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Surgery for Hallux Limitus

Posted by Mary B. on 3/03/01 at 10:21 (040330)

Hello,

I was diagosed with Hallux Limitus (functional?) of the left foot. The DPM advised that condition was due to an elevated first metatarsal, and has recommended extensive surgery - I don't know name of surgery(wedge cut of bone, NO Weight bearing for 8 weeks). I have a one year old son and don't think this is feasible. So, I went to see a Orthopedic surgeon, who did his own set of xrays and does not belive the metatarsal is elevated but does agree with dx and is recommending a modified procedure (remove bump, clean out joint). I'm very confused! I am down to two pairs of shoes which I can wear, having tingling feeling in left toe, considering surgery by orthopedic surgeon. Has anyone had surgery for this condition and if so, what type of surgery did you have? I would also be interested in hearing from physicians on why there is differing philosphical approaches to treating this condition. Thank you.

Re: Surgery for Hallux Limitus

wendyn on 3/03/01 at 10:47 (040332)

I had this surgery for a dorsal bunion (bunion on top of foot) when I was 23. Did not know enough to ask what the procedure was called but it sounds like what your orthepedic was describing. It was a long slow painful recover, but has given me about 10 years of relief. I had a very well respected orthepedic surgeon do the surgery, and bunions are pretty much her specialty. You will need lots of help at home for at least the first 3 to 4 weeks. If you are in good health, reasonably young, not diabetic, and you don't smoke - I would suspect you'll be getting around fairly comfortably by the 1 month mark.

I could not wear normal shoes for about 8-10 weeks at all. Full recovery really was in the 6 month to 1 year mark. I was off work for about 1 month, which was 4 weeks less than I was supposed to be off (I have a desk job though). So the recovery was shorter for me than it should have been, but I was amazed at how painful the recovery was. All in all thought - it was well worth it for me.

Re: Surgery for Hallux Limitus

Dr. Zuckerman on 3/03/01 at 11:51 (040341)

There are many type of bunion procedures for hallux limitus. Many bunion surgery or should I say joint surgery fail to just cleaning out the joint and not taking into consideration the structure of the joint. Is the first metatarsal head elevated. So that doing said let's talk about your option

1. I like to use a Valenti procedure which does improve the elevation of the joint.

2. If you need what is called a plantarflexory osteotomy that means moving the head back down to the ground so that there is better function of the joint , you still can be weigh bearing with the use of the revolutionary tiny screws that hold the the surgical cut into the bone so tight that you can and should walk on the foot. Now if they are talking about making the cut back at the base of the first metatarsal bone that is a different story and is rarely needed. Most hallux limitus surgery that has an elevated metatarsal head can be addressed with a procedure called a Youngwick or modified Austin bunionecotmy.

So avoid the first met cutting at the base with no weight bearing if all possible If there are any additinal question please feel free to ask

Re: Surgery for Hallux Limitus

john h on 3/03/01 at 19:24 (040371)

i have hallux limitus in both feet. had the chelictomy on left foot 18 months ago. i think he may have used the valenti procedure. he cut a wedge of of bone out to allow flexion and cleaned out the spurs.. the procedure is about a 30 minute out patient procedure. the incision runs from the base of the 1st to joint (top of foot) to about 3' straight back. you can start moving and should start flexing the toe within a few days so as to have flexion. i was full weight bearing in 12 days. some surgeons just remove the bump on top of the joint which does not address the problem. this is a no big deal surgery.

Re: Surgery for Hallux Limitus

Dr. Zuckerman on 3/03/01 at 21:45 (040378)

That is the Valenti procedure. I have done this procedure since 1991-1192.

It really is a very good procedure with fairly quick recovery. It does take into account the elevation of the first met head and at the same doesn't remove any of the weight bearing surface of the first metatarsal-phalangeal joint. And if there is a failure of this procedure very easy to covert to either an implant procedure, keller procedure. or most any other procedure. I know this because there have been some of the results that still didn't resolve the pain and had to either place an implant and a fusion of the joint. So in my opinion this is a very good procedure. I believe the literature supports my opinion.

Re: Surgery for Hallux Limitus

Mary B. on 3/04/01 at 09:36 (040391)

Thank you for the information! The Valenti procedure sounds very consistent with what the orthopedic surgeon discussed, and he did also mention that if this did not fix the problem, we could certainly move up to a more invasive procedure (perhaps more in line with what the DPM first mentioned). My concern was to do the least compromising surgery with hopefully a good benefit.

