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Saturday, July 14, 2012
Big Toe Joint Pain: Email Advice Regarding Possible Surgery
This is an email I just received regarding Hallux Rigidus possible surgery.
Big Dorsal Spur seen associated with an Arthritic Big Toe Joint
This is a great question and I hope you will be able to read my response. What you are talking about is preventative surgery? This would be surgery to prevent another surgery or delay another surgery. I suppose that there are a few cases of this that make sense, but not big toe joint surgery. Any surgery on the big toe joint will weaken and stiffen it. After surgery you are more reliant on orthotics, taping, icing, physical therapy, shoe gear, etc. You job now is to see what you can do to minimize/prevent the severe pain episodes. That is what will save your joint. Some, level 0-2, pain is par for the course with an arthritic joint. It is the pain from the low grade inflammation. Higher levels of pain may mean you are breaking down the joint. If you have surgery, it will not be a good joint, and you will have even more restrictions. There is no study that I know documenting the percentage of patients with an arthritic big toe, or knee, or hip, joint that go on to surgery. Do not do surgery to slow down the arthritis, since I am not sure that can happen. Have surgery if you can not control the soreness and it impacts your life (since we only have one of those for all I know). If I decided to have surgery for this, I would get a baseline MRI, and then spend 1 year rehabilitating the joint. Then I would get a comparison MRI to see if the joint is getting better, worse, or staying the same. My blog is full of information on what to do to help a painful joint. If you do not succeed, have the surgery with no regrets. But, you may get a lot better. My office has probably 500 plus patients with this problem in all different points of the progression of the disease. They have surgery only when the disability of the problem outweighs the disability and risks of the surgery. The smarter I become on this issue, the dumber I feel. There are so many variables to deal with to help someone avoid surgery and rehabilitate after surgery. I have patients with minimal X-ray findings with severe pain, and severe X-rays findings with no pain. Analyzing disability vs function is the most important tool we have in advising patients with this problem. My job is to get as good as I can at avoiding surgery for patients, so if they need surgery, the same tools can be used to successfully rehab them. Please email again with any other comments. DrRichBlake