms and they aren't even listening to me. They can't be listening to me. Cause I have repeatedly listed and showed and demonstrated all these signs of this hallux limitus stuff, AND I listed and showed and demonstrated all the signs of posterior tibial tendonitis, but all I keep hearing is pf pf pf. Like its the only foot terminology they know. And then all I get is a major attitude when I try to ask for tests to see if I have something else besides pf.
just ignore my venting. I am just really teed off right now. I made the mistake of posting before my morning coffee. :)

Re: hallux limitus/rigidus

john h on 2/23/01 at 16:06 (039742)

ask a doc to x-ray that toe salina. he would have to be blind not to recognize bone spurs or arthritis in that toe. a 10 minute diagnosis. the question is whether it is bothering you enough to want to do anything about it. proper shoes (stiff sole with a roll bar will take a lot of the load off that toe). some days it can hurt a lot worse than others for what ever reason (weather,etc). it is basically traumatic arthritis of the 2nd joint of the big toe. very very common.

Re: hallux limitus/rigidus

salina on 2/23/01 at 16:40 (039743)

Thanks. I am scheduled for another app next week. I know I sound so stupid. I was so oblivious to ANY injuries a person can get in their feet.
But even as ignorant to all this as I am, I knew something was obviously wrong with this toe. By just looking, along with symptoms etc etc. This is why I am just so upset about it not being checked out by my doctors. To me, at least one of them should have picked up on it. Especially with me complaining and asking for it to be checked out. And they just made me feel stupid, so I just assumed that there must not be anything that can really go wrong with this area and this is why they pretty much ignored me when I brought it up. Am I whining again? :) I am having a bad week is all. But I am so glad you posted about hallux limitus/rigidus problems.
At least I know to pay attention to it now. And I am stretching this area every day. And will demand that I get Xrays and whatever other tests so it goes on record that I DO have this, even if its not at the point of needing surgery.
I am depressed about this though, cause I have often thought (even when i didn't know what was wrong with it) that I would never be able to run or jog again, cause this toe would give me problems. I sometimes go through the motions to see if my foot could flex the wax it needs to while running.
And its definately a no no for me. I am just glad I am aware of this condition now. thanks

Re: hallux limitus/rigidus

john h on 2/23/01 at 20:33 (039772)

salina: having both bilaterial pf and hallux limitus i will take hallux limitus any day. the problem is easy to diagnose and in most cases easy to fix. it want go away on its on and depending on your activity level you may want to ignore it or fix it. don't sweat this one. let us know what the doc says when you mention hallux limitus/rigidus?

Re: hallux limitus/rigidus

Julie on 2/24/01 at 02:04 (039780)

Kay, I'm sure John is right. If your bunion isn't giving you trouble, please don't add it to your foot-worries. I've got a grade 3-4 hallux limitus on my left big toe - not my PF foot, though I do have a lesser grade 2 one on that foot too and was interested to read Dr Z's comment about bilateral bunions having a biomechanical cause, which would fit in nicely with my PF. But I digress. When I first went to my podiatrist about PF, he saw the bunion (you can't miss it) and said 'That joint is going to become arthritic and you should have surgery before it does'.

The joint is mobile, and it doesn't hurt. It complains mildly after an all-day hike, but then my feet hurt all over for a few hours, as most people's probably would. Anyway,I didn't like my pod's advice (he has recently qualified in foot surgery and perhaps a bit over-enthusiastic, so I was a bit sceptical) and I Asked the Doctors what they thought. Drs Z, B and W all agreed: 'if it ain't broke, don't fix it'. This accorded with my instincts, so I ain't fixing it unless/until it breaks. But as we - the bunion and I - have co-existed more or less comfortably for the whole 40 years of my adult life, I think there is a good chance the joint will last me.

Salina, yours on the other hand is obviously giving you some trouble or you wouldn't be concerned about it. I hope you will follow John's good advice and find a doctor who will take your concern seriously and send you for x-rays. One thing I did agree with my pod about - if a joint is going to need surgery, it's best to do it before there has been a lot of damage to it. Clearly age is an important factor here, as Dr Reid pointed out a few weeks ago.

Julie

Re: hallux limitus/rigidus

john h on 2/22/01 at 10:48 (039638)

two of the above urls will not work for somereason. wheeless of course is the orthopedic bible so you should be able to get to the wheeless book of orthopedics without much trouble.

Re: hallux limitus/rigidus

salina on 2/22/01 at 13:06 (039652)

Hi John,
I tried to read the info about this. But am still confused. I blame this on my watching way too many disney movies with the kiddies over the years, its as if my brain power is now limited to elementary homework and the Animal Planet channel.
You have this, so could you try to explain what it feels like? Symptoms?
I am interested, because I may have this, or something similar, in my right foot.
And have you had any surgeries or anything to get rid of it?
How has yours been treated?
thanks

Re: hallux limitus/rigidus

Dr. Zuckerman on 2/22/01 at 14:08 (039657)

I have used the Valenti procedure for the past ten years with very good results. It is my procedure of choice before I consider an implant of the human foot. I now looking into the new titanium implant which many show some promise. I still like to use and repair the joint that the man upstairs gave us. It is amazing what type of joint you can construct with the soft tissue that remains afte the osteotomy procedure with the valenti.

