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Old 10-16-2008, 02:56 PM   #1
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any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

Hi everyone,
I finally saw a podiatrist this year after suspecting for years that I have hallux limitus/rigidus. He confirmed it. Mine is caused by an elongated first metatarsal (in both feet). I've got nice big bone spurs on each big toe with some loose bone floating around in one joint. I also have Morton's neuroma in both feet, because of the way my feet have been rolling off to the outside for years.

We've started conservatively with orthotics, but the recommendation is for eventual cheilectomy to clean up the joints and shave off the spurs, and osteotomies to shorten the first metatarsals. My concern is this - I love to dance. I take ballet and modern dance classes regularly and while I'm not a professional, I can't imagine not dancing. It's the thing I love and it's what keeps me sane. I'm not afraid of surgery itself, since I've survived an arthroscopy for a hip problem with no ill effects, and I'm not expecting to recover overnight, but I do want to know what I'm getting myself into here. Can I expect to be able to go back to class within a few months of surgery? I'm concerned about the stability in my foot and particlarly in the first metatarsal joint after the surgery. I spoke to someone recently how had a cheilectomy only to clean up the big toe joint and she said that 4 years after surgery she still doesn't feel stable on that foot.

Any dancers out there who can comment on their experience?

thanks!

 
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Old 10-16-2008, 10:53 PM   #2
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

I am a former dancer who now dances for fun. As a start, go back and read my posts. I have been very happy with my surgery but I was at the point where I had only 10% ROM in my joint and I was out of options. It also depends upon how much cartiledge is left in your joint. 30-40% of former dancers have this condition. At 4 months out, my balance is wonky on one foot, barefoot, but I can do everything else. I don' t trust my axel turns but I can live with that. My balance is ok with stiffer jazz shoes. I can do inside turns but have been holding off on outside turns until the joint is remodeled further, a process that takes up to 8-9 months. I had both cheillectomy and osteotomy with a pin. I found that sports medicine docs did not take me and my needs as seriously as my own podiatrist. I shopped around a lot.
I was non weight bearing for most of 8 weeks but quickly went back to class after that. I postponed jumps a bit more. For me, I cannot overstate how beneficial the surgery was.
PS if you are flexible, it is very easy to be non-weight bearing because you just put the foot up on things, like the kitchen counter.

Last edited by dncergrl53; 10-16-2008 at 11:02 PM.

 
Old 10-17-2008, 06:54 AM   #3
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

thanks dncergrl53. I did read some of your posts before posting my own message, but at some point I didn't see any more messages from you, and I was wondering how things turned out. Your post is encouraging. I'm hoping that since I'm relatively active and healthy, without complicating factors like diabetes/weight issues/etc., that when I elect to have the surgery, it will go well. I had hip surgery a few years ago was able to get back into class about a month after the surgery - not doing things like jumps or and sort of fast, explosive movement like grand battement - I took it easy and just focused on maintaining my mobility and strength, and was back to my regular classes within 4-6 months. I'm hoping that a similar slow and steady approach will help with this, even thought the two surgeries are obviously quite different. In fact, I would think that a lot of the barre exercises from a ballet class, like slow, simple tendues (on flat, no releve) where you're really working the foot would actually help strenghten the foot and restore flexibility.

Last edited by Boots72; 10-17-2008 at 06:56 AM.

 
Old 11-29-2008, 11:02 AM   #4
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

Hi boots and dancergirl -
I am also a former ballet dancer, currently aged 34 with Hallux limitus. I haven't had surgery yet but wanted to just chime in -- reading about other dancers or former dancers on this forum is EXTREMELY helpful to me as I try to inform myself and decide what to do. Keep up the great posts :-)

I do have a question -- I'm in the San Francisco Bay Area. Can anyone recommend a good pod or ortho here? I am looking to go to SOAR Medical Clinic as they treat local sports team members (football/baseball,etc) -- but I also know that as a dancer, only dorsiflexion isn't enough for me -- I want to be able to plantarflex in the future too. Any suggestions are most appreciated.

