I was recently diagnosed with hallux limitus. (Actually, I figured it out myself by doing internet research, and a DPM confirmed my diagnosis...but sadly, no discount on his bill.) I have a "dorsal bunion" on the joint where my big toe joins my foot, and the range of motion of the toe in question is about 30 degrees less than the toe on the other foot. Although the toe feels a bit stiff, the only time it really gets sore is after I play tennis. (I play three or four times a week, always on hardcourts.) Of course, the rest of my 54 year old body also feels stiff and sore after a hard match, but I always recover after a good night's rest. (Even the toe feels OK the next day.) From doing my research I learned that this is a progressive condition, and it is best to get treatment as early as possible. After looking at my X-rays, the doc said that, while there are definitely signs of disease, the joint looked fairly healthy, and that there seemed to be lots of good cartilage in the joint. He recommended surgery to correct the problem. Said I should be pain free three or four days post-op, up and about within a week, and playing tennis again in two months. Sounds great. Maybe a little TOO great. After reading some of the foot surgery horror stories on this and other forums, I am beginning to have second thoughts about letting him carve up a foot that, while not perfect, I could probably live with.

Anyway...my questions:

1. Is it unusual that his first and only recommendation was surgery? He seemed awfully eager.
2. Should I have the surgery in order to avoid further damaging the joint?
3. Am I crazy for even considering surgery for a condition that really isn't affecting my lifestyle very much?

No...I don't expect anyone on here to make my decision for me. But if you've had any experience with a similar situation, I'd appreciate your input.

Thanks!

My advice is based solely on my symptoms and my internet research as well. I too, based on the great advice I have received on this board, did some internet research and seem to have the same thing, though mine is extremely painful whenver it is moved in certain ways or in certain directions. Some days it is not so bad, other days I am limping almost all day. I have not yet been to a podiatrist, but have done my insurance research and am going to make an appointment next week. In the meantime, based on what I have read, surgery is not usually suggested until many other things have been tried. One of the most popular treatments seems to be a special type of orthotics which are made to fit in your shoes. I think I would at least get a second opinion. As a matter of fact, your insurance may require it.

Nancy

Hi! I had this condition and had surgery. Since you play tennis, you will appreciate that it is also called tennis toe as well as turf toe, runner's toe, etc. I had a cheilectomy about 4 years ago. I am back running, dancing, wearing heels, etc. Sometimes I need a couple Aleve...no big deal. Am 60 years old and lad I had the surgery. Shaquille O'Neal had the same surgery in 2002 when he was with the Lakers. He was back playing basketball in about 6-8 weeks.

My suggestion to you is to find a good sports med doctor. I see you are in Ohio...no city listed. So, if you are in one that has a pro basketball or football team - like Cleveland - call their front office and ask who they use for this condition. If in a college town - like COlumbus - call the athletic department and ask the same question (not what foot doctor they use but who they use for THIS condition). Go see that person. Whoever it is will be up to date on the latest techniques and very dedicated to getting you back to your lifestyle. I found too many docs just wanted to get me where THEY thoug I should be. That wasn't good enough. I'm blessed with a internationally known sports med clinic in my home town so that's where I went. Good luck and keep us posted....

I am in a very similar situation - thanks for posting! I am not a tennis player but extremely active and I saw a podiatrist for stiffness and pain in my big toe. It's hallux rigidus and the podiatrist was very eager to do surgery. However, a friend of mine who is an orthopedic surgeon advised me not to let a podiatrist operate on me and recommended that I visit a surgeon. The orthopedic surgeon recommended anti-inflammatories and told me to try that for a while, probably up to a year.

I am really active (runner, general cardio workouts, etc) and the stiff big toe has effected my gait for years and caused other problems. Ultimately, the decision is one based on quality of life - is it limiting your movement enough to take the risk of surgery? I have heard chilectomy's are routine, but I've also heard stories of things gone wrong and the foot being worse off after it. At age 29, I just don't know what to do.

Well, since you are in Chicago, I'd call the Bulls and the Bears front offices and find out who they use....get his/her opinion. 29 is young but this is a degenerative condition. It isn't going to improve if you do nothing. Perhaps Celebrex could help you for a while - or even Aleve or Tylenol Arthritis if you haven't tried any of them. But they are only going to mask the symptoms - not cure the condition. Orthotics help some people...but you can't wear them with cute little sandals and the like. Since you have a good bit of cartilege left (I'd verify that with the second opinion), you'll probably get a long life out of the cheilectomy. Next is an implant and then fusion. Good luck!

I am in a very similar situation - thanks for posting! I am not a tennis player but extremely active and I saw a podiatrist for stiffness and pain in my big toe. It's hallux rigidus and the podiatrist was very eager to do surgery. However, a friend of mine who is an orthopedic surgeon advised me not to let a podiatrist operate on me and recommended that I visit a surgeon. The orthopedic surgeon recommended anti-inflammatories and told me to try that for a while, probably up to a year.

I am really active (runner, general cardio workouts, etc) and the stiff big toe has effected my gait for years and caused other problems. Ultimately, the decision is one based on quality of life - is it limiting your movement enough to take the risk of surgery? I have heard chilectomy's are routine, but I've also heard stories of things gone wrong and the foot being worse off after it. At age 29, I just don't know what to do.


Hello,

I just wanted to comment on what your friend told you about going to s "surgeon". Some podiatrists are very good surgeons for the foot and ankle. Many orthos will tell you to stay away from pods because of business competition. Pods have much more training on the foot and ankle than even the fellowship trained ortho surgeons. now, whatever you do is yor business but, I want you to at least have an informed decision.

I have to agree about the podiatrist. I was treated for heel spurs over a period of three years, about 15 years ago. First I was treated by my family doctor who then referred me to an orthopedic doctor. I was not at all happy with the bedside manner, nor the three hour wait every time I went in. I finally decided to go to a podiatrist. He had very good bedside manner, was very gentle and did a very effective job with my conservative treatments as well as with the surgery. He was great too at offering practical advice like what brands and types of shoes to wear. I now have this same problem which is being discussed here and have an appointment with the same podiatrist. I totally trust him.

Nancy

I WENT TO A POD AND HE RECOMENDED A cheilectomy FOR HALLUX RIDUGIS? I WENT TO AN ORTHO MD AND HE SAID HE WOULD NOT DO A cheilectomy SINCE THE JOINT APPEARED TO BE TOO FAR GONE ,HE WANTS TO DO A FUSION. NOW I DON'T KNOW WHAT TO DO. ANY ADVICE? THKS

Do the cheilectomy and buy yourself some time. A fusion is irreversible.

if you have a Volvo car and it needed some serious work, would you take it to a general auto repair shop or to a certified Vovo repair shop. Hallux limitus usually begins as an elevated metatarsal and as a result, the mechanical axis of the 1mpj is skewed. The phalanx is unable to slide ontop of the met so it jams as you continue your walking from midstance to push off. Over time the bone grows at the impact zone to try to create a larger effective surface are of the joint, it takes years and years. A cheilectomy (does not fix the cause but the symptom) would remove the bump and can restore much more motion then you have had in years. Perfect for you demographic age range as it would take 20 years to recurr. If you were a teenager then the surgery should decrease the metatarsal elevation or dorsiflexion via a wedge osteotomy.... as well as a cheilectomy..... Dont do a fusion. Not yet, google the Keller procedure, but warning, the toe does shorten a centimeter or so but the pain is gone...

This is all very helpful, thank you all so much. So I'm hearing that a chilectomy will essentially restore a fuller range of motion for several years (up to 20-ish) and a podiatrist may be fully qualified to do the procedure. I still don't feel 100% comfortable with the guy I saw before, but my massage therapist knows a good one who has worked on a lot of ballerinas from the Joffrey Ballet Company. That makes me feel more comfortable. So I'm going to set up an appointment and see if I can get this taken care of.

Titchou, can you give me more background on your experiences with the chilectomy? Was it performed by an ortho or a podiatrist? Were you put out completely? Did they do the incision on the top of your foot or the side and how long did it take for it to feel "normal" and get through daily activities with no pain?

Does anyone know the risks of a chilectomy? What can go wrong? How often are they sucessful?

This is all very helpful, thank you all so much. So I'm hearing that a chilectomy will essentially restore a fuller range of motion for several years (up to 20-ish) and a podiatrist may be fully qualified to do the procedure. I still don't feel 100% comfortable with the guy I saw before, but my massage therapist knows a good one who has worked on a lot of ballerinas from the Joffrey Ballet Company. That makes me feel more comfortable. So I'm going to set up an appointment and see if I can get this taken care of.