I had a few follow on questions:
1. Surgery done under local or general anesthesia?
2. Post op recovery time
3. Use of orthodics required after this type of surgery? Only the left foot appears to be affected.

Thank you again for the very excellent information. I love the internet!

Re: Surgery for Hallux Limitus

Dr. Zuckerman on 3/04/01 at 10:32 (040394)

Hi,
1. Local and or IV sedation. No general is needed
2. The foot can have alot of pain the first week and swell which can lasts for months.

3. Sutures out and in to a bending shoe within two weeks. (sneakers.)

4. Post-op recovery eight weeks on the avg but up to six months for full flexibility and return to more stylist shoes.

This is really a very good procedure and one of my favorites due to the quicker recovery.

One of the short complications that I see with this is short term pain on the bottom of the foot after this surgery. Not permenant but does occur in some patients.

Orthosis is the judgement of the doctor, and the function of your foot.

Usually one foot is due to trauma to that joint. But only the doctor can determine. This is where you are going to have a podiatric and orthopedic difference of opinion. My opionion it will depend of your life style and type of shoes you wear and the degree of biomechanical weakness. If you have a true met head elevation that should be addressed with the use of orhtosis if possible.

Re: Surgery for Hallux Limitus

john h on 3/04/01 at 13:10 (040410)

i did not experience much pain dr z. i did keep my foot elevated. because of the bandage it is difficult to ice it. swelling for about a week. sutures out on 10th day. started wearing birk sandals about the 12th day. the doctor gave me some loracet of which i took 2 pills. my buddy who is a paratrooper had the procedure and was back to jumping out of planes in about 5 months.

Re: Surgery for Hallux Limitus

Dr. Marlene Reid on 3/12/01 at 01:43 (041117)

Hi Mary,

I know I'm a little late on addressing this issue, but the answer to your question really lies on what the WEIGHT BEARING x-rays show. I say that strongly because many orthos do not take standing xrays and they do not show what foot specialists look at to evaluate the procedure needed. Some people that do have a significant elevation of their metatarsal do need a cut made at the base of the bone and that does require at least 6 weeks in a cast. As a mother of a 31/2 yr old and a 2 year old, you are better off doing it with a 1 y/o now then waiting another year. But it certainly isn't something that needs to be done today or tomorrow. You need to eval how much pain you are in, how much arthritis is setting in, how little motion you have and how much progression there has been.

A mild elevation will not require the bone cut at the base of the bone, but long term, you will do better with it if your elevation is significant.

Hope this helps and doesn;t confuse!!

Re: Surgery for Hallux Limitus

wendyn on 3/03/01 at 10:47 (040332)

I had this surgery for a dorsal bunion (bunion on top of foot) when I was 23. Did not know enough to ask what the procedure was called but it sounds like what your orthepedic was describing. It was a long slow painful recover, but has given me about 10 years of relief. I had a very well respected orthepedic surgeon do the surgery, and bunions are pretty much her specialty. You will need lots of help at home for at least the first 3 to 4 weeks. If you are in good health, reasonably young, not diabetic, and you don't smoke - I would suspect you'll be getting around fairly comfortably by the 1 month mark.

I could not wear normal shoes for about 8-10 weeks at all. Full recovery really was in the 6 month to 1 year mark. I was off work for about 1 month, which was 4 weeks less than I was supposed to be off (I have a desk job though). So the recovery was shorter for me than it should have been, but I was amazed at how painful the recovery was. All in all thought - it was well worth it for me.

Re: Surgery for Hallux Limitus

Dr. Zuckerman on 3/03/01 at 11:51 (040341)

There are many type of bunion procedures for hallux limitus. Many bunion surgery or should I say joint surgery fail to just cleaning out the joint and not taking into consideration the structure of the joint. Is the first metatarsal head elevated. So that doing said let's talk about your option

1. I like to use a Valenti procedure which does improve the elevation of the joint.

2. If you need what is called a plantarflexory osteotomy that means moving the head back down to the ground so that there is better function of the joint , you still can be weigh bearing with the use of the revolutionary tiny screws that hold the the surgical cut into the bone so tight that you can and should walk on the foot. Now if they are talking about making the cut back at the base of the first metatarsal bone that is a different story and is rarely needed. Most hallux limitus surgery that has an elevated metatarsal head can be addressed with a procedure called a Youngwick or modified Austin bunionecotmy.

