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Saturday, January 8, 2011

Big Toe Joint Pain: Email Advice

Good Afternoon, Dr. Blake.

Hope you had a great holiday. :)

It was fun, but definitely a blur.

I want to thank you for giving me a call this afternoon to let me know that you received
the X-Rays from my HMO. I really appreciate it, because I know you have got to be
a busy person, especially during this part of the year.

After my visit with you earlier in September, (when you didn't have the X-Rays) I went back
for my consultation with the HMO podiatrist.

She definitely said that it wasn't a bunion, but after viewing the images said it was a bone spur.

Originally, pre-imaging the doctor said that fusion of the big toe joint was an option, but after imaging said that wouldn't be

a good thing.

So I'm in agreement with both of you in that I don't want to fuse anything. I have more motion

by not doing so.

What I'm wondering, however, is if you would be in agreement that it is a bone spur and if you would

also agree that going in and smoothing out the surface, (which is what the podiatrist proposed) would be

a good option. If it would at all alleviate some of the pain I've been having when pressure is put on that area.

Also, if there is a chance that it would give me back a little more motion.

She said it would be probably around a two-week rehab with the smoothing out process.

Right now, my foot definitely lets me know when I've worked it too hard or am in the wrong kind of shoe.

All my shoes are pretty much flats, (supportive flats) but it still bothers me with all the dancing I do.

The orthotics were declined by the HMO, so I won't be getting those anytime soon.

Let me know if I should call you back today or tomorrow

or make a follow-up appointment to see you in person at St. Francis.

Thank you so much for your time.

Best Regards,
 
Heidi
 
Dear Heidi, Thank you for allowing me to answer this email on my blog. I have even changed your name to protect you. When you first saw me the podiatrist had been talking about fusing your big toe joint as a primary surgery and I was quite appalled. I am so glad that opinion has changed. You definitely need surgery, but good rehabilitation of the toe joint will take a few months, and you will have to be good to the toe for about one year.
 
Why do you need surgery? Let us look at your xrays. Here are the straight images from the top of your foot noting arthritic spurs and irregularities in the joint suggesting Hallux Rigidus with degenerative arthritis.
 
You can see part of the joint does not look healthy at all.

Here is the 2 links in which I discuss Hallux Rigidus that I know you have already seen. The 2nd one where you will be following surgery, and the same treatment will be needed (immobilization to some degree with anti-inflammatory, following by a restrengthening phase to return you to activity). Every one goes at a different pace.



This is just a zoomed out version of the above photo giving you more perspective on the arthritis in the big toe joint (irregularities) not seen in the 2nd joint next to it. This view however shows nothing that guarantees you need surgery (we see it in the side view called the lateral view).

It is this side (lateral view) of the big toe joint (first metatarsal-phalangeal joint) that shows why you should have surgery. See the large piece of bone wedged in the top of the joint. It is an arthritic spur that may have broken off at some time, but definitely you can not co-exist with this for your life. Surgery (called a cheilectomy pronouced ki lec toe me) would clean out this and all the other spurs and irregularities and give you an arthritic but less painful joint. The surgery just sets the stage for the rehab. The rehab of  your toe and physical fitness can not begin until this is cleaned out, and the doctor you mentioned has a good reputation. But, this is not To Cut Is To Cure, the surgery is 50% and the rehab is 50%. I would feel comfortable with you having surgery, if I felt comfortable that you will get all the right physical therapy, orthotics, taping, castings, etc that you need after. That should be your next big discussion with the surgeon. Without good rehab, you will get even less motion in the joint afterwards.
Heidi, I hope this has helped you. Rich



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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.