Titchou, can you give me more background on your experiences with the chilectomy? Was it performed by an ortho or a podiatrist? Were you put out completely? Did they do the incision on the top of your foot or the side and how long did it take for it to feel "normal" and get through daily activities with no pain?

Does anyone know the risks of a chilectomy? What can go wrong? How often are they sucessful?

Thanks for the questions. I went to a sports med ortho who does only feet. He was with an internationally known sports med clinic here until they broke up last year. He did all the foot - and some hand - work for them. His name is Dr. John GOuld if you want to look up his info. The incision was on the side and I was put under. I truly recommend that since they will be doing soe bone work and that is very painful. They will fill you with meds before you wake up so do not worry about the pain after. DO take your pain meds as they tell you. I tried to tough it out and was sorry. It took overnight for the meds to catch up. Please learn from my mistake! It was two weeks before the stitches came out and another week before I could get out of the surgical walking boot. There was just too much swelling. After that I wore a pair of Merrell's - slide in style like Primo Breeze - for maybe 4 weeks before I started trying other shoes. I would take the Merrell's with me to work in case I needed to change. As for pain free, I was after the stitches were out.
I still take Aleve (was on Vioxx till they took it off the market ) but I had a good bit of cartilege loss. I was very compliant about doing the exercises. That's VERY important. You have to move the joint to make sure it continues to move. That was sort of painful...more like very sore. It helped to do them at night in the bath after running very warm water over the toe to warm up the muscles. The exercise is basically pulling gently on the toe and then moving it up and down. Many reps a day. It's been 4 years and I just take 2 Aleve in the AM and 2 in the afternoon. I jog and dance and am very active. I'm 60 and mow my grass, etc. The toe doesn't impede me in any way. I can't wear heels over about 2 inches...just too high considering the joint damage. I was told i should 15 years or more out of the surgery and I think that's very conservative estimate considering what stage I am at now. Just be VERY sure of the doctor. Sounds like you have a lead on one that understands getting you back to activity rather than just pain free like some. Good luck! Keep us posted.

Thank You All,you Have Been Very Helpful. I Think I Will Go With The Pod Dr And Hope For The Best. My Son Is A Radiologist And He Casts His Vote Along With You Too.
Thanks Again

Was an osteotomy ever mentioned? It's the procedure between a cheilectomy and a fusion.

No it was not mentioned. What does it entail?
Thanks

It's not actually between the cheilectomy and the fusion. All they do is shave some of the bone off at the top of the met at an angle so that the joint moves up and down smoothly. It should be done during the cheilectomy if there is bone build up in that area.

A Cheilectomy addresses the bone spurring caused by the toe jamming of HL. An osteotomy works to address the underlying cause of the jamming either a long and/or elevated 1st metatarsal. A chevron shaped cut is made in the metatarsal. It's then shortened and/or repositioned lower and screwed back in place. The procedure is referred to as a Youngswick modification of an Austin Bunionectomy. A Cheilectomy will be performed at the same time to clean up the spurs to allow the toe to bend again. The goal is for a long term fix to preserve the joint so you never get to the point of needing a fusion or implant. Of course, recovery takes longer but my philosophy was if the doctor was in there anyway, he might as well fix the cause not just the symptom.

I had mine done about 8 weeks ago. I'm back in a regular flat shoe and walking with only a slight limp. By 12 weeks I hope to be back to normal. Post-op care and philosophies range widely from doctor to doctor. But if you're going under the knife anyway, it might be worth asking about.

Screws aren't always required. I had none.

I just would like to add to the previous comments re: Podiatrist vs Orthopedic Surgeon. I, too, tried the Ortho route. Prior to going to the Ortho Surgeon, I went to a Podiatrist who took X-Rays and explained my condition (no cartilage between two bones in my big toe causing bones to rub against each other, hence, the pain plus arthritis). He recommened implant. I then decided to see the Ortho to see if something non-surgical could be done. He concurred with the Podiatrist re: the results of the X-Rays but advised against surgery. He then put me on an anti-inflamatory which did nothing to ease my pain. Next, he suggested I start on Cortisone Shots. The feeling I got was that this was just going to be a never ending ordeal; treating the symptoms but never correcting the problem. I then decided to go back to the Podiatrist. Because he knew I was hesitant about having the surgery, he recommended that I get a second opinion from another Podiatrist; one who was the Head of Podiatry in a hospital where I live. This Podiatrist suggested I have the implant to correct my problem. As it turned out, many people I knew had used this Podiatrist as well as nurses, got great results, and they highly recommended him. I decided to take that route. I agree with the other responder, that there's a lot of competition between the Orthos and the Pods. The deciding factor for me was that I was looking to correct the problem and not just get a temporary fix. Be sure to do some research and go to someone you feel confident with. Hope this allays your fear about using a Pod.:)

I certainly concur that a lot of research is needed. My Pod, while I really like him and he does a good job, seemed to be more concerned with the outcome he wanted rather than the one I wanted - back to running, wearing heels, etc. The Ortho was on my wave length. I think either would have been fine surgically speaking but the Ortho does only feet in a sports med clinic so he was more inclined to get me back to running - which is what I wanted.

I agree that you need to find a doc that will work with your goals--but they should also give you all your options so that you can make an informed decision. I'm not one to put blind trust in a doc just because he has the initials MD behind his name.

My goal was to do this only once if possible. I was a diligent orthotic wearer for years before seeking surgery. But it had progressed from stage II to stage III even with the orthotics. I'm not an athlete and my HL is not injury related so I didn't feel a Cheilectomy was the right choice for me. My goal was joint preservation since it's still in good shape. I'm still early in my recovery but for me an osteotomy was the right way to go. Fortunately, my doc and I were on the same wave length.

Believe me, I checked out both docs! The ortho I used has great national creds. Locally I found several people to sing his praises...there was one story that convinced me. A friend's son had cut his hand on a circular saw cutting nerves and tendons. This doc was doing hands at the time and putit back together. He has complete use of it today. Figured he was good for removing a neuroma and the cheiletomy!

David614, Saw339, rh6445, and anyone else trying to decide how to deal with a Hallux Rigidus and/or Hallux Limitus condition;

Here's yet another Hallux victim's perspective...

I am 39 years old, am an avid soccer player, competitive cyclist, runner, etc. and have been having toe pain for a few years. Soccer was the worst, as whenever I stubbed my toe I'd get excruciating pain & I'd be badly swollen, sore, & limping for the next 2-3 days.

I finally visited a highly recommended podiatrist this summer, and he diagnosed it as Hallux Rigidus. He said it was caused by me having flat feet, which allowed tendons/ligaments to be less taught, and prevented the big toe from moving normally. His proposed solution was to do a chevron osteotomy (removing a wedge from the toe bone). For several reasons (among them the fact that I don't have even remotely flat feet) I decided to get a 2nd opinion.

After asking the fantastic orthopedic surgeon who rebuilt my ACL (knee) a couple years ago, I got the name of one of the top two or three foot specialist orthopedic surgeons in my city (they said to avoid podiatrists whenever possible, and that they frequently have to do repair to joints that podiatrists have operated on, presumably not very well). He also diagnosed it as Hallux Rigidus but recommended a cheilectomy, largely due to it being a less extreme option than the osteotomy. He did point out that other options may need to be pursued in the future (osteotomy or fusion), depending on the cheilectomy success. He also mentioned that implants aren't really very reliable, and would be likely to fail eventually.

Anyway, I underwent the cheilectomy surgery on 11/8/06. He used general anesthetic, as well as a "block" which numbed nearly everything below the knee for 14-16 hours post-op. Surgery took around 30 minutes, and I was on my way home about an hour later.

Pain was minimal. I took the meds for about two days. Haven't had a need for them since.

Mobility was very limited for 3-4 days and I used 1 or 2 crutches. By day #7 I didn't need the crutches. My follow-up appointment was on day #9, and the Dr. removed the stitches and cleared me to dump the "boot" and wear whatever shoe I could get my foot into comfortably. Since then I've been in tennis shoes, sandals, or a soft/flexible pair of dress shoes. He also said I can do exercise as I can tolerate, although not to jog/run for a couple more weeks. As far as toe exercises go, he said "you can't hurt it, it can only hurt you." (funny!)

It's now day #12 and I'm planning on a hard bike ride today (feeling great!) My toe already bends back about as far as it did pre-surgery. With continued toe stretching I should be able to greatly increase the range-of-motion within a few weeks.

Overall, I'm VERY satisfied with the results.