(I was out of the US when i injured the toe so haven't yet been seen by someone Stateside).

 
Old 11-29-2008, 03:31 PM   #5
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

Hi F- D. Since you talk about an injury and you are relatively young, perhaps your hallux rigidius arose from simpler factors than mine and might be easier to treat. Mine was very long in developing. I am able to plantarflex the toe and it is pretty close to the unaffected toe, although not perfect. I just worked on ROM in that direction, too. In the end, you want the most functional toe and you might have to compromise.

I haven't been posting much because I have been dancing!

I also went to sports med guys and in my personal experience they did not take me as seriously as my own pod who I had a relationship with and who did all the conservative treatment with me first. The sport med guys I saw did not understand how dancers need to use their feet and did not seem interested in learning about it. I remember showing the ROM of my good foot to the ortho and he was surprised. But did not ask to see it, like my pod did.

Last edited by dncergrl53; 11-30-2008 at 05:35 PM.

 
Old 11-30-2008, 05:04 AM   #6
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

One poster a while back had called the local professional ballet company (forget where she lived but it somewhere like New York and she maybe called ABT) and asked what doctor they used. Since all of you would like someone with an understanding of dance, I'm sure that would be a good way to get a valid referral. I'm not up on which ones are well known in DC or SF, etc....

And while my problem was caused from years of jogging and wearing high heels, I do also enjoy dancing (Cajun, Zydeco, ballroom, East and West Coast Swing) on a regular basis and have no problems with any of it. I do take 2 Aleve every morning and before going to a dance in the evening but not before jogging in the afternoon. I can pick up towels with the toe so bending either way is fine.

Last edited by Titchou; 11-30-2008 at 10:19 AM. Reason: add info

 
Old 11-30-2008, 06:06 PM   #7
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

For you dancers, I discovered that in jazz class, my foot is much happier not being barefoot, so I wear foot thongs instead. That decreases the friction on the bottom of my foot, for turns and for tondues, etc. Then I have different shoes for turning (that are not sticky and have lateral support across where the ball of the foot is) and spongy jazz sneakers for jumping (like big jetes across the floor). I spend all class changing my shoes, but my foot is happy. If we do big jumps and turns together, I am up the proverbial creek, but decide which is more fun and do it with the proper shoes and mark the rest. I do not turn with sticky shoes because it would be too much torque on my still recovering foot (at 6 months out).

You have to be careful about "working the foot" againgst the floor because you don't want to stress the joint (hence the foot thongs, etc.)

I can do chaines now but my en dehors turns are wonky because my big toe is shorter than it used to be. C'est la vie.

 
Old 06-09-2010, 08:49 PM   #8
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

Hi former_dancer.

I am a "former dancer" myself. However only 19 years of age. I have Hallux Rigidus and have very little ROM in my right toe. I am scheduled to have surgery, in fact at SOAR in the bay area. However I am feeling quite apprehensive. I was wondering if you ever discovered any alternatives?

I am nervous and being so young and never having had any operation other than my "wisdom teeth" being pulled.....I would really appreciate any input you have.

the surgery that is scheduled is a cutting and re alignment of the bone, shaving of the top part as well as drilling holes in the bone to help cartilidge regrow and also a screw the hold the realignment of the bone in place....for me, this is a big deal because it's irreversible and I have only one set of feet for the rest of my life.

My case of hallux rigidus has progressively gotten worse over a period of about 6 years. At first I had much physical therapy for temporary relief however it's gotten worse. It is different every day but especially painful in cold, moist conditions and when walking heavily. I don't dance anymore but would absolutely love to, for it was my passion and what I lived for for about 13 years of my life growing up. However the podiatrist/ surgeon says that I might not be able to dance even after getting this surgery, and the healing process is very timely.

do you have any advice, or does anyone have any advice?

