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Foot & Ankle Problems Message Board

Foot & Ankle Problems Board Index

Re: Hallux Limitus
Aug 29, 2003
I can relate to your frustration. I have been trying to decide how to treat stiff big toe for a year and half, with varying and conflicting opinions from an ortho foot surgeon and two podiatrists, as well as conflicting web info. My ortho says toe fusion--that it will take away pain, enable me to hike and run, quick healing time, walk out office in foot cast, drive right away. He would put in two pins and a plate. First podiatrist said a year and a half ago, do straight bunionectomy. I was skeptical since much of pain is in ball of foot. Second pod pursued sesamoid problem, eventually came around to bunionectomy recommendation after continually asking what the other pod and the ortho said (I kept saying, no, I just want YOUR opinion). Ortho, meanwhile, says I DON't have a bunion problem, just osteoarthritis, degenerated joint. Yesterday I went back to first podiatrist--he was perturbed that I had consulted two others and very brusque. This time he said he would do a Keller bunionectomy--removing all joint debris and cutting out a portion of toe bone, leaving a space that would fill with scar tissue. Possible downside is floppy toe, but you at least have motion. He said that Ortho surgeons push fusion for people over 50 (I am 60) cause they heal more slowly, but that he feels older fit people can heal the space left by the Keller procedure. I was ready to go for it till I came home and researched Keller on web and find that it's recommended for INACTIVE older people! Here's what one site says about fusion, implant, and Keller:
"""In young fit people, especially those doing heavy jobs, a fusion of the joint would be recommended. This removes the painful joint and stiffens it completely. 95% of people will get rid of their pain. However, the toe is stiffer than before and the choice of shoes is more limited. A few people will go on to get arthritis of the small joint in the middle of the toe after a fusion, but this is not usually troublesome.
In retired, active people, a plastic ("silastic") replacement of the joint may be offered. This gets rid of the painful joint and, unlike a fusion, keeps some movement. This makes it easier to walk and to choose shoes (though high heels are still not advisable). However, the joint may wear out and if it does the toe may become very inflamed again. This can be difficult to treat and another operation may be needed. This is why replacement is only advised in people who are not very physically active.
In an elderly person who walks very little, the simplest operation is simply to cut out the arthritic joint (Keller's procedure) and leave the toe a little floppy. This can be quite successful in people who walk very little. However, in the more active person the toe may remain too floppy......."""
Worse yet, the site of the Am. Coll. of Ortho Foot Surgeons says fusion requires 6 weeks in a cast followed by 6 WEEKS on crutches! Whom are we to believe??? I would be interested to hear of any further info you find and what you decide.Sounds as if our problems are similar, except I am interested in returning to serious hiking, not running, and my joint is probably further deteriorated than yours. Right now I am opting to stick it out, hoping to find some other way to improve joint health. Check out low-level laser therapy for chronic joint conditions. I found a great review of studies on this subject---search article in Australian Journal of Physiotherapy by Bjordal et al. You can do this therapy yourself with the simple laser pen pointers found in any computer store. See article for times and how to do it.

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