The one thing I find strange is that it doesn't bend down very far at all now. I used to be able to bend it down probably around 110 degrees. Right now it only bends around 20 degrees. I wasn't aware that the "bending down" flexion would be affected at all. Anyone else experience this?

Anyway, sorry to be so wordy, but just wanted to share how well the cheilectomy option can go. I'm sure everyone is different though, but I like the route I took.

That bending down issue often happens with this. I have the same thing. However, you only need them to bend down if you pick something up with them. And since homo sapiens typically uses hands for that function, any restriction shouldn't be noticed. I never notice mine unless I just bend my toes down...I had my surgery almost 4 years ago and am still thrilled with the results. 60 years old, jog, dance, wear heels (low ones!)...no problems.

I've been often called "Monkey Toes", and I often use them to pick things up! :D I guess I'll have to rely on my other foot for these chores from now on. :'(

After doing additional research, consulting with my family MD, and just worrying in general for the past month, I have decided to go ahead with the surgery. Scheduled for next Wednesday, the 29th. I'm not looking forward to the pain and recovery period, but I am very much looking forward to get this increasingly bothersome condition resolved.

Although any surgery can go badly, according to my family doctor, many of the foot surgery horror stories one hears are from people who had underlying health problems that complicate their recovery. Especially obesity and diabetes. Thankfully, I have neither of those conditions, so that isn't a concern for me. Also, he said that a surprisingly large number of patients take no responsibility for their own recovery and don't even bother to follow the surgeon's post-operative instructions regarding rest, physical therapy, etc. Myself, I plan to follow the instructions religiously, so hopefully that will further reduce the risk of a bad outcome.

While doing my research I was surprised to learn that the average length of time a patient goes between first starting to suffer with HL/HR and finally resorting to surgery is more than EIGHT YEARS. :eek: During that time, every painful step is causing more damage to the joint. By the time the surgeon tries to repair the damage, the joint is pretty much destroyed. From my perspective, it seems to make sense to correct it before the damage has become extensive.

Anyway...that's what I've been telling myself. Hopefully I'll still be feeling positive about it two weeks from now when my foot is black and blue, swelled up, and throbbing with pain. If anyone's interested, I'll post a "journal" of my experience.

I appreciate all the thoughts and feedback this thread generated.

Wish me luck!

Good luck Mr. 614! Sounds like you're on the right track. Yeah, definitely follow the Dr.'s instructions. Keeping it elevated helps to minimize the throbbing. Also, as soon as I started applying ice and taking ibuprophen the swelling reduced quickly (within a couple days). On day #13 now and it's just slightly larger than the other foot. By the way, which surgery option are you going with?

If you are just having a cheilectomy, the pain and throbbing should be non-existent after 1 day - much less 2 weeks. I never even iced mine. Was walking from day one. I'm sure you'll be fine.

By the way, which surgery option are you going with?

I'm having a cheilectomy. Hope I'm doing as well at 13 days as you are.

Here's what I found out by going to 2 POD's in two days to get opinions:

First a lil' history, I have a severe Hallux limitus that was damaged 20 plus years ago. Have been living with it since. The joint is swollen and full of bone spurs on both bones behind big toe [left foot]. It is also full of arthritis, swelling, etc. Very painful most of the time, very limited movement, etc. Now you got the picture.
In short, first Dr. [yesterday] recommended cleaning spurs off both bones and shortening the long bone [in foot] to give joint "room" to move in. He also suggested adding an implant [cup] on the end of the toe bone to help accomodate things.
Second Dr. agreed with first with the exception of the "implant" cup. Said he would get in there and look to see if there was any cartilage left, first. Do the cleanup of the spurs [chilectomy] and if there was sufficient cartilage there to work with probably just drill a few holes in toe bone to encourage more and new cartilage growth. However in my case, by the x-rays there probably isn't a whole lot of cartilage there since I damaged my toe and have been living with this for a long time before seeking treatment. In that case he suggested going further by doing the procedure mentioned above [shortening the foot bone to accomodate space], BUT NOT putting the implant cup in. He receommend not doing implant surgery because they're not reliable and for that reason he doesn't like them. He also said that there could be further complications down the road if electing to do implant. By cleaning up the spurs and reshaping the ends of the bones and encouraging cartilage growth in the new space it would buy time from 5 to 15 years depending on use, wear and tear, etc. Then if it becomes a problem down the road to elect fusion of the bones and be done with it. Fusion is ALWAYS a last resort in this particular type of surgery and Dr. said a middle aged person with this condition, under normal circumstances shouldn't elect fusion unless absolutely medically necessary.
I've elected to do the above mentioned procedure without the implant and am scheduling surgery as I write this but I am still anxious to read all relevant message boards from people that have had this type of surgery.

Thanks for your post and good luck. :)

You lived with this for TWENTY YEARS????:eek: YIKES!!!!! I can't imagine!!

Anyway...I think that you are doing the right thing by going with the more conservative surgery. If it doesn't give you the relief you need, you can always go back for more. Keep us posted. Best of luck.

Anyway, I underwent the cheilectomy surgery on 11/8/06.

So...according to my calculations, you are on day 20 now. How does it feel? Still satisfied?

My surgery is tomorrow. Starting to get nervous.:dizzy:

I lived with mine for about 8 years. But finally wanted to run again sohad the surgery. Good luck! You'll be fine. Just be sure to do those exercises....that is essential!

Just be sure to do those exercises....that is essential!

Thanks for the advice. I'll do my exercises religiously. :angel: Gotta be in tennis shape by spring.

Well...I had my surgery Wednesday morning. Hardly slept the night before, but everything went very smoothly. Was home by early afternoon. I have instructions to ice and elevate for three days. Doc said to take Percocet until midnight of day of surgery, then as needed. Haven't taken any since. Still taking antibiotic and NSAID as prescribed. Probably should have stuck with the Percocet for another day, because my foot was VERY sore yesterday. Today, however, it feels great. Just an occasional bit of mild soreness. Two more days of ice and elevation, then off to the doctor for my follow-up visit on Tuesday. It feels so good, I have to remind myself not to push it too soon.

Good luck to those still facing their day with the surgeon.

Glad it turned out well for you. Hope your recovery continues in this same manner. Keep us posted.

Well...I am now 10 days post-op and doing pretty well. Went to see the doc for my first follow-up visit last Tuesday. He was happy with my progress at that time. My foot had just some mild swelling and a bit of bruising, but, for the most part, looked OK. Doc cleared me to walk as much as I wanted. Although he said I could wear any shoe I could get my foot into, I still find that to be uncomfortable...especially since, when he re-wrapped my foot, he put a quarter inch wide pad between my big toe and the one next to it. It feels like an inch wide metal wedge in there, and I just can't find a way to make it bearable while in a shoe. Plus, the incision is easily irritated by a shoe. So, I am still getting around in the surgical shoe. I go back to see him on Thursday, and I'm hoping he takes the stiches out at that time. As soon as I'm sure the incision site is healed properly, I guess I'll just have to work at getting my foot toughened up again. As for that wedge between my toes, if he tries to put that back in, HE is going to have a wedge in a very uncomfortable place. :mad: I got for physical therapy on Wednesday, so I'm looking forward to learning some exercises to help get my foot back into shape.

Everybody take care. :wave:

It was 3 weeks after surgery before I could get a regular shoe on and then it was Merrell with a wide toe box. Don't push it...also, the main exercise is to pull on the toe and then move it up and down.....many times a day! Keep us posted....

David, I am glad to hear you're progressing nicely. So far so good, right!? I am visiting a sports podiatrist on Jan 4th (have to wait for insurance to change) and I cannot wait. The more I think about it, I am leaning towards having the chilectomy. I can't wear heels or any angled shoe, or even a lot of flat dress shoes because the edge hits right at the joint. Ouch. Not that I wear heels regularly, but I can't imagine not being able to wear them ever again and if I don't address it, that's what I'll be stuck with.

My biggest fear is that the toe will be worse afterwards, though I know that it's not ever planned that way. Does anyone have any suggestions of questions I should ask the pod when I meet with her? I am getting a list together so I don't forget anything.

Thanks,
Sharon

Be sure to ask exactly what all she will do and what exercises/PT she recommends afterward. Get her to draw you a diagram if necessary...mine did and it really helped me to understand exactly what was going to happen.
Hope whoever you're going to is associated with the Bears or the Bulls....since this is also called turf toe, etc....

Well...I'm 15 days post-op and still healing nicely. Went for my first PT session yesterday. The therapist said that while the range of motion in my toe is only half of what it should be, that is pretty good for where I am. She said that with work, it will eventually be normal.