Thank you so much

Kaylee

 
Old 01-18-2011, 04:19 PM   #9
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

[QUOTE=kayleeanna;4263008]Hi former_dancer.
the surgery that is scheduled is a cutting and re alignment of the bone, shaving of the top part as well as drilling holes in the bone to help cartilidge regrow and also a screw the hold the realignment of the bone in place....for me, this is a big deal because it's irreversible and I have only one set of feet for the rest of my life.

My case of hallux rigidus has progressively gotten worse over a period of about 6 years. At first I had much physical therapy for temporary relief however it's gotten worse. It is different every day but especially painful in cold, moist conditions and when walking heavily. I don't dance anymore but would absolutely love to, for it was my passion and what I lived for for about 13 years of my life growing up. However the podiatrist/ surgeon says that I might not be able to dance even after getting this surgery, and the healing process is very timely.

do you have any advice, or does anyone have any advice?
Thank you so much
Kaylee[/QUOTE]

Hi Kaylee,

Have you had the surgery yet? I went to SOAR but was not impressed with being handed off to the resident students, who knew less about the formation of my structural issues and their related bone spurs than I did after 2 yrs of reading, so I left after 1 appointment and never went back. I also did not want a student performing this all-important surgery on me.

One option is the St Francis Hospital -- they have the sports med/dancer clinic. However they're very expensive.

I got free consultations from a clinic at ODC...theyhave a resident there from UCSF who gives free evaluations every Thursday night. You cant have surgery there per se, but you can talk to an ortho surgeon who danced and understands dancers. I went to her for my 3rd opinion (and went back for confirmation of what a 4th physician recommended). She agreed that with hallux limitus in a dancer, doing a chilectomy at early stages or medium stages is a good idea bc it will 1) preserve what good cartilage you have left and 2) give you back the part of the ROM that was lost due to the bone spurs getting in the way -- which is my issue.

She recommended against osteotomy initially> She said that if i did it, be prepared to lose some ability to "pointe" the foot fully, and there's a risk of floppy toe. However, I am not dancing much at all anymore, so I'm OK with this. I do understand from all whom I spoke with, that if you do ONLY chilectomy you are just having a bandaid procedure... in my case the issue is structural, the first ray is too high. Chilectomy will elimninate the bone spurs that i have grown the past 2 yrs, bc you essentially just shave them off, but they will grow back unless you fix the root ofthe problem. The Osteotomy lowers that bone, closer to the ground, so the joint isnt jamming and osteocytes stop racing to the site of injury, in theory preventing the spurs from growing back. It depends on the reason you have hallux limitus, if it was from a sudden injury or is mechanical (they way you were born etc).

She gave me a recommendation for another MD (ortho surg) at UCSF. I had an appointment there but after reading his bio i cancelled. His focus is on research and 3rd world countries. I wnated someone who has done a TON of these surgeries with a LOT of operating room experience.

I settled on a Pod in Petaluma (happy to give you info offline). My friend, also a former dancer, had him do her chilectomies and she had only good things to say. She told me about recovery -- all the MDs i have spoken to said the same thing: elevate, weight bearing only to tolerance, can wiggle toe but not too much until stitches heal bc you dont want to rip the stitches open. Pain killers given for at night (Vicodin or a variation thereof) and motrin/tyl for daytime unless you need the stronger stuff. Elevated as much as possible when not walking. 2 weeks basically off it; 6 weeks total healing. But should be able to walk for about an hour around the 3-week mark. Obviously every human is differnet and some recover faster or slower depending on health/nutrition/age/weight etc etc etc.

If you went forwrd with surgery already, please post for the rest of us!!

Hugs,
E.

 
Old 01-18-2011, 06:57 PM   #10
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

Former dancer and boots: I can recommend a surgeon in Santa Rosa. I got a second opinion from him when I had surgery recommended by my doc who is in Los angeles. I've also seen him once during recovery. My doc is with ucla and the northern cal doc was a professor at ucla. I highly recommend both of them ( i have a home in so cal too and i stayed there for the surgery and returned to san francisco for work after i was weightbearing.)

