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28.03.2015, admin  
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Hallux Limitus Surgery Pain in the big toe joint is one of the most common complaints I hear in my podiatry surgery practice. When your problem requires surgery, you can rest assured that you are in the hands of a competent and highly trained surgeon.
To resolve all of your foot and ankle problems, simply look around this site and make an appointment with Dr. Pain in the big toe joint is one of the most common complaints I hear in my podiatric surgery practice. I really enjoy doing surgery for MPJ pain caused by arthritis in this joint because the surgery works so well.
Arthritis of the big toe joint can be caused by many things: bunions, gout, inflammatory arthropathy such as rheumatoid arthritis and other autoimmune diseases, trauma, infection, bad shoes, overuse such as athletes, congenital malformation, congenital anomalies such as longer or shorter bones than normal, higher or lower bones than normal, misshaped bones or cartilage, functional anomalies like flat feet or curvature of bones of the leg, and some other that I’m sure I left out of this list.
Most of the above lead to the slow progression of arthritis in the form of loss of cartilage of the joint.
Once a joint doesn’t move, your body compensates by trying to move other joints to make up for the lack of motion. Arthritis of the big toe joint presents with pain in the joint that usually starts off minor and intermittent and slowly progresses to happen more often and with more intense pain.
One of the main reasons people come in to see me for big toe joint pain is for something called Hallux Limitus. Hallux Limitus can be broken down into two major categories but both describe lack of range of motion of the big toe joint.
As I stated above, functional hallux limitus often leads to big toe joint arthritis by causing abnormal forces on the joint and wearing away of cartilage which in turn leads to structural hallux limitus with loss of cartilage and bone spurs that block motion. Okay, we’ve now discussed what causes hallux limitus and arthritis as well as signs and symptoms of big toe joint arthritis. When a patient comes into my office with a complaint of big toe joint pain, I first do a thorough history and physical exam. Once I’ve completed my history and exam with x-rays I am able to determine the extent of the problem and the cause(s) of it.
I take great pride in my ethics and the ethical treatment of my patients that trust me to take care of them.
I make most of my profits by performing surgeries but I would never tell a patient that they need surgery when I can help them with a less invasive, less risky, less painful alternative non-surgical treatment. After I evaluate the cause and extent of the problem I decide on which surgical procedure to perform.
One of the most common procedures I do is the decompressional  metatarsal osteotomy procedure. The next procedure is the great toe implant arthroplasty or great toe joint implant procedure. In the below example, I felt there was just no way that any less invasive procedure would realign this joint and give satisfaction to the patient. As you can see I am passionate about big toe joint pain and consider myself an expert in it. Using the most advanced biomechanical evaluation technologies and techniques to help individuals and organizations achieve their BEST Performance. Much of the following description of shoulder kinematics is taken from Zatsiorsky’s Kinematics of Human Motion as he provides an excellent description and review of this very complex topic.
When discussing shoulder kinematics, the shoulder bone will often be defined with regard to the thorax rather than with relative to a proximal bone.
When considering glenohumeral joint kinematics, the motion of the humerus is measured with respect to the glenoid fossa of the scapula.
The glenohumeral joint surfaces are very close to spherical and the mating joint surfaces are quite congruent and have radii within a 3 mm difference. However, the radii of curvature of the glenoid and the humeral head are not completely identical.
Due to these curvature differences, the glenoidal center of rotation and the humeral head center of rotation will be different. Because the glenohumeral joint is modeled as a ball-and-socket joint with 3 rotational DOF, the inherent problems of describing 3D rotations such as induced twist are often found in the literature for shoulder kinematics.
Because of the complex character of the rotation, the instantaneous center of rotation (ICR) displaces substantially.  Between 0°-80° of arm elevation the ICR is near the root of the spine of the scapula, between 80°-140° the center migrates towards the acromioclavicular joint, and beyond 140° the center is at the acromioclavicular joint. For truly efficient movement patterns the body needs the scapula and humerus to work synergistically. The shoulder complex is comprised of two individual mechanisms: (a) the shoulder girdle, consisting of the clavicle and scapula as the moving links and the sternum with the rib cage as a frame, and (b) the humerus as a moving link and the scapula and clavicle as a frame. Bone rotations should be defined relative to the virtual reference position as rotations in the global (laboratory) reference frame.