Went to the doc today for my second post-op check-up. The bruising is gone and there is only minimal swelling. He took out the stitches and put on a much smaller bandage. I can now get my foot into an old athletic shoe with a certain degree of comfort. In fact, I went for a 1/2 mile walk this evening. I go back next Thursday for another check-up. He indicated that if things were still going well I wouldn't need to see him for a few weeks. I just hope I leave his office with no bandage at all. I am SO tired of having to keep my foot dry. I'd KILL for a normal shower.

Everyone take care.

To any and all
I also have bilateral hallus limitus. Like many others, I went for far too long without having it corrected and could no longer stand the pain. I am very active, previously a marathon runner, and enjoy all outdoor activities.
I finally decided to have the surgery and started with just a cheilectomy on one foot. The podiatrist that I went to didn't push for a metarsal osteotomy. In a nutshell, six months after the surgery I was still in pain and the operated foot actually was more painful than the other. I sought some other opinions and finally decided to just try to get this fixed once and far all. 4 weeks ago I had surgery on both feet, 3 procedures each: cheilectomy, metarsal osteotomy, and cartilage transplant.
I am writing this post in order to share my experience and possibly help others as they make these difficult decisions.
Currently I am optimistic about my recovery but it has been pretty rough -- the cheilectomy was a walk in the park compared to this. I am anxious to hear about the results others have had with the osteotomy procedure and how they feel today.
Blessings to all

To any and all
I also have bilateral hallus limitus. Like many others, I went for far too long without having it corrected and could no longer stand the pain. I am very active, previously a marathon runner, and enjoy all outdoor activities.
I finally decided to have the surgery and started with just a cheilectomy on one foot. The podiatrist that I went to didn't push for a metatarsal osteotomy. In a nutshell, six months after the surgery I was still in pain and the operated foot actually was more painful than the other. I sought some other opinions and finally decided to just try to get this fixed once and far all. 4 weeks ago I had surgery on both feet, 3 procedures each: cheilectomy, metarsal osteotomy, and cartilage transplant.
I am writing this post in order to share my experience and possibly help others as they make these difficult decisions.
Currently I am optimistic about my recovery but it has been pretty rough -- the cheilectomy was a walk in the park compared to this. I am anxious to hear about the results others have had with the osteotomy procedure and how they feel today.
Blessings to all

Did you have screws inserted? I had the cheilectomy with just the beveling of the met type osteotomy. Worked great.

Greetings one and all,

Day 22 - Went to the doc today for my third post-op checkup. He is very pleased with the progress I am making. I still have a bit of swelling, but he said that is to be expected and that it will probably last another seven or eight weeks. I also have a bit of "popping" in the joint when I flex the toe, but the doc said that is also to be expected since "the joint has to realign itself after the changes made to it during the surgery." This should also resolve itself in a few weeks. I no longer have to wear a bandage or keep the foot dry. (FINALLY...I can take a normal shower!!!) I can wear a normal shoe now.

I also had my fifth physical therapy session this morning. The therapist is starting to get a bit more aggressive with her treatment, and she really gave me a workout. It must be working because my foot is getting noticeably stronger and it's range of motion is dramatically increasing. I feel confident that it will eventually be normal.

At his point I feel that the worst is behind me. Also, the most dramatic improvement is probably behind me too, and from this point on my improvement will be much slower and more gradual. Unless this thread is buried so deep that I cannot find it in the spring, I will make a post after my first tennis match. That will be the REAL test of how successful this surgery has been.

Best of luck to everyone.

Screws are placed to fixate the osteotomy site. A cheilectomy is just removal of the born spurs and does not involve remodeling the lst metatarsal bone and does not require any metal implants. The cheilectomy is simple and much less invasive with a quicker recovery. "My" cheilectomy was unsuccessful because the doctor did not remove enough of the spur to allow the 1st phalanx to glide upward, ie, the bone spur was still in the way. This was confirmed on radiographs by other doctors (md and pod) when I sought alternate opinions.

I wrote a few months back (different thread) about my hallux rigidus, wondering what to do. Well, I had the cheilectomy done December 27. For me, the pain the first two days (after the local wore off) was incredible. As bad as kidney stone pain. Vicodin didn't touch it! The doc said I'd be able to walk on my foot right away, but it was only yesterday that I could do it without a crutch, and it was pretty painful by the end of the day. I've been icing all week, and keeping it up pretty much the whole time, so the swelling isn't too bad. Tired of laying around!

Anyway, I go back to the Dr. tomorrow to have the dressing changed and will have the stitches out next week.

Sorry to hear that you experienced so much pain. I can relate to getting bored with just sitting around, but try not to push it too much. You'll be up and around very soon. Good luck.

Hello everyone - I just wanted to give you an update on my progress. I met with an incredible podiatrist that treats a lot of runners and ballerinas and who has worked at the Olympics. She spent over an hour with me discussing my various aches and pains, from my toe to my leg. Before even looking at my x-rays, she told me what she would find - a metatarsal that is longer and higher than it should be. That is what's causing the hallus limitus. However, she noticed that I had decent range in the toe when the joint was allowed to drop down to the level of the other joints. Therefore, she recommended orthotics as opposed to surgery. She said that she has had many patients in the last 10 years with the same exact problem and that had good success with orthotics. Surgery is still a long-term option if the orthotics don't work, but for now, I'm going to take that route and see if it helps. Because I also pronate, they should correct my alignment and I should feel a difference in just a few months. Most of my pain comes from my leg from the misalignment anyway so we'll see.

I'll check in and let you know - but I was glad to hear that I don't have to resort to surgery until I've exhausted other options.

Did anyone else try orthotics before surgery?

Sounds like you found yourself a good doctor. I think many of them are a little too quick to suggest surgery.

In my case, after looking at the x-rays, even I could see that surgery would be required to solve my problem. Although my my outcome has been great, I would have much prefered to skip the whole ordeal. Good luck with your more conservative treatment.

Saw - What you are describing is called Functional Hallux Limitus where the joint only jams (has limited ROM) when weight bearing. I have the same thing and was able to put off surgery for 7 years by using orthotics.

I had an osteotomy w/cheilectomy on Sept 15. I'm still waiting for my foot to feel 100% "normal" again but otherwise I am doing good.

Even if the orthotics work for you too, keep in mind that HL is degenerative so it's only going to get worse with time. The big question though is how much time--months, years who knows? You can do damage by waiting too long for surgical intervention. But it sounds like you are in good hands.

Good luck with the orthotics! :jester:

I had my second Chilectomy done 3 months ago (I'm only 22!)
I recovered really quickly from the first op, and was back into serious sport within 8 weeks.
This time however, 3 months down the line it's still painful to walk - almost worse than before the surgery.

Make sure you get it done right the first time, so you don't end up like me!

Reecie - How long was it between your two cheilectomy procedures? Was the 2nd one needed because not enough bone was shaved the first time?

I ask because it may not be that it was done wrong the first time... It could just be further progression of the HL. If that's the case, I'm surprised that your doctor did the cheilectomy again instead of a more aggressive surgery.

Good to hear that you put off surgery for so many years! I do know that I will likely have to have it someday but for now am happy just to plug along with other treatment. I have started to break in my orthotics, but haven't run in them yet - the pamphlet my doctor gave me told me to wait 3-4 weeks to wear them full time and for working out. They are a little uncomfortable - I can wear them a few hours then my feet, hips, and lower back get sore. I know in the end they will help.

For anyone else with orthotics, how long did it take for you to feel an improvement from them, especially in your alignment and stride?

Thanks!

I am 51. I ski, run, bike, do taekwondo, tennis etc. Intensive physical sports are a big part of my life. I have had pain in both of my toe joints that started about 3 years ago. Extensive walking caused the most immediate pain. Running was less but I was usually sore the next day after running. The pain was very variable day to day and week to week but definitely became more frequent and more severe year to year. I was limited in the movement in my toe joints from probably 45 degrees 3 years ago to 25-30 degrees this year. One year ago I visited an experienced podiatrist. He diagnosed stage III hallux limitus (the podiatrist term) and said that I should do an osteomety and a fusion of the bone to the bottom of the metatarsal since I had a misaligned bone structure. Recovery started with 6 weeks in a cast. Doing both toes at the same time would require a wheelchair. Then visited a physical therapist who prescribed hot and cold water baths and exercises to increase range of motion but he consulted with podiatrist and felt that I had a more severe condition but suggested that I also visit the orthopedic surgeon near me who specializes only in foot and ankle. He said that I had stage II hallux rigidus (orthopedic surgeon term) and recommended cheilectomy. He also asked whether I wanted to go ahead though since my range of motion was pretty good in his experience. He gave me a 2006 study done by Boise, Id orthopedic surgeon that did long term followup on 100+ cheilectomies and reported good to excellent outcomes averaging 8 years out in 90+% of patients.

