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Wednesday, March 30, 2011

Big Toe Joint Pain: Remedy for Dress Shoes

Margaret has right big toe joint pain. Her xrays which follow show slight peripheral bone irregularities classic for mild wear and tear arthritis. The pen points to the abnormal bone projections that can cause low grade pain and swelling in the joint on a chronic basis.

 Bone projection noted on top of the joint.
 Bone projection noted on the side of the joint closest to the second toe.
Bone projection noted on the outside border of the joint.

These subtle wear and tear changes can lead to low grade irritation which makes the joint fragile. That sensitivity means that the joint can get inflammed and painful easier than another joint.

When Margaret first came into the office the joint was so inflammed that physical therapy, icing, and spica taping was needed to cool it off. As she got back to normal activity, that sensitivity still made it impossible to wear fashionable shoes. After trying to have them stretched to no avail, she came back into the office today. Since the joint had great range of motion, and the pain seemed to be from pure pressure, 1/4 inch adhesive felt from http://www.mooremedical.com/ was used to off weight the sore area.



Margaret intentionally did not place her foot above all the way into the shoe so that the photo could capture the placement of the padding. Even though 1/4 felt was used the patient could add or subtract easily from the overall thickness. Felt is very easy thin out. The padding is never placed over the sore area, only next to it. Care would be taken in most cases to trim or place so that is not obvious to others.

Here was Margaret's email to me that afternoon (and she also got a medium gel toe separator to keep the big toe in alignment).


Hi Dr. Blake,
Got the X-ray...got the toe spacers. The toe spacers are great and I think they are helping in addition to the felt!

I am feeling much better!

Keep me posted on the X-ray.
Thank you so very much for your time!
Your are terrific!

Margaret
Sent from my Verizon Wireless BlackBerry

On Mar 30, 2011, at 6:02 PM, Richard Blake wrote:
Margaret, The xrays show very little arthritis on the joint, but enough to give you some chronic swelling. The toe seps and padding may be part of your wardrobe for awhile. Work on the swelling and see if you and I can make this happier. I will email when I put it on the blog. Rich



Hi Dr. Blake,


Thanks for the update on my X-ray. I do hope the terms "very little" stay "very little" and we can keep this arthritis from spreading.

I will continue to "do the right thing" and add the spacers, tape, and padding to my routine along with the ice massages.

In the meantime....if anything new comes up I will contact you.

Thanks again for your help.

Best,

Margaret











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On Wed, Mar 30, 2011 at 11:27 AM, wrote:





Hi Dr. Blake,



Got the X-ray...got the toe spacers. The toe spacers are great and I think they are helping in addition to the felt!

I am feeling much better!

Keep me posted on the X-ray.

Thank you so very much for your time!

Your are terrific!

Margaret

Sent from my Verizon Wireless BlackBerry

2 comments:

  1. Here from Uruguay:

    a couple questions

    1. do you use de filter pad circumferential or in the dorsal surface fo the great toe?
    2. what kind of shoes do you suggest?


    Best Regards


    Gerardo Amilivia

    ReplyDelete
  2. Dear Gerardo, The principles are:
    1. Use the patient's shoes that they can not wear at present due to the discomfort.
    2. Avoid placing the pad over the sore area.
    3. Use an open mind to place the pads in one, two, or multiple places on the foot to take the pressure off (off weight bearing).
    4. You start with one pad in the position on the foot under the shoe that gives you the best chance of relieving pain. If that only works somewhat, you can increase the thickness if you have room, or place more padding in other spots.

    Hope this helps. Dr Rich Blake

    ReplyDelete

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.