Because each of the individual shoulder complex joints defined previously has three DOF, one would expect the shoulder complex to have 12 DOF in its entirety.  However, the clavicle and scapula move conjointly as the shoulder girdle complex. To describe the shoulder configuration with regard to the sternum system nine Euler’s angles, three for each bone system, are necessary.  In what follows, either the angles in the plane of motion or the projection angles on the reference planes are reported. Because of the displacement of the shoulder girdle during arm movements, the ICR for the shoulder complex differs greatly from the ICR for the shoulder joint.  The path of the centrode is extremely large. Lawrence Silverberg, one the most compassionate and skilled foot doctors in the New York City Metro area and the country.
Silverberg takes great pride in providing excellent medical care along with great bedside manner and takes the extra time to explain your problems and the treatment options in detail. I’ve already written blog articles on bunions and gout which are two very common causes of great toe joint pain. This is because the two bones that make up the joint are the “first metatarsal bone” and the “first proximal phalanx bone”.
Arthritis is a general term for pain and inflammation of a joint and can be used to refer to any joint in the body. Cartilage is the smooth semi-hard substance between bones that allows bones to glide smoothly together in a joint and not grind or scrape each other.
Bone spurs usually grow due to small micro-trauma to the bone that heals by producing more bone.
This, in turn, causes those other joints to have abnormal forces and range of motion and they get overused and injured leading to arthritis. Activities or certain shoes that didn’t hurt in the past, start to hurt more often and more intensely. I wrote an article not too long about about people who have bunions but no pain associated with them. This Latin term comes from the word Hallux which is the medical term for the big toe and Limitus, which means limited range of motion of a joint.
This describes a condition in which the bones don’t move enough due to abnormal forces on the bones of the foot. In my article and video about bunions I describe how functional hallux limitus causes the bunion. I ask them all about the pain including what it feels like, where they get it, how long have they had it, what was the onset like, fast or slow progression, what activities cause pain, what shoe types cause pain, and what treatments have they tried and which worked or did not work.
I check the entire foot starting with the circulation, the nerves, and the range of motion of all the joints including the big toe joint. Most often the treatment is surgical but there are a few non-surgical treatments that can be done. I will try to keep this tangent as short as possible but I’m very passionate about the subject.
Unfortunately, in my career I have come across many doctors that do not practice this way and do make decisions based on profit to some extent at the cost of their patients but I will not expand on this further here. The reason I like it is because by the time people need surgery they are usually in a great deal of pain and it affects their lifestyle, and it is such a big relief for them when I correct the problem. One of these is called the Youngswick procedure named after the doctor that first described it.
This procedure is called more joint destructive because it involves removing part of the joint.
I have performed many of these procedures in the past but often prefer other procedures over them. Silverberg has been called the best foot surgeon in NYC and the best bunion surgeon in NYC. Once the cartilage is gone, bones grind on one another and cause pain and decreased range of motions. Each time the bone heals the tiny breaks, it produces more and more bone until finally you have a piece of bone sticking out where it should not be. Women often tell me that they progressively can wear their high heel shoes for less time or less distances before the pain starts.
One of the only times I tell people to have bunion surgery when they are not in pain is when they have signs of arthritis on x-ray but no associated arthritic pain. This describes a joint that cannot move enough due to changes in the structure of the joint. Most commonly people who have arches that collapse or flat feet have functional hallux limitus.
When the arthritis is not too severe non-surgical treatment works better than once the arthritis has progressed more.
I remove bone spurs and loose extra bones in order to allow the joint to move more freely and more normally.


This involves cutting the metatarsal bone and moving it down and back in order to create more space between the metatarsal and the proximal phalanx. I remove the base of the proximal phalanx bone in order to create a space between the bones.
The theory here is that if there is no motion, there is no pain, and that theory almost always works. Silverberg’s office is conveniently located in Midtown Manhattan near Grand Central Station.
The doctor performs all foot and ankle surgery including traditional open surgery, minimally invasive surgery, laser surgery, radio frequency surgery and extra-corporeal shock wave therapy.
Doctors often refer to the big toe joint (“First Metatarsal Phalangeal Joint”) as the “First MPJ” or just “MPJ”.
This can be due to lack of cartilage between the bones, bone spurs that block the motion and sometimes bone growth that actually fuses the bones together.
When the arch collapses the first metatarsal bone gets pushed up and out of the way by the ground forces. When there is functional hallux limitus and not structural hallux limitus, as described above, non-surgical treatment works better.
These procedures include: Cheilectomy, decompressional metatarsal osteotomy, Keller procedure of the proximal phalanx, joint implant arthroplasty, and joint fusion. When I choose this procedure the cartilage has to be mostly intact as it does not address the lack of space between the bones, but only the extra bones that block motion. The trick here is to maintain that space for years after the surgery as it has a natural tendency for the bones to move back together over time. This procedure involves removing either the head of the metatarsal or the base of the proximal phalanx and replacing it with a metallic joint implant.
He also takes histime to explain patients problems in detail and spells out explicit treatment plans.
When the bones fuse together two bones actually become one piece without any space between them. When the first metatarsal is elevated, the phalanx bone cannot move up enough to make it over the metatarsal and flex upwards to bend the toe joint. Strangers come to me for help and expect me to do the right thing, tell them the whole truth, and act in their best interest, not my own. We treat pain and inflammation with anti-inflammatory medications, or pain killers; pills and injections. There are many ways doctors try to maintain this space including using metal pins to hold the bones while they heal, implanting cadaver soft tissue grafts and skin components between the bones and various other ways.
I wish I had enough time to write back to everyone but it has gotten a bit overwhelming to do so.
I often think about other circumstances in life where this happens and I, unfortunately, cannot think of many or any for that matter. Pills are often non-steroidal anti-inflammatories such as aspirin, Motrin, Aleve, Celebrex and many over-the-counter and prescription medications.
Recently, I have been modifying this procedure in my own unique way in order to treat more advance loss of cartilage and I’m having excellent outcomes.
I feel my way is the best and I have seen patients follow-up long term with preservation of the space. Also, it can slow a patient down because as we walk faster or run, we need the big toe joint to move up more and the fusion blocks that. She was extremely happy with the result and was pain free last I spoke to her over a year after surgery. I have not done one of these procedures in a while because many patients reported stiffness postoperatively. We also treat inflammatory symptoms with icing, rest, compression and physical therapy modalities. This is the most challenging and difficult part of the procedure but I have discovered a way to make it work. After expertly diagnosing patients’ conditions, he plans out his procedures with great skill. When there is contracture of the soft tissues that misaligns the big toe joint or when the bones have been previously altered in other surgeries, I will perform a fusion. He also takes into consideration aesthetics with his incision planning and plastic surgery type suturing techniques.



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