Based upon horror stories on this board and elsewhere, I then did Bikram (hot) yoga more intensively and eliminated the pain. I believe this was due to anti-inflammatory effect of hot yoga practice. However the pain returned over time and was worse this year.

4 days ago I did bilateral (both toes) cheilectomy with orthopedic surgeon. Surgery at 11:30 under general anesthetic. I walked out in surgical boots at 1:30. I was religious about keeping feet very elevated and icing for 48 hours. First night I needed hydrocodone plus ibuprofen (I would not take vicoden due to liver issues with combined tylenol) but slept mostly through night. After 48 hours just occasional ibuprofen, no narcotics. No pain at all when not on my feet. Walked around the house. On third day very mobile around town in surgical boots. Today (fourth day) walking throughout the day but slowly. Had bandages changed, surgeon said I could wear regular shoes so I could one size bigger to accomodate bandage. Minimal swelling in feet. Walking much better.

I was instructed to do range of motion exercises starting at day 2. Now have 70 degrees in each toe from 25 degrees before . Still a little painful on walking when bending toe but getting much better every day. Stitches scheduled to be removed on day 9 from surgery.

Surgeon is concerned that I had approx 30% of the joint surface on both toes with no cartilage so he thinks I will not be pain free for as long as he otherwise was hoping. Noone knows whether this will be 5,10 or 20 years. Next step if unacceptable pain returns is arthrodesis (joint fusion) which still leaves you able to do many activities.

So far I am pleasantly surprised with ease of recovery.

Sounds like you had a good surgeon. I will tell you that you need to be religious about the exercises. That will make a world of difference. I had a cheilectomy 4 years ago and it turned out great. I hope I get the 10-15 years out of it my surgeon thinks I will!

BTW, why did he say go to fusion next? My doc, and several others I have read about, say do the implant next.

The research that I have reviewed as well as my doctor's experience (I don't know if he himself has done implants) is that the implants are problematical and wear out. Perhaps there are now "second generation" ones that work but I wouldn't want to be a guinea pig. I believe it is more problematical to do a fusion if you have done an implant. I think it depends upon how active you are. In my case with a lot of outdoor athletic activities, my doc recommended the fusion in the future if pain returns since his patiients have not been slowed down by it. You will of course not be able to sprint at the same level as before since you can't push off on the toe.

Titchou:

Was all your cartilage intact when you did the cheilectomy or was there some, like mine, that was gone?

rgreenburg,

Congratulations on what seems to be a great recovery so far.

I just turned 55 and, like you, am very active...avid tennis player (singles, hard courts). I had a cheilectomy during the last week of November, so I am now 12 weeks post op. Although I have yet to play full speed tennis (due mostly to our terrible Ohio winter), I have no doubt that I would do OK. I still have some very minor swelling that the doc said might take months to resolve, but I can fit into all my shoes with absolutely no pain. There is some minor "popping" in the joint if I push it to extremes, but the doc assured me that it is not bone-on-bone, but a soft tissue adjustment that will work itself out in time. It causes absolutely no pain, just a rather disconcerting "pop." :eek: I have noticed that it is getting better with each passing week. When the doc took my initial pre-op x-rays, he said that I had plenty of good cartilage, but during surgery he discovered that some of it had worn away. He drilled a few holes into the remaining cartilage hoping to promote some new growth. Don't know if it is working, but I have had no issues with it.

Like most people, I did a ton of research before my surgery. Now, three months post-op, and am very pleased with my result. I'm glad I did it.

Best of luck with your continuing recover.

Oh yeah...gutsy move getting both of your feet done at the same time.

Yes, I had some cartilege left. My doctor also drilled the holes to promote growth and I believe it helped. I also have the popping in the joint at times - like popping your knuckles. Doesn't really bother me though.

David614 - thanks for the update. It gives me much to look forward to. I asked my doc about the drilling to develop faux cartilage. He is not a believer in it for the toe. He is part of an orthopedic practice where the knee doctor (who is the ortho for the US Ski Team) did a microfracture surgery on my left knee 9 years ago which was very successful. This involves "drilling" small holes in the kneecap and the scar tissue from the fractures becomes pseudo cartilage. However, he told me then that it only works if you are immediately put on a knee motion machine for 3 hours per day or spin on an exercise bike for 2 hours per day for one month. I chose the latter. It is hard to see how you could get the same motion in the MTP joint for a month so I concurred with my ortho who did my surgery not to do the microfracture.

I had the popping in my right toe joint before the surgery. None now though.

Hi, guys. Im totally new to this site. I just joined 10 minutes ago, after sitting and reading the postings for an hour.

I have had Hallux rigidus for about 8 years. I have been to podiatrists and had conservative treatment . I was nearly incapacitated when they took Vioxx off the market. I now use celebrex which makes me walk like a human being. With advil only I limped everywhere.

I cant wear my nice shoes. I dont even mean heels I have reconciled myself to not wearing my heels. My most comfortable footwear are Ariat cowboy boots.

However I stopped running about 7 years ago. I ski without too much of a problem unless its cold getting into my boots.

I hike put up with the pain and then spend the week after the hike limping around.

It hurts to push off swimming so I stopped pushing off last year. I kayak in the summer but I have to be careful not to push down too hard on my foot when really working out hard.

I saw an orthopedist today who specializes in foot AND ANKLE SURGERY and he told me I had two choices a cheilectomy or a fusion. I have an 8 year old and Im a single mother so the idea of being off my feet and in casts etc seemed intolerable. However the orthopedist said that although he could still do a cheilectomy at my stage, he recommended a fusion as that would get rid of the probelm once and for all. Again the idea of going through the horror one foot at a time is gruesome.

However I am a young young 51 and I worry about ultimately having to have a fusion when Im old and not as strong and limber.

Do you know of anyone who has had a cheilectomy who has not needed a fusion down the line?

In fact any advice on any of this would be greatly appreciated as Im at my wits end. Im going skiing in two weeks and hiking over the summer so Im guessing I would schedule whatever for the fall.

hi david, i live in the chicago area and i am just wondering what dr. you went to. i really need to see someone since my toe fusion i had in nov isnt going well. thank you so much- debie g and snowbird if you can stay away from fusion, you should. thats my opinion, but i do think drs know best. debbie g

I am 61 and had a cheilectomy 4 years ago. I jog, dance, wear heels with no problem in the toe. I went to a sports med ortho who specializes in feet only.
He was wonderful. It is my understanding that he expects this procedure to last for about 15 years at which point we would go to an implant. Only after that would he do a fusion. Hope this helps. Oh - and i miss my Vioxx too!

Again the idea of going through the horror one foot at a time is gruesome.

Do you have to have surgery on one foot at a time? Although my doctor didn't encourage it, last spring I had bunionectomies & hammertoe surgery on both of my feet at the same time. I have absolutely no regrets about having it all done at once! I chose to do it that way for several reasons—even though it was more time away from work initially, I felt that it would be less total time off than with two surgeries. Secondly, I knew that a huge part of recovery is to keep one's foot elevated and iced—It’s pretty hard to get around while your foot is being elevated, so I figured why not elevate both feet at the same time? Same with pre-surgery exams & check-ups, dealing with side effects from anesthesia, pain drugs, etc.—Two for the price of one. The main reason my doctor isn't generally enthusiastic about doing double procedures is concern that patients may not follow orders for recovery. I assured him that I would be compliant and that I had the support I needed from family and friends. I did well and he ended up being very satisfied with the whole situation. (BTW, I wasn't that dependent on others--by keeping a well-stocked small fridge with a freezer section for ice packs/drinks/food, other snacks, meds, toiletries, books, TV remote, laptop, phone, and other such resources within reach, I was able to be pretty self-sufficient.)

Hi, guys. Im totally new to this site. I just joined 10 minutes ago, after sitting and reading the postings for an hour.
Me too. :) Looks like there's a lot of good info here.


It hurts to push off swimming so I stopped pushing off last year.
Same here - I noticed that when pushing off the wall the big toe joint hurt. It was like that for about 3 months, just a nuisance, before I really examined the foot and found some sore spots on the joint. Went in to a foot doc who x-rayed and pronounced HR.

