Houston Methodist. Leading Medicine

Foot FAQ

Question:

I am a semi-professional dancer with a few years left in me but my big toe on the left side is going. I've been told I have a degenerative joint called hallux rigidus. The only treatment is to cut out the damaged part and/or fuse the joint. I'm definitely NOT ready for that. Do you have any other suggestions?

Answer:

There is a new study out from the Hospital for Special Surgery in New York City that may be of interest to you. They see many athletes and dancers with a wide range of orthopedic problems who want to remain active. Treatment for painful, limiting hallux valgus is usually surgical. In early stages (mild to moderate disease), there is a wide range of surgical approaches that can be taken. The surgeon can simply remove the bone spurs or take out the damaged portion of the joint surface. Sometimes releasing the soft tissue (capsule or synovium) is sufficient. In more advanced cases, arthrodesis (fusion) of the joint is advised. In the report from the Hospital for Special Surgery results are given for 64 patients who had a combination of two surgical procedures for advanced hallux rigidus. Joint reconstruction (referred to as cheilectomy) using one or several of the methods described was combined with a second procedure known as proximal phalangeal osteotomy. After removing one-third of the big toe's metatarsal head, a wedge-shaped piece of bone was cut out of the phalange (toe bone). By moving the two remaining pieces of bone apart, it was possible to lengthen the metatarsal, thereby maintaining the length of the toe after removing the metatarsal head. By combining these two techniques, the surgery is considered a joint-sparing (saving) procedure. By keeping the joint and avoiding a fusion procedure, patients are able to walk right away. They use special (stiff-soled) shoes to protect the osteotomy site until the bone heals. There is a100 per cent success rate for bone healing. The procedure makes it possible for the first toe to bend as it should so that when walking, the patient can properly roll over the big toe to push the foot off the floor. This motion is called dorsiflexion. In order to preserve metatarsophalangeal dorsiflexion (toe bend before toe off), the patient does lose a portion of the opposite motion (toe pointing called plantar flexion. These results are a significant improvement over foot function reported after an arthrodesis (fusion) procedure. But the results may not be enough for someone who is a dancer and requires extreme foot flexibility. Given your diagnosis and desire to keep dancing, it may be worth exploring these additional options. Often, surgeons with this type of expertise are willing to see if some type of surgical modification would work for you. It may require some creative changes in your movement patterns but perhaps that won't be such a bad thing when looking for new ways to express yourself through dance. Martin Joseph O'Malley, MD, et al. Treatment of Advanced Stages of Hallux Rigidus with Cheilectomy and Phalangeal Osteotomy. In The Journal of Bone and Joint Surgery. April 3, 2013. Vol. 95A. No. 7. Pp. 606-610.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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