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Is surgery needed for BILATERAL HALLUX LIMITUS?

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I have bi-lateral hallux limitus. It appeared in my left toe about 4 years ago, presenting with a slight pain in the toe, difficulty running and walking (especially stairs and hills) and leg and hip pain due to revised gait. Xrays showed a noticeable bone spur and elevated first metatarsal but limited narrowing of the joint. Orthotics, physical therapy and NSAIDs worked and still allowed for fairly full activity – I exercise 6 days a week and do high-intensity boot camp, cross-fit and cycling. I used to run frequently, but had to limit my running to one 5-6 mile run per week. I also had to limit hiking to a few times a year, and when I do hike, I pay for it afterwards.
In the past year, the hallux limitus developed in my left toe, same symptoms and presentation, but the pain in the toe and leg/hips is much worse. The conservative treatment did not work, and I have had to really limit my physical activity. I can control the pain as long as I stay off my feet and choose exercise wisely (bike, swim, strength). Walking is difficult.
The podiatrist recommended surgery (osteotomy) to preserve the joints. She said that the condition is progressive and recommended that I do the surgery BEFORE it gets worse. She said that most patients respond very well to the surgery and can return to normal activity (walking, running).
I am not opposed to surgery if there is a good chance that I can return to a more active lifecycle. Please provide your opinion on this recommendation.

I am a 54 year old female, average weight, excellent health.

Category: Orthopedic Surgeon

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Category: Spine Surgeon
Dr. Mukesh Tiwari is online now

Expert:  Dr. Mukesh Tiwari replied 4 Days.

Thank you for your query at DoctorSpring.com.

Yes I would recommend the same. The problem is with your 1st metatarsophalangeal joint. Surgery will definitely provide you relief.
Many patients obtain relief after osteotomy of proximal phalanx. This procedure is combined with cheliectomy where they remove a small part of the head of the toe bone (Metatarsal). This is more effective than just removing spur. It also increases the range of movement at this joint.

Studies with follow up for 10 or more years show good results for this procedure. So it is quite effective and recommended for you.
If the joint is left alone and if it undergoes more degeneration, this procedure may not be effective and the joint has to be surgically fused. So I would suggest the same, as your doctor, that you undergo this procedure.

Hope this was helpful to you. Let me know if you have further queries.

With best wishes.

Patient replied :

Thank you for the reply. One more question. I am seeing a podiatrist for this condition and he would do the surgery. Someone advised that I should have an orthopedic surgeon do the surgery instead. Is there a difference? I am happy with the podiatrist and he gets good reviews by other patients.

Expert:  Dr. Mukesh Tiwari replied 3 Days.

Thank you for posting the follow up.
Podiatrist are specially qualified with foot diseases & surgery.You should choose a qualified podiatrist.
With best wishes.

Dr. Mukesh Tiwari
Category: Spine Surgeon
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
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