Celebrex isn't helping at all, so she wants to do a cortisone shot. I'm wondering how that helps, since the bone spur isn't going to be affected by an anti-inflamatory?

The HR is becoming a nuisance, I notice it whenever I walk very far, even in a supermarket. The orthotics she gave me (flat feet) seem to make the problem *worse* so I quit using them.

The pod said from the x-rays it looked fairly mild, and I'm certainly not in great pain or anything. She said that sometimes they'll find a lot of calcination that hasn't gotten bad enough for the x-ray to pick it up, so surgery is an option, the chileo-thing.

I'm 38 and pretty active. I can't imagine never taking a long walk again without soreness. I'm hesitant to do anything surgical, but I would like to get it taken care of it now when it's mild if it's only going to get worse. I am going to get a second opinion.

What do you guys think? It sounds like you have all been facing the pain of HR for years. Is it too soon for me to worry about it, or should I fix it when it's still small and easliy fixable?

KathJack - My reasons for choosing to do only one foot at a time was because 1) I wanted to have a "good" foot to fall back on while the other recovered and 2) my second foot wasn't quite as bad and surgery wasn't needed yet. Plus, I read somewhere that statistically speaking people who have both done at once generally don't have as good results. Whether true or not, I can't say. I know that docs generally discourage having both done at the same time.

Ireland - A cortisone shot is only a short-term solution which may be all you need for the moment to help you deal with the arthritis pain. However, as HR/HL is degenerative, surgery will usually be called for at some point.

When considering surgery, just keep in mind that a cheilectomy doesn't permanently "fix" the problem, it just rolls back the clock--hopefully for 10-15 years. The doctor can take off the bone spurs (thus allowing for better ROM) but the spurs will eventually come back. Or your cartilage could deteriorate further. Which is why an implant or fusion would be called for in the future.

For my FHL (Functional Hallux Limitus) which is caused by a long and/or elevated 1st met, I had an osteotomy & cheilectomy. The osteotomy was to actually shorten my metatarsal bone to allow the joint to function properly. The intent being that by addressing the underlying mechanical issue, the bone spurs won't return and this will be a permanent fix. Got my fingers crossed! However, I could be looking at an implant and/or fusion down the road too. But you got to try ;)

I'm 38 and pretty active. I can't imagine never taking a long walk again without soreness. I'm hesitant to do anything surgical, but I would like to get it taken care of it now when it's mild if it's only going to get worse. I am going to get a second opinion.

What do you guys think? It sounds like you have all been facing the pain of HR for years. Is it too soon for me to worry about it, or should I fix it when it's still small and easliy fixable?

As the OP of this lengthy thread, I was in the same place you are just a few months ago. I wasn't in terrible 24/7 pain, but my HL was a nuisance and was starting to limit my activity. Also like you, I was not at all thrilled at the prospect of surgery. But, the more research I did, the more I was convinced that the "conservative" treatments merely postponed the inevitable, and that the only real fix was surgical. I also learned that HL, unless treated, will get progressively worse and will do more and more damage to the joint, possibly requiring a more extensive and debilitating surgery than would have been required if treated earlier. So...I took the plunge and had a cheilectomy in late November of last year. Now, 15 weeks post-op, I have the occasional ache and some very minor swelling, but it is MUCH better than it was before the surgery. In fact, today I played my first tennis match since the surgery. I had absolutely no pain.

Of course, everyone is unique and will experience their own surgical outcomes. I've read some horror stories on this and other forums. But based on my experience, if I was in your (painful) shoes again, I wouldn't hesitate to have the surgery.

Good luck with whatever course of treatment you choose.

Misfish and David, thank you for your input. Your info gives me a better starting point when I see the second pod for a second opinion. The med sites I found didn't answer my questions like you guys did. Best of luck to you, Misfish!

David, since I've been "following your case" since October in this thread (well, reading it all in the past couple days, but you know what I mean), it's GREAT to hear things went well for you! Congratulations! Tennis must be a pretty good stress test for feet, so if you can manage that all right that's a heck of a success story.

David, since I've been "following your case" since October in this thread (well, reading it all in the past couple days, but you know what I mean), it's GREAT to hear things went well for you! Congratulations! Tennis must be a pretty good stress test for feet, so if you can manage that all right that's a heck of a success story.

Yes, I had a good outcome. I'm pleased. Wishing you similar luck.:)

I am 61 and had a cheilectomy 4 years ago. I jog, dance, wear heels with no problem in the toe. I went to a sports med ortho who specializes in feet only.
He was wonderful. It is my understanding that he expects this procedure to last for about 15 years at which point we would go to an implant. Only after that would he do a fusion. Hope this helps. Oh - and i miss my Vioxx too!

I am 61 and had a cheilectomy 4 years ago. I jog, dance, wear heels with no problem in the toe. I went to a sports med ortho who specializes in feet only.
He was wonderful. It is my understanding that he expects this procedure to last for about 15 years at which point we would go to an implant. Only after that would he do a fusion. Hope this helps. Oh - and i miss my Vioxx too!

I am 65 and have been told since I am a very active senior citizen that I have to have the toe fusion. This was due to the fact that the joint replacement would wear out and I would have to have a fusion eventually. I am surprised that you seem to have been told a totally different thing. I am very active as I play tennis, do a lot of line dancing, ballroom dancing, party dancing, aerobics, etc. If it lasts for 15 years, that would make me very happy. How are you doing now?

I'm doing great. What kind of doc did you go to? And where is Trinity? I always refer people to the nearest pro football or basketball team to find out who they use for this (it's also called turf toe and runner's toe). Or the nearest major college athletic program. They all will have an excellent doc they use for this. Don't go straight to the fusion unless you have no cartilege left to speak of. It's a very long recovery period though you most likely can still dance and do aerobics...it could be a year before you'd be able to. I was dancing about 3 weeks after sutures were removed - very gently dancing and in Merrell shoes with duct tape on the soles so they would slide...but I was dancing! I do cajun and zydeco with some ballroom every now and then.

Trinity is actually a new suberb of New Port Richey, which is north of Tampa, Florida. I have no cartiledge left. It is bone on bone with a spur on top. I saw the xrays. I have been getting shots for several years now and did not know just how bad it really was since the doctor I had before never took any except the first time I visited him. I had to change doctor's due to being on medicare now. I just got home from a dance at the clubhouse and my feet are killing me, especially the bad one. And I had my last shot last week. It hasn't kicked in yet and probably won't last more than 3-4 weeks, since my last one only lasted that long. I am trying to put the surgery off until summer when I can stay home where it is cool, lol

No cartiledge is tough. Have you discussed an implant(joint replacement)?

Yes, but it is for couch potatoes according to the doctor. He says it just doesn't hold up to activity and people end up getting the fusion anyway. I had a total knee done two years ago. I was really hoping for the joint replacement. I wish there were more posititve stories on this site. The negatives are what makes the surgery so scary.

Hello Everyone - I have been following this thread for some time now as I am looking at surgery in May for HR. I am in Fla for the winter months, Medicare just kicked in and I had a real problem when 2 PODs in same office disagreed on what procedure would be best for me! One recemmended a cheilectomy, the other recommended an implant. Since I am leaving here on 4/28 for my summer home in PA I've decided to have my surgery done up there by an Orthopedic Surgeon in a major medical center. I will see him on May 7 and have no idea what he will recommend now. Last year he did mention doing the cheilectomy with the idea that the procedure would probably last for 15-20 years. My foot has gotten much worse in the past month.

I do have a questions for those "in the know". What is the draw back of having a fusion? I am 65 and my goal is to be able to walk long distances without pain. I play golf, no tennis, no dancing, etc. I don't want to look at additional procedures down the road. I am very active and the idea of being off my feet for a few weeks is driving me nuts....Also, can you drive with the surgical shoe? I live on top of a mountain 45 minutes from everything!

I'll appreciate any thoughts those with experience might have.

Have a great day everyone!:wave:

Ok, here's the deal. You're 65...you get 15-20 years out of the cheilectomy. You'll be 80-85 when you are looking at POSSIBLY doing something else. You may not need anything at that point. And you will have had no limitations in the meantime. If you have the fusion, you're done. That's it. Nothing else can be done. And during those 15-20 years when you could have had no limitations on your activities, you will have limitations.
Not to mention that the recovery time for the fusion is MUCH longer than for the cheilectomy.

Driving in the surgical boot...not on the right foot - in fact, it's illegal. Mine waas my left foot so I just drove my car with automatic and left the sports car with stick in the garage.

