The Minimally Invasive Approach to Hallux Rigidus by Dr. Kevin Lam
Hallux rigidus, often referred to as big toe joint arthritis, is a debilitating condition that can severely impact mobility and quality of life. Often confused with bunions, Hallux rigidus and its precursor, Hallux limitus, present unique challenges for patients seeking relief. Let us explore the groundbreaking work of Dr. Kevin Lam, D.P.M., FACFAS, DABLES, DABPS, in revolutionizing the treatment of Hallux rigidus through minimally invasive techniques.
Understanding Hallux Rigidus and Hallux Limitus:
Before delving into treatment options, it’s crucial to differentiate between Hallux rigidus and Hallux limitus. While both conditions affect the big toe joint, Hallux rigidus refers to advanced arthritis of the joint, resulting in stiffness, pain, and limited range of motion. Conversely, Hallux limitus is characterized by restricted motion at the joint, often mistaken for a dorsal bunion.
The Conventional Approach vs. Minimally Invasive Surgery:
Traditionally, the treatment for Hallux rigidus has involved joint fusion or more invasive surgical procedures. However, Dr. Kevin Lam has pioneered a minimally invasive approach that offers patients a faster recovery and superior outcomes.
In a live case demonstration, Dr. Lam showcases the minimally invasive technique, making a small stab incision and using a rotating burr to precisely remove the bone spur causing pain and stiffness. Unlike traditional methods, which may require extensive incisions and prolonged recovery periods, patients undergoing minimally invasive surgery heal with just one stitch and can walk immediately post-procedure.
Benefits of Minimally Invasive Surgery:
The advantages of minimally invasive surgery for Hallux rigidus are manifold. Patients experience minimal wound healing complications, reduced postoperative pain, and faster return to daily activities. Additionally, the preservation of healthy tissue and smaller incisions result in cosmetically appealing outcomes, with virtually no visible scarring.
Comparing Minimally Invasive Surgery to Traditional Joint Fusion:
One of the key distinctions between minimally invasive surgery and traditional joint fusion lies in the preservation of joint motion. While joint fusion aims to eliminate pain by fusing the bones together, it can limit mobility and may necessitate alterations in gait. In contrast, minimally invasive techniques focus on preserving joint function while addressing the underlying pathology, allowing patients to maintain a more natural range of motion and mobility.
Dr. Kevin Lam’s innovative approach to treating Hallux rigidus represents a paradigm shift in foot and ankle surgery. By embracing minimally invasive techniques, patients can undergo treatment with confidence, knowing they’ll experience less pain, faster recovery, and superior outcomes. If you’re suffering from Hallux rigidus, consider consulting with Dr. Lam to explore the benefits of minimally invasive surgery and take the first step towards reclaiming your mobility and quality of life.
——
Video Transcription:
Hi 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 inflamed, 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.
