Patients come into the office with a great toe that isn't as mobile as it should be. In some cases, the motion is limited. In other cases, it's rigid in both cases, they're painful. And after taking an x-ray, there's usually a bone spur on top of the great toe joint.
When most people think of a Bunion they think of a prominent bump on the side of the great toe joint. It makes the foot wider and can be painful with shoes. I recorded a video series all about Bunions such as these, you can go over to our YouTube channel.
What about a #bunion on top of the great toe joint? The bunion on top of the joint, it's a bit different. It can also be because of faulty mechanics, where the first metatarsal bone is longer than it should be. This causes the joint to jam and the bone spur forms on the top of the metatarsal head. Bunions on top of the joint also formed because of trauma to the joints. Spraining the joint causes it to hyperextend and also causes a bone spur to form on top of the metatarsal head. This is commonly seen in injuries such as #TurfToe.
Once the joint is jammed, every step causes a microtrauma. This causes the bone spur to grow larger. It can also make the joint become stiff. This is a condition called Hallux Limitus or Hallux Rigidus. Hallux Limitus is a condition where there's limited motion of the great toe joint. It can lead to pain in the joint. Often, it's associated with a bone spur on top of the first metatarsal bone. This bone spur serves as a doorstop and prevents the great toe from moving further. This persistent jamming of the toe against the spur can erode the joint and lead to Hallux Rigidus, which occurs when the great toe joint is bone on bone and barely moves. When the toe does move, it's very painful. It makes exercise painful and makes it almost impossible to wear a high heeled shoe. Both conditions can be treated conservatively. This usually involves the use of a custom orthotic. The orthotic fools the foot into thinking there's more motion available than there really is.
An orthotic can prevent the condition from from progressing and can also offer pain relief. There are times, however, when the only way to restore motion is to remove the bone spur. This is accomplished with a procedure called the cheilectomy. A cheilectomy removes the spur on top of the metatarsal bone. The head of the bone is remodeled to ensure that the great toe moves fluidly on the metatarsal bone. In Hallux Limitus conditions, this is the preferred procedure. It's important to note that the joint needs to be in good shape for this procedure to be a success. In cases of Hallux Rigidus, where the joint is not in good condition, it's essential to not only remove the bone spur, but also develop a working joint space. In these cases, I'll usually work with an implant that's placed on the head of the metatarsal bone. It serves as artificial cartilage to allow the great toe to move through a range of motion. When necessary, both of these procedures provide excellent results and restores the full motion to the great toe joint.