My suggestion to Mkenyon2 - find out who the Bucs use and go see him/her.
Stitcher, you don't show where in FL or PA but I suggest you contact the local pro basketball or football team for their doc's name. The reasons I suggest this is that this condition is also called turf toe and runner's toe. These docs are very well versed in this injury. They operate on multi-million dollar assets and have to be good. Their goal is always to get the patient pain free and back to the activities they are involved in. Most docs just want to fix it according to their criteria - not yours! The doctor I used here in Birmingham operates on pro athletes, does only feet and ankles and is very well known and respected. He removed a neuroma one year and did the cheilectomy the next. Both have worked out great.

Good luck to you both.

if you can skip the fusion-go for it. debbie g

Thanks for the information. I also have a neuroma on the same foot and a hammer toe on the second toe. I was hoping to have it all done at the same time. I am on medicare and have to go to the doctors that my insurance covers. I will check, but am almost sure that the sports med docs don't use my insurance. This is the first time in my life that I don't have a choice and it is really bugging me. But I will look into it. Thanks again.

Good information.

This is my RIGHT foot. UGH ... So, how long would you anticipate I won't be driving if I just have the cheilectomy? Guess I had better stock up on lots of good books. I am an avid quilter and hopefully I'll be able to use my right foot to sew with as well, boot or no boot....

I am getting less and less excited about this......


Regarding insurance. I have Medicare and AARP Suppplimental Plan F and have been told no matter what the cost, dr's participation, etc. I am covered 100%. Am I missing something here?

Thanks again everyone.

Well, my experience was I had the boot on for about 3 weeks....two until the sutures were removed and about 5 days after before I could get into another shoe comfortably. I could walk too...walked out of the surgery center day of surgery. So you should be able to walk. It's just the boot is problematic and they don't want you driving with it on your driving foot as it's big and you might hit the gas when you go to hit the brakes. I danced at about 4 weeks. He told me the total recovery time was maybe a year for all things to settle down and that's about right. I do still take an anti-inflammatory every morning (Vioxx when it was on the market and now Aleve). I had about 40% cartlege left and they drilled holes to make it grow. SOme people don't think that helps but I can tell a difference. I think it's been about 4 years or mrore since my surgery and I have pain every now and then and it does get sore sometimes when I overdo, but all in all, great outcome. Would do it again.

And there are a few docs who don't take Medicare - I've seen a sign or two in offices - but most seem to. It won;t hurt to call and ask.

If either of you want to come to Birmingham to have it done, I recommend Dr. John Gould. He's my hero!

Thanks again for your time and information, Titchou...

I will be checking in again after the 7th to keep you updated on my situation. I am confident with my choice of Dr's and medical center as I have a referral from a former patient who had very successful surgery last year. Traveling 3 hrs to Philadelphia or 6 hrs to Pittsburg isn't an option for me. Geisinger Medical Center in Danville does enjoy a great reputation in all specialities so that's what I have to go with.

Good luck everyone. I'll keep you all posted and hopefully my experience will be helpful to others.

I have an HMO which doesn't give you a choice of doctors, but I get my meds free. That is why we picked Humana Gold Plus. We also get the use of the "Y" free of charge which I use. But I found out all the good orthos are on my plan so I will pick one of them.

Good deal to both of you. Be sure and check out the doctor..seriously! Find out how many of your procedures he's done, the outcomes, why he prefers a certain procedure over another. Be sure he understands your expectations for this. And see if he has any patients who have agreed to be references if you can't find someone on your own who has used him. Keep us posted!

Find out how many of your procedures he's done, the outcomes, why he prefers a certain procedure over another.

_______________


But how do you do this?

you might hit the gas when you go to hit the brakes.

_______________


Couldn't you use your left foot to work the brake pedal?

Stitcher - consider practicing your hand quilting rather than machine quilting at least for a few weeks. I had grand ideas of sewing during my recovery but I found swelling and pressure to be an issue when I didn't keep my foot elevated. If you can rig your presser foot up on a chair and push with your heel you just might manage it though. Good luck!

JoeFine- you can but that's not the way you are supposed to do it. The real issue is that it is against the law....and after having a boot 3 times on my left foot, I'm not sure that it's all that easy to do with your right.

Thanks everyone.

I am taking good notes. Guess I'll definitely stock up on good books and DVD's to watch.....

I am SO NOT looking forward to this.....:dizzy: Just how many weeks do you think I will looking forward to being totally out of commission regarding driving etc? I realize a lot has to do with the actual procedure, etc., but just a tiny estimate??????

Unless there are complications, you should be walking from day one and driving once the boot is off. I still had some swelling after the sutures were removed at 2 weeks so I kept wearing the boot for about 5 more days. I will tell you this - take your pain meds! I thought I'd try to gut it out when I got home from the hospital...baaaad idea! Once the stuff they had given me wore off, the pain was pretty bad. Took a couple of rounds to catch up. I was on the pain meds for about 4-5 days and then just Aleve.

Hi Titchou

I am so grateful for your inside information.

What pain medication was prescribed for you? Did it make you sick? I usually don't do well with stuff like that. I have Compazine which I take for migraine headaches if I need it. Guess I can always ask for an anti-emetic as well.

Do you also ice periodically throughout the day? How about a bag of frozen peas, good enough?

How about sleeping and blankets, etc. Does the weight bother you? I though about making a "tent" for my foot!

Again, my thanks
Linda

Linda: I took Lortab...worked well for me. And no, I didn;t ice it. And it was so thickly bandaged that there was no need for a "tent". My doc is known for huge bandaging! I doubt any icing would have pentrated it!

compazine is an antiemetic. Why don't you take imitrex or one of the other meds made just for migraines? Compazine knocks me out but is my favorite antiemetic.

Oh yeah...also make sure they give you - or you get - a cast cover. It's a rubber thingy that goes over your foot up to the knee so you can bathe and shower. Don't know what I would have done without it!

WOW - my laundry list grows. I'd DIE without a daily shower.....I'll also have stairs to deal with.....probably be crawling up/down for a few days! YEEKS....

I will be honest about this...I have a high pain threshold so I end up doing more than most people (like jogging 2 miles a week after having my gallbladder out). I had the cheilectomy on Wednesday, stayed home all day Thursday, got a manicure on Friday, went to a book signing for a friend on Saturday and work on Monday. But I'm just that way....too stubborn to sit around....

I hope to be "up and running" in short order. I also experienced NO problems after my GB was removed and used nothing but Tylenol....I am probably in more pain now, after stubbing my toe two weeks ago in my bare feet, than I will after the surgery...hopefully, at least. It will be SO good to get this over and done with at last. I really miss my marathon walks....

It's so nice of you to share your knowledge and experience, Titchou.

I'll alert everyone as I get closer to my surgery date. Dr's Appt is 5/7. I am currently in Fla and getting ready to pack up and go north for the summer. The little mountain top town I live in just had 8 inches of snow and has been without power for 3 days. Maybe I am leaving a little too early, it's gorgeous down here today!!

Cheers,
Linda

i have hallux limitus stage II. my podiatrist has recommended that i get surgery sooner than later, as the damage will only get worse. i have it both feet and his plan would involve doing each surgery seperately. i've noticed that some on this board have had both at the same time. any advice on which course is better would be very much appreciated. i am probably leaning towards both at the same time, just to 'get it over with', but am nervous about having 2 bad feet at the same time.

Hi tjb,

Interesting what your Dr. told you. I went for my pre-op visit last week and Dr said he doesn't push surgery and also said my condition "may" not get any worse.... but that the bone spurs would probably continue to grow. He didn't mention what stage I am at but I estimate it to be stage IV. He said he could eliminate the pain I have been experiencing but did mention various residual problems that could crop up. Even though my toe doesn't elevate more than 10 degrees, with my orthotics and a metal plate worn underneath it, I found I could walk for 30 minutes the other night without my foot feeling any worse. I now put my shoes on first thing in the morning and don't remove them until I go to bed which helps. Are you in pain when you walk barefoot? I am not but I think I am starting to walk on the outside of my foot more. Don't think that is good.

My surgery was scheduled for 6/7 and I canceled it. My POD was very understanding and accomodating. I am 65 and decided that if my foot doesn't get any worse than it is now, I may not do anything. I am concerned about making the situation worse.

What procedure is your Dr. recommending. Mine is the Keller Procedure. Dr. says he has good results with this and said I would also continue to wear special orthotics afterwards but I could also wear dress shoes and sandals which I cannot do at the present. An implant was his first recommendation but I don't want someing in my foot that may break down in the future.

