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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!
Foot and ankle athletic injuries are very common. We specialize in sports medicine getting you back to sports as soon as possible. The most common foot and ankle sports injuries are plantar fasciitis, ankle sprains, shin splints, Achilles tendonitis, peroneal tendonitis, stress fractures, posterior tibial tendonitis, anterior tibial tendonitis, neuromas, tarsal tunnel syndrome, ankle instability, and metatarsalgia. Gait problems can also cause ileotibial band syndrome, patella tendonitis, back pain, hip pain and piriformis syndrome. Medications, injections, splinting, orthotics and/or physical therapy are often quite helpful in treating most injuries. Our doctors will discuss your injury and prescribe a course of treatment that will return you to sport stronger than when you came into the office.
Fall down, go boom? Foot and ankle trauma is extremely common no matter how young or old you are. Fractures, torn ligaments and tendons, sprain and strains, puncture wounds and toenail trauma occurs every day. Our physicians can help put you back together so that you can recover from your accident as fast as possible. Don't wait too long to seek medical advice after your accident or injury. Delaying treatment often only worsens the problem!
Foot pain related to congenital and acquired foot and ankle deformities is extremely prevalent in our society. Pain can be from flat feet or a high arched foot and associated gait problems; or be from a progressive deformity like a bunion or a hammertoe. Our doctors are extensively trained to diagnose and treat the underlying deformity to help you function at your best. We want to prevent your problems from getting worse, no matter what you inherited from your family! God may have had a sense of humor when he created your feet, but we will work with you to optimize your biomechanical function and aesthetics! No one should suffer from ugly, painful feet!
Neurological foot and ankle issues can be a burning or shooting pain, numbness, weakness or just a "pins and needles" sensation. Nerve can be affected by compression at the spine level, knee level, ankle level or in your foot. Neuropathy can be a subtle nerve degeneration from aging, diabetes, and a myriad of other causes. Do not assume your nerve issues will go away or that nothing can be done. A proper diagnosis can lead to alleviation of your nerve troubles.
Healthy Steps Shoe Store and Spa welcomes patients and their families as well as the surrounding communities of Grapevine, Southlake, Colleyville and beyond to help them with their therapeutic shoe gear needs. A certified pedorthotist is always available by appointment for consultation, and safe pedicures by a licensed medical nail technician highlight your spa experience. An extensive array of prefabricated and custom orthotics as well as many foot care essentials are also readily available to compliment your shoe and sandal purchases. We carry a wide variety of comfort shoe gear that are as pretty as they are comfortable.