hHy guys this is Dr. Lam talking about hallux limitus
we're going to go over a case, a live case later on
but I just want to give you a little background of hallux limitus.
Hallux limitus or AKA big toe joint arthritis
sometimes people come in and confuse that with a bunion
okay this foot model is a bunion but hallux limitus is what we call a dorsal bunion or
you get this bunion, this bump on top of the big toe joint, it can also be gout
but we can figure that out really easily with an x-ray
so let's talk about hallux limitus / rigidus today in this video
again we'll show you a live case and show now we're able to now make a small little incision
on top, I'm gonna show you on top a small little incision you'll see a live case
basically make a small incision on top right about here
that's the big toe joint as you can see trying to work backwards here
pretty much I stick a rotating burr that protects the tendon and the nerve, it only cuts bone
no soft tissue; soft tissue is well protected
so I make a small little stab incision, put this burr in there and just pretty much just burr down the spur
basically just cut down the spur as you'll see
Okay this is Dr. Lam again coming to you from one of the rooms
where we talk about hallux limitus
we're gonna go right here hallux rigidus
make a small little incision in the skin, put the burr down here and just burr this down
so that reach over and burr this down a little bit too
and you'll see before and after the rigidus is very painful because it's jamming right about here
the joint is jamming so traditionally we would open it up, shave it down this way
and you still cause a lot of stiffness, so what did we do?
Didn't really help very much, right?
So now we're able to do it minimally invasively and able to burr this down
without opening up the joint and that seems to get better results
we're not exposing the bone -- I mean we're not exposing to air
and patients heel with one stitch
they're walking on it right away
no wound healing complications and patients get back to activity almost right away
depending on how bad your spur is
Now if it's really bad, the stage of the hallux limitus obviously the very severe cases
the joint fusion is still the best choice but we pushed the limit on this before
I've had patients who say, "Doc I don't care, I know you tell me that I need a fusion or an implant
but I would like to try the minimally invasive cheilectomy."
Well this case will show one of those cases, enjoy.
Hallux rigidus right here, big bump on top
right here the whole joint is inflaed
it's locked and there's really not much motion and range of motion is right about here, it's locked
so the bones were right here
so that we're going to try to get rid of this with the minimally invasive method
we're going to look from here this side again, you see that locking mechanism right there
causing a lot of pain
the goal is to go ahead and shave this bunch off with a small little incision
so that the joint can at least move up to about 90 degrees today,
that's my goal today is get up to 90 degrees with the MIS method
Let's take a look.
Take a shot.
Finish off right here,
and that's what we have, just pull out the bone paste
all that bone paste out of the bone
okay, yes, that's all the bone paste
now let's watch the range of motion now
we had a big spur right here before on both sides
now motion motion is great
checking the motion right here
check out the motion from the side
range of motion
pushing that motion all the way up, range of motion all the way up.