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When is A Bunion Not A Bunion?

It happened again today in my office. A woman came in asking for bunion surgery. She had put up with the pain in her big toe for years and finally had had enough. Many years ago her family physician told her to wait until she couldn't stand the pain in her foot before discussing surgery with a podiatrist. Like many physicians, they assumed any pain in the great toe accompanied by a bump was a "bunion" or Hallux Abducto Valgus. Unfortunately in this case, her doctor was wrong. The patient actually has Hallux Limitis also known as osteoarthritis of the great toe joint. If she had sought treatment many years ago, her joint may have been salvaged. Now her joint was so destroyed that she needed a joint replacement or fusion. Not what she wanted to hear! In her mind, she came in the office asking for a simple bunionectomy and left needing a joint replacement. She regretted not seeking the advice of a podiatrist earlier.

So what's the difference between Hallux valgus and Hallux limitis?

Hallux valgus is a crooked big toe joint. Over a period of years, the great toe becomes much friendlier with the second toe and drifts toward and eventually under or over the second toe. At the same time, the first metatarsal (long bone connected to the great toe) drifts towards the center of your body making the distinctive bump. This starts out as a minor annoyance, but then quickly becomes a shoe problem with rubbing on the bump. Most people seek the attention of a podiatrist when the bump is rubbing in their shoe and becomes painful. If the deformity is allowed to progress, the great toe joint can actually start to dislocate and you will start to experience joint pain and degeneration.

Hallux limitis is wear and tear arthritis or osteoarthritis of the great toe joint. Many people are predisposed to have this problem by the underlying biomechanical function of their joint. It becomes much worse after an injury or repetitive trauma from things like high heeled shoes, ballet or some sports. The symptoms are different than Hallux valgus. Hallux limitis usually starts with a feeling of stiffness of the joint. It can be accompanied by swelling and redness. This usually progresses to a decrease in range of motion, a distinctive crunching feeling when moving the joint and then a bump that forms usually more toward the top of the joint, not the side like Hallux valgus.

Hallux valgus and Hallux limitis can occur together in a more complex foot deformity. Usually the bunion deformity has progressed and then is injured by repetitive trauma or a distinctive injury. This starts the progression of the arthritis change. Bottom line: don't ignore pain in your great toe joint. Treatment of Hallux limitis early can save you from needed a fusion or joint replacement!

Why is treatment of Hallux limitis so important in the early stages? Once you have destroyed the cartilage in your joint, there is nothing a physician or surgeon can do to make more cartilage. Research is underway trying to replace or regrow cartilage, but we are many years from a solution. Hallux limitis in the early stages can be controlled with a functional shoe orthotic to control the biomechanics. A clean up procedure known as a cheilectomy can help remove all the debris from the joint and get rid of much of the crunching. This will slow down the progression. Some patients can really benefit from a surgical procedure to realign and shorten the metatarsal to give the joint better biomechanics and more joint space. Unaddressed Hallux limitis leads to complete joint destruction and the need for a fusion or joint replacement.

The flip side to this story is that patients with Hallux valgus or your tradition bunion can often delay treatment until they start to have pain. Bunions in the early stages are a cosmetic concern, but the joint is usually not damaged until the later stages. It is important to address Hallux valgus when it starts to hurt so the joint is not permanently injured, but a bump, in the absence, of pain can wait.

The take home message is to have your great toe pain examined by a podiatrist. A full examination including functional biomechanics and x-rays can determine whether your pain is from Hallux valgus, Hallux limitis or a combination. Only then can you make an informed decision on treatments for your foot deformity and pain. Waiting until you can't stand it anymore is a recipe for unhappy outcomes! If you have great toe pain with or without a bump, don't delay. See your podiatrist today!


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Business Team

Welcome to the Business Team at Foot and Ankle Associates of North Texas. Our appointment schedulers and billing department work in tandem to assist you and your family during your FAANT experience.
Our scheduling team will complete a short appointment questionnaire that will allow us the opportunity to contact your plan prior to your visit. We will find out what type of Podiatry benefits you should expect, including your coverage limits, which we will then review with you before you are seen.
If you are a new patient, we ask that you complete our online patient forms. We also update paperwork for established patients at least once a year or upon any changes. Having the most accurate information on you and your family will help us better treat your medical conditions, and it will also allow us to process your insurance claims more efficiently.
Thank you for helping us to be more prepared for your visit. Please download our online patient forms and fax them to our confidential fax at least 48 hours prior to your visit at 817-886-3612. We ask that you arrive 20 minutes prior to your visit with your insurance and identification cards; we will scan each card to validate your electronic health record. Please allow for ample time to check in with our team in order to help prevent your appointment being delayed or even rescheduled.
We invite you to bring your socks and athletic/dress shoes along with a list of prepared questions. For a list of sample questions visit http://www.ahrq.gov/questionsaretheanswer/ You may also visit our business office library, where you can view frequently asked questions, insurance contract list and become even more familiar with our office.