Joint Disorders
Hallux Limitus
CAUSES
Hallux Limitus is a decrease in the range of motion of the big toe joint. This decrease in motion is most commonly caused from a genetic disorder where the 1st metatarsal (the long bone before the big toe) is elevated upon weight bearing and causes the big toe to jam into the metatarsal. Over many years this constant jamming rubs the ends of the bones and forms a bone spur on the top of the big toe joint. Once enough damage to the bone has occurred, the shock absorbing function of the joint is lost and the pain begins. Also once the spur becomes large enough the nerve in the area begins to rub over the spur and causes pain most often when shoes are worn.
DIAGNOSIS
Diagnosis is made by obtaining X-rays of the feet and identifying the dorsal spur and a decrease in the joint space. Also range of motion is performed to see if at least 40 degrees of dorsiflexion is obtained. Along with palpation of the big toe joint which induces pain.
Hallux Limitus is a decrease in the range of motion of the joint and hallux rigidus is a complete loss of motion in the joint.
TREATMENT
Once the diagnosis is made conservative treatment may include hard rigid orthotics to limit the motion of the required movement of the big toe joint, wider shoes and /or padding. Surgical corrections consists of either a joint saving procedure which is performed for the hallux limitus, most commonly called a cheilectomy or a total joint replacement is performed to correct the hallux rigidus.
A lot of surgeons like to recommend a fusion of the big toe joint. At Mid-Ohio Foot & Ankle Specialists we do not recommend a fusion since this causes your walking to be altered and can lead to knee and hip pain over time. With our procedures you are able to bear weight immediately after surgery unlike the fusions that require a non weight bearing status for 4-6 weeks.
Bunion
CAUSES
Bunion deformities are most commonly a result of genetics. Someone in your family tree has the genetic predisposition for the bunions. One misconception is that tight shoes caused the bunion. In all actuality the tight shoes worsened the condition and made the bunion become more severe quicker. The entire deformity began because of a tight muscle called the adductor hallucis muscle which is pulling the big toe to the side near the second toe instead of straight up and down. This puts a backwards pressure on the metatarsal causing the bump on the inside of the foot near the big toe joint to become bigger as time goes on. Shoe pressure causes the nerve that runs along the inside of the foot to become irritated and the pain begins.
DIAGNOSIS
At Mid-Ohio Foot & Ankle Specialists we will obtain a set of X-rays so that we can determine the severity of the bunion deformity utlizing the necessary angles (called the intermetatarsal angle IM) and then offer you the appropriate procedure for correction.
The wider the IM angle the worse the Bunion. Normal: 0-8 Degrees ; Mild: 9-12 Degrees ; Moderate: 13-15 Degrees ; Large: 16-18 Degrees ; Severe: 18+ Degrees
TREATMENT
At Mid-Ohio Foot & Ankle Specialists our doctors have performed 1000’s of bunion surgeries with excellent results and minimal pain and scarring. Our patients take an average of 3 pain pills over the 1st couple of days and then switch to tylenol or ibuprofen. We also specialize in the correction of previous bunion surgeries that had less than optimal outcomes. Dr. Staschiak is also a certified Lapiplasty specialist for severe bunion surgery correction.
Tailor Bunion
CAUSES
Tailor bunions often called a bunion on the pinky toe are caused from an increase in the 4th and 5th intermetatarsal angle which leads to a protrusion or widening of the outside of the foot. The 5th toe also moves closer to the 4th toe and causes an impingement and subsequent pain.
DIAGNOSIS
Diagnosis is made by obtaining X-rays to determine the angles of the 4th and 5th metatarsals and also the angle of the 5th toe on the metatarsal head. The normal 4-5 angle is between 6-8 degrees with a symptomatic foot measuring greater than 9 degrees.
Also noted is a callous on the outside of the foot and most commonly on the bottom of the foot behind the little toe which is painful. An inflamed nerve called a neuroma can also be associated from the constant pressure irritating the nerve once the fatty pad has degenerated over time.
TREATMENT
Conservative therapy consists of shaving the callous, wearing cushioned insoles, wider shoes and padding to protect the area.
Surgical treatment may consist of Planing the 5th metatarsal head if the callous and pain are only on the bottom of the foot. Otherwise a special bone cut can be performed to move the head of the 5th metatarsal into a more corrected position and secured in place allowing you to walk immediately. This will also realign the 5th toe back onto the 5th metatarsal to give a straighter appearance.
