Many of us treat Hallux Rigidus and Limitus conservatively, but also should inform our patients of the surgical treatments. This was a position paper I was asked to write for an Arthritis online publication. We all know that neither surgery or conservative treatment can ever make an arthritic joint normal again. However, the goal of any treatment has to be 2 fold:
1) Maintaining pain within 0-2 pain levels, and
2) Full Function for that individual when possible.
Whereas pain can vary from patient to patient and be hard to gauge due to pain tolerances (i.e. high or low pain tolerances), function can be easier to measure progress. When treating patients, each visit I am focused on their pain level and function. For many of my 70-80 year olds, which are probably my highest number of patients in this group, they seem to be happy getting their pain between 0-2 (knowing that this is a safe level for their joints), and gradually getting their steps to 10,000 per day. I also try to encourage 3 types of exercise on a routine basis with stationary bikes, weights, yoga, pilates and swimming common choices for this generation. Of course, certain positions like the “downward dog” have to be avoided.
My next group are the 40 and 50 year olds typically just getting symptoms for the first time. This group responds well to conservative treatments and typically do not need full orthotic devices all the time. Dr. Stefan Feldman just wrote a post outlining the decision we need to make. Orthotic devices with Morton’s Extensions are meant to limit motion, and orthotic devices with dancer’s pads (AKA reverse Mortons) and dynamic wedging are meant to free up the joint. So many of my patients in this group have both types, although they initially presented with symptoms needing one or the other. I hope this position paper below gives you better understanding of my treatment philosophy.
