Dr Blake's comment: Hallux Rigidus is defined as stiffness in the Big Toe Joint of less than 30 degrees of dorsiflexion (the bend of the joint as we try and push off). Normally the big toe joint (called the first metatarsal phalangeal joint) is between 75-90 degrees of bend. We normally need 75 degrees to comfortably function in sports, and 60 degrees for normal walking. This is a common measurement taken.
Tonight my pain level is around 7.
Dr Blake's comment: My favorite post on this blog is called Good Pain vs Bad Pain. Good Pain is considered pain levels of 0-2 on a pain scale of 0-10. 10 means you are in very serious pain and 1 means you are annoyed but still smiling since the San Francisco Giants just beat the Detroit Tigers in the 2012 World Series. 7 is getting very bad and we need to fix ASAP.
My left big toe joint is totally frozen. It swells. It bruises. I walk funny. Since Sunday my knee on that side is sorta clicking/popping when I walk. My ankle swells.
My foot looks awful. It’s like it is continuously bruised around the joint, along the base of the toes and on the top of the foot though I think some might be due to meds that I take and sun exposure and the rest to reinjuring it over and over. It’s ugly.
Dr Blake's comments: You are not going to get any absolution of your sins from me. When you keep ignoring the pain, the pain can become it's own problem. The skin discoloration could be a sign that your pain has been out of control too long. Prolonged pain can cause vasospasm (loss of blood flow) since the nerves feed the blood vessels. The loss of blood flow for too long can cause rebound increase blood flow which can cause skin discorations or ugliness!!! The vascular specialist would probably be the correct person in that scenario to see.
Dr Blake's comments: Yellow, of course, is deep blood and the darker stains are the most superficial blood. Both of these colors are from the constant beating up on this or these joints. But, could indicate a bleeding problem. Please have some blood work including the standard CBC with Differential.
This bruising gets better and then worse when I hurt the joint accidently or wear shoes that are too soft. Anyway, I never got the insert made. This past year the pain has been getting worse. This past weekend I wore new boots with the same heel as the other boots I wear. I wore them around for around five hours and it got increasing more painful to walk. When I got home my foot was throbbing. I took off the boot and it felt like my joint was coming apart. It hurt and the area around the joint swelled as well as my ankle. I did walk though and by Monday the next morning it was somewhat better. I was limping and it was really sore and I am yet today.
Dr Blake's comment: I know when you have something for a long time, you just want to ignore it and live life. However, this problem is crying out to be treated seriously, and you must start with creating a pain free environment for it, and keeping it pain free for 3 to 6 months. This probably will mean a removable cast, like the Anklizer, to reduce the bend in the joint. Perhaps just a shoe like the MBT will produce less bend to minimize the discomfort. In this task however, you should be armed with good protective orthotics and the skill of spica taping.
Dr Blake's comment: Bone on Bone means that the cartilage (pillow) covering the bone is gone and the bone nerve endings are exposed. Pressure from the opposite side of the joint produces pain since the pillow is gone. Cartilage has no nerve endings, so in a normal joint you do not feel the joint moving. In an arthritic joint, with exposed bone on one side of the joint hitting exposed bone on the other side of the joint, the nerve endings produce a lot of pain with this pressure.
While examining my foot he asked me if I was diabetic. I told him I was not. He said my foot looked the way a diabetic foot looks. He was referring to the discoloration/bruising. I told him about the meds I take (nipedipine and hydrochlorthiazide) and what I thought some of the discolorations were along with injury. He really did not say any more about that. He then gave me three options. Do nothing, joint replacement or fusion. I asked him what he would do and he said if it was him he would probably do the fusion. He set me up to have the surgery on November 15th.
Dr Blake's comment: If you are pre-diabetic, signifying possibly poor healing, you need to get that checked out before any type of elective surgery. Check if your drugs for high blood pressure can cause easy bleeding. Definitely, you need you internist to work things up and make sure you can have surgery in the first place, or do you need to get your circulation, blood sugars, platelets, etc, evaluated?
Dr Blake's comment: Doctors are human, at least some of them. You need to feel comfortable with any doctor who is making major decisions about the rest of your life. If you do not feel comfortable calling him, switch to another doctor. But, I would encourage you to stay with him and call. Doctors can not remember everything in the short time of the visit. Golden Rule of Foot: If a doctor does not discuss something you think is important, it is important, and they were just thinking of too many things at the time. So ask!!!
Linda (name changed for privacy)
Dr Blake's initial response:
Linda, I will have more time this weekend to explore your email. Definitely you should be in a removable boot for the next 3 months while you analyze the pros and cons of various surgeries. I will help. I need photos of your foot, copies of your MRI and xrays. I prefer you cancel surgery while you really think this out. Rich You also need to have a good vascular workup to make sure you will heal from any surgery.
Dr Blake's response:
Hey Linda, So here are the steps you need to do if possible over the next few months. Get a vascular workup to make sure you do not have any bleeding problems that would interfere with surgery. Get an MRI to document the status of cartilage destruction on the joint. Get another opinion after these on the viability of conservative care vs joint cleanout vs joint replacement vs joint fusion. Definitely get into a removable boot with EvenUp, get orthotics that seem to place your weight into the center of your foot, learn to spica tape, and ice twice per day. I sure hope this has been helpful. Rich