In addition there is no destruction to the very important flexor tendons that are below this joint and play a very important role in the gait cycle.

Re: hallux limitus/rigidus

john h on 2/22/01 at 14:21 (039658)

judy i think is considering the titanium implant dr z. from all i read one should try the cheilectomy first and if that does not work then try the implant-right? why would a titanium implant be more successful than any other. are the failures the result of the material used for the implant or the stress put on the hallux joint - especially an active person?

Re: hallux limitus/rigidus

john h on 2/22/01 at 14:24 (039660)

salina there is no mistaken hallux limitus/rigidus. if you develop a big bump on top of the second joint of the great toe and it becomes painful an x-ray will quickly show the problem. spurs develop in the joint space and there is deterioration of the cartlidge. very common with women because of tight/high heeled shoes.

Re: hallux limitus/rigidus

Dr. Zuckerman on 2/22/01 at 16:38 (039666)

It is the stress of the implant. The silicone implant can wear out and can cause inflamatory reaction and there have been cases where the silcone material has traveled into the lymphatic system. Yes this is rare but true and no one wants to talk about this. I agree that the cheilectomy is the first choice but when you are in surgery and you find that the joint is well there is a very very bad joint then a titanium implant could be your choice instead of the keller arthroplasty. There is a big difference between the cheilectomy and the valenti. The Valenti is about as close to the keller as you are going to get without doing the keller . Now the keller has its own set of problems. I like the keller in patients that are older and lack what is called a toe off with the big toe joint in the gait cycle.

Re: hallux limitus/rigidus

Dr. Zuckerman on 2/22/01 at 16:45 (039668)

Very common in injury, long first metatarsal bone, bad shoes, (tight).
Rheumatoid Arthritis, Osteoarthritis. Gouty arthritis
When it is both feet then it is probaby a biomechanical problem as opposed to an injury. I find alot of patients having both feet big toe joint problems with injury to one starting the pain. So the problem or structure was there but the injury started the pain with additional damage.

Re: hallux limitus/rigidus

Kay S on 2/22/01 at 18:46 (039676)

Dr.Z--For the record, is this something that I really need to be paying attention to, or is my condition going to be 'handled' by these new orthotics? That's ALL I need now, to be planning for another big major horrible lousy crummy unneeded foot problem, along with what I am already dealing with! Since my big toes really don't hurt, can I just ignore them?
(except to discuss them with JohnH and Richard from time to time)
Honestly, I feel like I am becoming paranoid about anything remotely connected to my feet and their various problems. If I ever get to the point where I don't think about my feet at least once in a day, it will be a true miracle.
Kay

Re: hallux limitus/rigidus

Dr. Zuckerman on 2/22/01 at 20:24 (039685)

Tbe orthosis is the best treatment and only treatment to help prevent any pain or additional stress to these joints. So don't think about the big toe joints. You are and have done everything that a human being can do.

Time is going to help your feet. I have a very good feeling about the future of your foot problems.

Re: hallux limitus/rigidus

wendyn on 2/23/01 at 07:48 (039714)

I have a dorsal bunion on my right foot. I had it operated on when I was 22 but it's slowly coming back. BELIEVE ME - you will know if it's there. You will have a big bump that's basically bone and it may or may not hurt. I know people who have very large bunions that don't hurt them at all - mine used to keep me awake at night. Glad I had it operated on - but the surgery was most painful.

Re: hallux limitus/rigidus

john h on 2/23/01 at 10:24 (039720)

kay from all i have read if it does not bother you much leave it alone. recommended shoes for hallux limitus/rigidus is shoes with a stiff sole and a rocker. many labs can build a rocker into your existing shoes. they are standard on the New Balance 852,853 and other New Balance shoes. My right foot also has hallux limitus and i have not had surger on it and it does not bother me much. If i were running i bet it would bother me a lot.

Re: hallux limitus/rigidus

john h on 2/23/01 at 10:32 (039721)

when one has a chelictomy for hallux limitus it is very important to start moving the joint as soon as possible so as to keep the range of motion achieved by surgery. i used a small rope within a few day to start pulling up on the toe (i called it the torture rope). if you do not actively move this toe up and down as soon as you can tolerate it you will have very little range of motion. my doctor (female) had a cheilectomy herself and she told me the day after surgery she would sit and put her foot against some object like a wall and bend the devil out of her toe. that will cause some major pain but as she said it would likely do no damage. she is tough as nails and swims with the sharks in south american and climbs mountains.

