Members do not see these Ads. Sign Up.

Dear Fellow Podiatrists,

I recently saw a 75 yo lady who runs 8-10 k per week, ( slowly she says).she has very limited motion in her R 1st MPJ due to lipping around MPJ. It is not painful, but she "is aware " of the joint at times. She has never had any previous orthosis prescribed.

She is concerned because her late mother had terrible bunions apparently-and she doesn't want to get them.
this lady has no deviation of the Hallux only the enlargement of the joint area due to the bony exostosis. She wanted to know if she should have surgery now while she is young enough.

My thought is to leave it alone if she is still so active and , but would appreciate any opinions /advice.

thanks Jill

 

If her LROM is due to lipping only she may do quite well with a simple cheilectomy- provided there is still adequate cartilage and a negative axial grind test. Orthotics would be of benefit thereafter.

 

I agree w/ Scorpio;
Always a good idea to Tx the patient and not just the foot. Certainly some of the Orthotic Gurus can suggest an orthotic to take pressure off the 1st MTPJ and slow progression of her arthritis.

Cheilectomies- I've never had long term success with these. But at age 75 she may be a canditate if you can relate symptoms to osteophytic lipping or perhaps a fractured osteophyte. IF not, I would leave it alone surgically.

Hope that helps.

Steve

 

Jill:

I agree with Steve. I wouldn't do any surgery on this 75 y/o lady if she is asymptomatic. Cheilectomies are not very successful and, if they are, are not successful for very long, in my experience. In addition, jogging/running will tend to irritate the 1st MPJ joint pain from hallux limitus less than will walking. If she were my patient, I would not initially make her orthoses but may recommend over-the-counter orthoses and add a Morton's extension to it in the office to see how she liked it. Also, if she were my patient, I would tell her to enjoy her running and be happy that she can still run at this age, since so few people at her age can run the distances she can with the relative comfort she has.