I hope I haven't made the wrong decision to caancel. I was emotionally and physically ready to do this. I don't believe the recovery time for the Keller procedure is as long as those where screws and pins are required. Basically mostly soft tissue recovery.

Please keep me posted on your decision and progress. I am sure I am not done with this problem. All I need is a flar up and I am re-scheduling.:)

Have a great day....

Hi tjb,

Interesting what your Dr. told you. I went for my pre-op visit last week and Dr said he doesn't push surgery and also said my condition "may" not get any worse.... but that the bone spurs would probably continue to grow. He didn't mention what stage I am at but I estimate it to be stage IV. He said he could eliminate the pain I have been experiencing but did mention various residual problems that could crop up. Even though my toe doesn't elevate more than 10 degrees, with my orthotics and a metal plate worn underneath it, I found I could walk for 30 minutes the other night without my foot feeling any worse. I now put my shoes on first thing in the morning and don't remove them until I go to bed which helps. Are you in pain when you walk barefoot? I am not but I think I am starting to walk on the outside of my foot more. Don't think that is good.

My surgery was scheduled for 6/7 and I canceled it. My POD was very understanding and accomodating. I am 65 and decided that if my foot doesn't get any worse than it is now, I may not do anything. I am concerned about making the situation worse.

What procedure is your Dr. recommending. Mine is the Keller Procedure. Dr. says he has good results with this and said I would also continue to wear special orthotics afterwards but I could also wear dress shoes and sandals which I cannot do at the present. An implant was his first recommendation but I don't want someing in my foot that may break down in the future.

I hope I haven't made the wrong decision to caancel. I was emotionally and physically ready to do this. I don't believe the recovery time for the Keller procedure is as long as those where screws and pins are required. Basically mostly soft tissue recovery.

Please keep me posted on your decision and progress. I am sure I am not done with this problem. All I need is a flar up and I am re-scheduling.:)

Have a great day....
i am not sure what procedure my POD is recommending although he described it in two parts. one is cleaning out the toe and the other involves 'shaving' the bone a bit to correct the range of motion issues.

i am certainly not eager to have surgery, but i like to keep pretty active (i walk about 2.5 miles a day going to and from work, plus i work out (weightlifting, stationary bike) around 4 times a week. prior to my diagnosis i also used to run, but this is no longer an option. i would love to get back into that at some point and surgery seems the only way to accomplish this. i'm pretty young (37) so i'd rather take care of sooner than later if i can.

i certainly understand your hesitation on your own surgery. everyone's situation is different, so in the end you have to make the choice that works for you.

cheilectomy is cleaning out the joint and osteotomy is shaving/angling the bone. I had these done about 5 years ago. It's great to be back running!
Good luck to you!

I was told by 2 PODs that a cheilectomy was not an option for me due to the loss of cartilege. I've also been told that bunions, bone spurs, etc. can grow back......yeeks. Don't think I have enough time left to worry about that!

I realize I will most likely be sorry I didn't go through with the surgery this week but I do have 5-6 months to go before I return to Fla for the winter. I am stepping up the power walking to see how I do. I found a POD I have complete trust in so will see how things go by August. I will not entertain the idea of having it done down there....

I am eager to hear how everything goes for you.....

Hello everyone - I just wanted to give you an update on my progress. I met with an incredible podiatrist that treats a lot of runners and ballerinas and who has worked at the Olympics. She spent over an hour with me discussing my various aches and pains, from my toe to my leg. Before even looking at my x-rays, she told me what she would find - a metatarsal that is longer and higher than it should be. That is what's causing the hallus limitus. However, she noticed that I had decent range in the toe when the joint was allowed to drop down to the level of the other joints. Therefore, she recommended orthotics as opposed to surgery. She said that she has had many patients in the last 10 years with the same exact problem and that had good success with orthotics. Surgery is still a long-term option if the orthotics don't work, but for now, I'm going to take that route and see if it helps. Because I also pronate, they should correct my alignment and I should feel a difference in just a few months. Most of my pain comes from my leg from the misalignment anyway so we'll see.

I'll check in and let you know - but I was glad to hear that I don't have to resort to surgery until I've exhausted other options.

Did anyone else try orthotics before surgery?
I've worn orthotics for years, but I think it's time for surgery. Your LA podiatrist sounds excellent. Can you give me her name? Many thanks

Hi this message is for Saw339 - I have been reading these boards and have been very intrigued by your experience. I am 27 years old and very active (running, hiking, etc.) and am devastated to find out I have Hallux Rigidus. I do not want surgery (at this age), but am not sure what else to do . I am scheduled to get orthotics in the next few weeks. I am interested to see what you decided to do and how your foot is feeling. Are you active with the orthotics now? I appreciate anything you can provide!! thank you. thank you

I am 50, and an avid tennis player the last 5 years or so.

I developed this toe pain about 15 years ago in my right foot and had an chilectomy done at that time. The doctor didn't tell me anything about it other than it was bone spurs which developed the growth which limited movement and he needed to cut out some of the bone so I could get back movement.

Five years ago I developed the pain and limited movement in my left foot. At that time a different doctor told me more about it, that it was due to arthritis and that I have two choices chilectomy or fusion. That he coud do the chilectomy to provide movement but the pain would progress due to loss of cartilidge. I had the chilectomy done to that foot as well.

I was OK over the years after the surgeries with aches and pains in both feet. The last few months however, the left foot has been much worse. It can even wake me up at night with throbbing pain. It is particularly bad after a tennis match or after a lot of walking.

The left toe now has no upward movement capability again. I have put a rigid sole made for turf toe in my left tennis shoe and it does seem to help some.

I guess it is time for either another chilectomy in the left foot, fusion or the osteotomy.

I wonder if my first doctor was a better surgeon, or if he actually did an osteotomy. I notice the incision on my right foot is higher, on the top corner of the joint, while the left foot is totally on the side.

Time to see the doctor again, though, I don't believe my current insurance will cover it. They consider it a pre-existing condition.

I suppose I could try switching insurance again to one which wouldn't consider this an exclusion and waiting a few months until I can be covered for an elective surgery. My current insurance is really more of a group sharing plan, Medishare, and it is very restrictive. They consider any condition that I had prior, at any time, as an uncovered prior condition. They wouldn't cover a kidney stone problem I had because I had a prior kidney stone 13 years earlier!

Julieb - I just saw your message. I don't check these boards any more but am glad to help you because it sounds like we are going through similar things. The orthotics are helping me when I wear them consistently but mostly I've just learned which shoes I can wear regularly and which ones will make my toe hurt by the end of the day. I did run the marathon last year and as long as I didn't run too fast my toe never got too painful. Since then I've been diagnosed with Rheumatoid arthritis and now have stiffness on and off in my hands so I can only assume that the arthritis in my toe was just my first arthritis symptoms rather than isolated issues. So I do probably have hallux limitus but I've opted not to treat it surgically for as long as I can. I tolerate the pain okay - the only thing that helps is to wear orthotics religiously. I don't like to wear heels anyway and I doubt it will get much worse in the next 5 years or so based on the past 2 years.

Hope that helps.

Hi Julieb,

I totally sympathize with your situation. I have (had) Hallux Limitus/Rigidus for several years. Over the years as my HL/HR increased I made the normal adjustments in my daily living. I decreased my power walks, I wore orthotics intermittently, then constantly. I give up everything but wide comfortable sneaksrs. I also consulted not less than 6 Dr's seeking someone who would have a magic cure so that I could avoid surgery, etc. I scheduled surgery last summer only to cancel it days before. Becasue I was fearful of surgery and potential complications I felt would rather put up with the discomfort and limited foot wear. Then, suddenly, after a 40 minute walk with my dogs that left me extremely painful, I realizes this was NOT going to improve and only get worse as the years progressed. So, I finally had the surgery performed on June 23rd. It's been 4 weeks, my foot is still bandaged but I am looking forward to a good result. It is too early to tell whether I've had a perfect outcome but I made the decision and stuck with it...I opted not to have an implant or fusion. Instead, I had what is called a "Keller Bunionectomy". It's an older procedure that isn't imbraced by many younger Dr's and it is primarly suggested for older less active people. (HA,, he is 40 and I am 66 and VERY active) The recovery period is much less than a fusion. My Dr. tells me we will discuss transitioning to a shoe next week. HOORAY!

I'll keep you posted on how I do. I have complete faith in my Dr. his experience and his recommendation. He is Board Certified and is the POD for a major univeristy's athletic dept. A friend of mine had the same procedure on both her feet and now walks 5 miles a day.

Hope my experience was helpful. I'll keep you posted...Next PO visit Tues.

Have a great day...