Re: hallux limitus/rigidus

Barbara TX on 2/23/01 at 12:22 (039733)

Wow! That is some he-woman podiatrist! I also had treatment by an extremities chiropractor who worked on my hallux limitus with trigger point/myofascial release therary. I now have very good range of motion in my big toe. If you have a mild case, maybe this is worthy of being tried. John - if you landed on the ground running in Laos, NO WONDER you have pf! Such are the spoils of war. B.

Re: hallux limitus/rigidus

salina on 2/23/01 at 13:04 (039735)

After reading about this, I am more than positive that I have this problem on my right foot.
I am so upset, because I have repeatedly asked my doctor about the problems I have with this toe, and asked why it looks the way it does, and actually demonstrated how I can't use it to toe off properly.
And all I get is a mumble about some pf jargon. I give up. I am sick of going to doctors and explaining my symptoms and they aren't even listening to me. They can't be listening to me. Cause I have repeatedly listed and showed and demonstrated all these signs of this hallux limitus stuff, AND I listed and showed and demonstrated all the signs of posterior tibial tendonitis, but all I keep hearing is pf pf pf. Like its the only foot terminology they know. And then all I get is a major attitude when I try to ask for tests to see if I have something else besides pf.
just ignore my venting. I am just really teed off right now. I made the mistake of posting before my morning coffee. :)

Re: hallux limitus/rigidus

john h on 2/23/01 at 16:06 (039742)

ask a doc to x-ray that toe salina. he would have to be blind not to recognize bone spurs or arthritis in that toe. a 10 minute diagnosis. the question is whether it is bothering you enough to want to do anything about it. proper shoes (stiff sole with a roll bar will take a lot of the load off that toe). some days it can hurt a lot worse than others for what ever reason (weather,etc). it is basically traumatic arthritis of the 2nd joint of the big toe. very very common.

Re: hallux limitus/rigidus

salina on 2/23/01 at 16:40 (039743)

Thanks. I am scheduled for another app next week. I know I sound so stupid. I was so oblivious to ANY injuries a person can get in their feet.
But even as ignorant to all this as I am, I knew something was obviously wrong with this toe. By just looking, along with symptoms etc etc. This is why I am just so upset about it not being checked out by my doctors. To me, at least one of them should have picked up on it. Especially with me complaining and asking for it to be checked out. And they just made me feel stupid, so I just assumed that there must not be anything that can really go wrong with this area and this is why they pretty much ignored me when I brought it up. Am I whining again? :) I am having a bad week is all. But I am so glad you posted about hallux limitus/rigidus problems.
At least I know to pay attention to it now. And I am stretching this area every day. And will demand that I get Xrays and whatever other tests so it goes on record that I DO have this, even if its not at the point of needing surgery.
I am depressed about this though, cause I have often thought (even when i didn't know what was wrong with it) that I would never be able to run or jog again, cause this toe would give me problems. I sometimes go through the motions to see if my foot could flex the wax it needs to while running.
And its definately a no no for me. I am just glad I am aware of this condition now. thanks

Re: hallux limitus/rigidus

john h on 2/23/01 at 20:33 (039772)

salina: having both bilaterial pf and hallux limitus i will take hallux limitus any day. the problem is easy to diagnose and in most cases easy to fix. it want go away on its on and depending on your activity level you may want to ignore it or fix it. don't sweat this one. let us know what the doc says when you mention hallux limitus/rigidus?

Re: hallux limitus/rigidus

Julie on 2/24/01 at 02:04 (039780)

Kay, I'm sure John is right. If your bunion isn't giving you trouble, please don't add it to your foot-worries. I've got a grade 3-4 hallux limitus on my left big toe - not my PF foot, though I do have a lesser grade 2 one on that foot too and was interested to read Dr Z's comment about bilateral bunions having a biomechanical cause, which would fit in nicely with my PF. But I digress. When I first went to my podiatrist about PF, he saw the bunion (you can't miss it) and said 'That joint is going to become arthritic and you should have surgery before it does'.

The joint is mobile, and it doesn't hurt. It complains mildly after an all-day hike, but then my feet hurt all over for a few hours, as most people's probably would. Anyway,I didn't like my pod's advice (he has recently qualified in foot surgery and perhaps a bit over-enthusiastic, so I was a bit sceptical) and I Asked the Doctors what they thought. Drs Z, B and W all agreed: 'if it ain't broke, don't fix it'. This accorded with my instincts, so I ain't fixing it unless/until it breaks. But as we - the bunion and I - have co-existed more or less comfortably for the whole 40 years of my adult life, I think there is a good chance the joint will last me.

Salina, yours on the other hand is obviously giving you some trouble or you wouldn't be concerned about it. I hope you will follow John's good advice and find a doctor who will take your concern seriously and send you for x-rays. One thing I did agree with my pod about - if a joint is going to need surgery, it's best to do it before there has been a lot of damage to it. Clearly age is an important factor here, as Dr Reid pointed out a few weeks ago.

Julie