What can a runner do when you have hallux rigidus but you’re not a good candidate for cheilectomy surgery? Well, that is what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from an inquiry sent in through the running injury inquiry form from Jamie, and Jamie wanted to know about hallux rigidus. But one of the questions that I ask for you to be able to submit this to me is what event were you training for. The answer, no event. And I hate to tell you this, but I start to lose interest when somebody’s not a runner because this channel is all about helping runners.
I don’t know if Jamie is just so demoralized that there is no event on the calendar or if Jamie’s not a runner, I don’t know. But the question specifically was, “Are there any non-surgical approaches to helping hallux rigidus when you are not a good candidate for a cheilectomy?”
Yes, there are lots of other options. The first thing is, is that based on the way the questions were, I have to presume that Jamie saw a doctor because doctors say you’re not a good candidate for cheilectomy and when they say that they usually pitch something to you. You need a different surgery, a more joint destructive surgery, something that is going to fix it more permanently.
So, hallux rigidus, just to back up for a second, if you don’t know what that is, it’s where you get stiffness in the big toe joint. The diagnosis code that we have is for hallux rigidus. However, many many years ago I wrote a review article that was published in a medical journal in three parts because it was so long and it was called From Hallux Limitus to Hallux Rigidus, A Complete Review of the Literature.
I went through and read and then summarized and wrote a review of all of the stuff that we know about this condition. That is why I know about it. The thing is, is that you get some limitation of motion in the joint and many times a thing called a cheilectomy where we basically clean up the joint, get it to move more, remove bone spurs, try to get some cartilage to grow in there and stuff. It’s sort of a simple procedure and it doesn’t really destroy the joint.
There are other alternatives to that to surgery that do destroy the joint. We take out the cartilage or we fuse the joint. There are lots of different ways to do it but they’re more damaging and more permanent. You can’t undo it once you do it. At the base of Jamie’s question is, is there something else I can do that is not surgery at all? Yes, there are lots of things.
Number one, get a second opinion. If you see the doctor and they tell you that surgery is your only option, you definitely need a second opinion. Don’t ever just go have surgery right off the bat unless you’re in a life-threatening or limb-threatening situation or something. Now again, I presume Jamie saw a doctor because that whole thing of you’re not a good candidate for a cheilectomy implies that this is a doctor who’s looked at you.
If the doctor didn’t explain these other non-surgical things to you, I think you’re being sold short. Even if there’s only a small chance that one of these alternative non-surgical things might help you, I think the doctor should present it to you as an option that then you can either take or leave. I would certainly try to get an opinion from somebody who’s not going to try to operate on you.
You can either do that by seeing a non-surgical podiatrist or a non-surgical orthopedist or by doing a consultation with somebody over webcam who’s definitely not going to come see you because they don’t actually do operations in your specific area where you live. For example, I do see people in person in the San Francisco Bay Area and I do see people in person in Texas, but I do not see people in person in Florida.
But I’m licensed to see people by either webcam or in person or whatever in these three states. If you’re in Florida and you call me for a second opinion, I am definitely not going to do an operation on you because I don’t see patients in person in Florida. Somebody called me yesterday and wanted me to see them in Florida and I said, no, I don’t see people in person in Florida. So no, I can’t do your surgery, but I could do a surgical second opinion for you and you need to get the information you need.
I can’t, based on this question, make an episode that discusses every possible non-surgical intervention because I don’t know about your limitations of activities. I don’t know about your fitness level or the things that you’re worried about in terms of getting back to running or training. And so, the doctor that saw you should have considered those things and then offered you other treatments that can better help you achieve those goals.
If you think cheilectomy is a thing that may help you, to me, that tells me that you’re hoping to find something that is non-surgical and there are lots of non-surgical options that you should look into.
If you like this episode, please like it, please subscribe, and I’ll see you in the next training.
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