So avoid the first met cutting at the base with no weight bearing if all possible If there are any additinal question please feel free to ask

Re: Surgery for Hallux Limitus

john h on 3/03/01 at 19:24 (040371)

i have hallux limitus in both feet. had the chelictomy on left foot 18 months ago. i think he may have used the valenti procedure. he cut a wedge of of bone out to allow flexion and cleaned out the spurs.. the procedure is about a 30 minute out patient procedure. the incision runs from the base of the 1st to joint (top of foot) to about 3' straight back. you can start moving and should start flexing the toe within a few days so as to have flexion. i was full weight bearing in 12 days. some surgeons just remove the bump on top of the joint which does not address the problem. this is a no big deal surgery.

Re: Surgery for Hallux Limitus

Dr. Zuckerman on 3/03/01 at 21:45 (040378)

That is the Valenti procedure. I have done this procedure since 1991-1192.

It really is a very good procedure with fairly quick recovery. It does take into account the elevation of the first met head and at the same doesn't remove any of the weight bearing surface of the first metatarsal-phalangeal joint. And if there is a failure of this procedure very easy to covert to either an implant procedure, keller procedure. or most any other procedure. I know this because there have been some of the results that still didn't resolve the pain and had to either place an implant and a fusion of the joint. So in my opinion this is a very good procedure. I believe the literature supports my opinion.

Re: Surgery for Hallux Limitus

Mary B. on 3/04/01 at 09:36 (040391)

Thank you for the information! The Valenti procedure sounds very consistent with what the orthopedic surgeon discussed, and he did also mention that if this did not fix the problem, we could certainly move up to a more invasive procedure (perhaps more in line with what the DPM first mentioned). My concern was to do the least compromising surgery with hopefully a good benefit.

I had a few follow on questions:
1. Surgery done under local or general anesthesia?
2. Post op recovery time
3. Use of orthodics required after this type of surgery? Only the left foot appears to be affected.

Thank you again for the very excellent information. I love the internet!

Re: Surgery for Hallux Limitus

Dr. Zuckerman on 3/04/01 at 10:32 (040394)

Hi,
1. Local and or IV sedation. No general is needed
2. The foot can have alot of pain the first week and swell which can lasts for months.

3. Sutures out and in to a bending shoe within two weeks. (sneakers.)

4. Post-op recovery eight weeks on the avg but up to six months for full flexibility and return to more stylist shoes.

This is really a very good procedure and one of my favorites due to the quicker recovery.

One of the short complications that I see with this is short term pain on the bottom of the foot after this surgery. Not permenant but does occur in some patients.

Orthosis is the judgement of the doctor, and the function of your foot.

Usually one foot is due to trauma to that joint. But only the doctor can determine. This is where you are going to have a podiatric and orthopedic difference of opinion. My opionion it will depend of your life style and type of shoes you wear and the degree of biomechanical weakness. If you have a true met head elevation that should be addressed with the use of orhtosis if possible.

Re: Surgery for Hallux Limitus

john h on 3/04/01 at 13:10 (040410)

i did not experience much pain dr z. i did keep my foot elevated. because of the bandage it is difficult to ice it. swelling for about a week. sutures out on 10th day. started wearing birk sandals about the 12th day. the doctor gave me some loracet of which i took 2 pills. my buddy who is a paratrooper had the procedure and was back to jumping out of planes in about 5 months.

Re: Surgery for Hallux Limitus

Dr. Marlene Reid on 3/12/01 at 01:43 (041117)

Hi Mary,

I know I'm a little late on addressing this issue, but the answer to your question really lies on what the WEIGHT BEARING x-rays show. I say that strongly because many orthos do not take standing xrays and they do not show what foot specialists look at to evaluate the procedure needed. Some people that do have a significant elevation of their metatarsal do need a cut made at the base of the bone and that does require at least 6 weeks in a cast. As a mother of a 31/2 yr old and a 2 year old, you are better off doing it with a 1 y/o now then waiting another year. But it certainly isn't something that needs to be done today or tomorrow. You need to eval how much pain you are in, how much arthritis is setting in, how little motion you have and how much progression there has been.

A mild elevation will not require the bone cut at the base of the bone, but long term, you will do better with it if your elevation is significant.

Hope this helps and doesn;t confuse!!