Today on the Doc On The Run Podcast we’re talking about three reasons for cheilectomy failure after hallux rigidus surgery.
If you have this condition called hallux rigidus or hallux limitus, the name tells you what’s wrong. Hallux means big toe, rigid means it doesn’t move at all and limitus just means it’s limited and stiff. It doesn’t bend and move the way it’s supposed to.
There are three problems with hallux rigidus, which are damaging the cartilage, bone spurs around the joint and restriction of the soft tissues being stiffer so that the toy toe doesn’t move up and down the way it’s supposed to. Those three reasons that you get the condition are the same reasons that can fail if you have a cheilectomy surgery. Let me explain.
I was just doing a consultation call over webcam with someone who had a non-surgical procedure and improved a lot and then was told he might need to have surgery based on his most recent X-rays. So, we got on a webcam call went through his X-rays and found out a couple of interesting things that made me concerned that this surgery might be a failure if he did it.
The first thing is that when we started talking about the surgical incision and the way that we just open up the joint and we release all of the scarring or soft tissue adhesions that make the joint stiffer and the toe move less. He said he happened to know that he was known as a cheloid former, and a cheloid is a really thick big scar that happens reactively. In fact, it’s overactive, you form way too much collagen way too fast. You get a big nasty scar.
If you are somebody who forms cheloid and that implies that if you go in surgically into the joint and cut away the scar tissue to release it, you’re just going to form a whole bunch more scar tissue. And if you do that, the surgery is going to fail because the soft tissue is going to be so scarred and so stiff that it’s not going to move naturally.
The second thing is when I was looking at his X-rays, he had what looked to me to be a hard bone callus or a bump formed on several of the metatarsals in his foot. Now this does happen to some people if they have a sudden increase in activity, they get a stress reaction or a mild stress fracture and one of the bones. The body’s way to fix that is to make a stiff thickened area around the area where it was bending, cracking, moving too much to make it more stable. But in the same way you can be somebody who reactively forms thick scars, you can also be a reactive bone former and you form more bone faster than other people too.
I said “Look, if you have these bone spurs all around your joint and we go in and we cut out all the bone spurs, but you reactively form more bone, they might just come right back really quickly” And that does happen sometimes. In medical school when they teach us about surgically removing bumps of bone in this way, they say you’re supposed to take a dimple which is a bump and you’re supposed to turn it into a dimple. You’re supposed to make it a depression so that when that bone fills back in, it’ll be flat, instead of a bump or the depressions going to fill back in.
If you’re a reactive bone former, instead of it just filling back into flat, it might make another bump again and that bump’s causing a limitation in your toe basically bumps up against that bone spur. And you have another problem and that could cause a failure of the surgery.
The third reason is the joint space or the cartilage damage in there and he had a very, very narrow joint space. I know that there are a couple of different long term studies that show that when few people had a cheilectomy surgery and in surgery when looking at the metatarsal bone, if there’s an erosion or a hole basically where there’s no cartilage in the head of the metatarsal and that hole is basically 50% of the surface area, the head of the metatarsal, all those people go on to have a surgery later. Either a fusion or an implant surgery because the cheilectomy surgery fails.
So, the last thing you want to do when you have hallux rigidus is have surgery that fails because you didn’t you have to have a different surgery later. And in the end, you’re no better. So if you understand these things, you can talk to your surgeon and make a better decision about what next treatment might be right for you.
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