I had flatfoot reconstruction. And except for years ago in college I no longer dance. So I don't have any experience with surgery for your specific toe issues. I got plantar fasciitis badly years ago and it stopped my dancing all together. However if I had had either one of my doctors I'm positive the feet wouldn't have gotten so bad.
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Last edited by moderator2; 01-24-2011 at 08:28 AM.

 
Old 01-18-2011, 10:18 PM   #11
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

FlatFootDiva (Love the name!)
the one i am going to has two offices, one is in Sonoma I think... for a second I was hoping it might be the same guy!
I only have 3 days to back out without a $250 fee but i think i will probably go through with it. If i dont, the spur will start to disrupt the tendon atop the foot...this wont get better on its own, that much i do know...

Last edited by moderator2; 01-24-2011 at 08:29 AM.

 
Old 01-18-2011, 11:11 PM   #12
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

I used to sing opera, so that's why the name....once a diva, always a diva so they say! Even with a flat duck walk. The doc is a former professor and author-editor of a major textbook on feet
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Last edited by moderator2; 01-24-2011 at 08:29 AM.

 
Old 12-13-2011, 09:50 PM   #13
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Re: any dancers who've had cheilectomy/osteotomy for Hallux Rigidus?

[QUOTE=dncergrl53;3763922]I am a former dancer who now dances for fun. As a start, go back and read my posts. I have been very happy with my surgery but I was at the point where I had only 10% ROM in my joint and I was out of options. It also depends upon how much cartiledge is left in your joint. 30-40% of former dancers have this condition. At 4 months out, my balance is wonky on one foot, barefoot, but I can do everything else. I don' t trust my axel turns but I can live with that. My balance is ok with stiffer jazz shoes. I can do inside turns but have been holding off on outside turns until the joint is remodeled further, a process that takes up to 8-9 months. I had both cheillectomy and osteotomy with a pin. I found that sports medicine docs did not take me and my needs as seriously as my own podiatrist. I shopped around a lot.
I was non weight bearing for most of 8 weeks but quickly went back to class after that. I postponed jumps a bit more. For me, I cannot overstate how beneficial the surgery was.
PS if you are flexible, it is very easy to be non-weight bearing because you just put the foot up on things, like the kitchen counter.[/QUOTE]

Hey dancergirl,
Not sure if you are still on this forum but I was combing it trying to find fellow ballet dancers to ask a question.

I reread your comments on this thread. Can i ask you about how much ROM you have now in the operated-on foot? And how do you manage to do turns of any kind or releve if you do not have 90 degrees of flexion towards you?

In order for me to do a releve and balance on one leg, I always had about 85-90 degrees of flexion in the big toe (well in all the toes). Before I got Hallux Rigidus I mean. I have the same mechanical defect you have--longer first ray and hyper mobility and high arches. I can't take classes now bc i have only 40 degrees ROM in the operated on foot. The cartilage is too thin there to allow me a higher releve, and I can't turn when my weight isnt fully OVER the foot, if that makes sense. So I am curious your experience. ie can you balance on the operated-on foot? Or do you just not do things on that side?? And, based on how long it is after your surgery, did you notice significant increase in ROM as you got further and further along time-wise?

If you're around, happy holidays and hope you are dancing!!
Hugs,
Former Dancer :-)

p.s. my balance is off due to the osteotomy too. Standing barefoot is tough on that leg, I notice a huge difference. Apparently moving that joint backwards and down (as they do in the osteotomy) throws off your entire weight bc we depend so much on that first metatarsal in terms of the % of body weight that goes there. The osteotomy apparentoly also distributes more weight to the other toes...Who knew?

p.s.2 -- If Kaylee is still on this forum, I am curious if you went thru with the surgery at SOAR after all and if so, how did it go???

Last edited by Former_Dancer; 12-13-2011 at 09:54 PM. Reason: added p.s.

 
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