#halluxlimitus

-This woman presented to our office this morning with a capsular interposition procedure that didn’t go so well (placing material between the distal first Ray and first phalanx to create cushioning and increased hallux dorsiflexion). 

-She has opted for conservative treatment for the time being. We are working on decreasing inflammation to see if we can increase plantar flexion of the distal aspect of the first Ray. She currently has 0° in her shoes and 5° when we planter flex the distal first. 

-Exercises included the lift/spread/reach exercise, short foot exercise, toe waving and one leg standing. 

-We will keep you posted. 

-Look for her x-rays tomorrow

What happens when a ganglionectomy goes south?

- This patient had a ganglionectomy. Unfortunately, they tagged the joint capsule of the first MTP. By affecting the integrity of the capsule, as well as the surrounding musculature, she’s developed the beginnings of a hallux valgus (bunion) as well as hallux limitus (limited dorsiflexion of the first metatarsalphalangeal articulation). 

- she has degeneration of the first MTP as well as an osteophytic  crown at the distal aspect of the first metatarsal and tenderness over the capsule as well as the extensor hallucis tendon and proximal phalanx. 

-dorsiflexion is 30° on this side, 50 on the opposite side. We need about 50° to have adequate for foot rocker

– she also has moderate external tibial torsion, right greater than left and a left anatomically short leg secondary to a femur fracture.

– Since the mobility of the first ray was limited, we worked on first Ray mobility as well as exercises to descend the 1st ray, with acupuncture for pain control. 

-we are considering an orthotic to assist in raising the base and dropping the head of the first metatarsal to create more hallux dorsiflexion. When performed manually, she had a few extra degrees we would like to take advantage of. 

-We will keep you posted :-)