Hallux limitus presents with a number of choices that in many cases require surgical decisions. And in many cases, the choices aren’t all so clear. No one universal solution is used by foot and ankle surgeons to address hallux limitus. So how do you choose? Perhaps some of my surgical experiences can help.
One common question is ‘how do I know that I have hallux limitus?’ That’s actually a very good question due to the fact that in stage 1 hallux limitus, there’s no clear radiographic signs to confirm hallux limitus. So in that case, the diagnosis is made the old fashion way…your doctor’s clinical judgment.
Although stages 2 and 3 do show radiographic signs of change about the great toe joint, how do you know what procedure is best for you? Many doctors advocate a simple cheilectomy, but when you look deeper at the etiology of hallux limitus, you come to realize that the most common cause of hallux limitus is an elevated or long first metatarsal. So a cheilectomy can be somewhat short sighted. An osteotomy of the first metatarsal ought to be a consideration to shorten and plantarflex the first metatarsal.
Fusion vs joint replacement? When we get to late stage 3 and stage 4, my choice is typically joint replacement with a double stem Dow Corning Swanson great toe implant. In 25 years of practice, I’ve put in many and never replaced one. Certainly, a man made substance does have a finite life span, but in my experience, they can indeed last a life time.
Fusion? I’ll have many disagree with me, but fusion has upfront disability and the possibility of non-union. Not to mention the unnatural aspect of a fused joint. There are specific indications where fusion is the procedure of choice, but for most cases of hallux limitus, I’d opt for joint replacement any day.
