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Saturday, March 2, 2013

Hallux Rigidus: Email Advice

Dr. Blake, I was recently diagnosed by an orthopedist with Hallux Rigidus. He took X-rays, pronounced I had it, gave me Mobic, said I could never wear flip flops, high heels or even the flats I had on and waved goodbye. (Mobic made me feel dizzy and nauseated, so that was out).
Dr Blake's comment: Mobic, generic is meloxicam, is one of the non steriodal anti-inflammatories. There are 9 classes of these drugs, and several may be ideal for you. If this is an option, you need your internist to begin to experiment and find one that really helps. I like the 10 day on and 4 day off rotation. This allows you to detoxify from the drug and the 4 days off should be ample time to decide if the drug is helping you. If not, or unsure, switch to another class of drug for another 10/4 rotation. 

http://www.spine-health.com/treatment/pain-medication/types-nsaids

http://www.drugs.com/mobic.html

Thankfully, I found your website. I was going to buy a Budin Splint, but they don't make them to go over the problem joint/toe which is the big toe? I'm confused.
Dr Blake's comment: For the big toe joint, spica taping works like a budin splint for the lesser toes. 




I am trying to run/walk, but realize I am no longer walking normal. I am walking on the side of my foot and know this is going to be big trouble- soon.
Dr Blake's comment: Limping or favoring the injured area is potentially very damaging and can cause worse problems in your knees and hips. Probably okay when you stand to roll to the outside, but not when you walk and run. You need an insert/dancer's padding that enables you to off weight the sore area without limping. 




My toe joint feels like it is on fire at the end of the day. Putting weight on it isn't the problem, but if that joint bends, it honestly feels like it is going to break and hurts like the devil. I just began icing it recently. I have been very careful to buy shoes that exert little to no pressure on this toe joint for years. 
Dr Blake's comment: For the next month, ice pack the bottom of the joint for 15 minutes twice daily and do one end of the day contrasts to flush the joint of fluid. This typically works better than medications, although once you are doing your topical treatments, the meds may be a good choice to add. 

Exercise has proved daunting and the resulting weight gain has done nothing to ease the pain, as you can imagine.
Dr Blake's comment: Stationary Biking has been a great exercise, since you can put the pedal in your arch. Swimming is also great without pushing off the wall with your bad foot. If you can design a good dancer's pad, even elliptical can be used as long as the weight is on the lesser metatarsals and you do not use your arms. It is so crucial you keep your quads/core strong to help support your frame off the foot. Weaker core, more collapse of the foot and more pressure on the big toe joint. Even Pilates and Yoga mat exercises at home with a DVD can prove very important.

 I have Voltaren gel, but just used it a couple of times and noticed no difference.
Dr Blake's comment: Voltaren gel, or Flector patches can be used on the top of the joint 24/7 since it does not interfere with the Spica taping. You must use for 1 month 3 times a day before you really see the benefit, or decide to not use.

 I take aspirin regularly, but dont take Ibuprofen because it raises my blood pressure a lot. I have Aleve, but don't use it much cause I'm afraid of its effects on BP.
Dr Blake's comment: I really do not like any of them, unless it is just to help control flares. I would rather you ice and contrast bath. You can ice 10 minutes hourly (when you are home) for a 2 week period to see how that works. It is 100% anti-inflammatory without GI or cardio-vascular side-effects. 

Would you advise that I see a podiatrist to get orthotics? I don't intend to have surgery in the near future, so I'll do just about anything else.
Dr Blake's comments: Yes, orthotics that take the pressure off the joint with a dancer's pad will be great for some shoes. Other shoes the orthotics will probably place too much pressure on the big toe by crowding the shoe or shifting your weight forward. It is wonderful to have a good pair of orthotics that support the arch and shift the weight to the center of the foot. Consider going up one half shoe size with orthotics. Look into getting carbon plates for some shoes. Also, look into rocker shoes like the New Balance 928 or Mizuno Wave Nirvana.

Thank you so much for your blog. I wish I had found this years ago before all the damage had been done. I'm about ready to get the old boot and immobilize my foot. My husband thinks I should get a cortizone shot, but I am hesitant to get hooked on those.
Dr Blake's comment: I agree with delaying. You are going to mask pain for awhile with the cortisone, and that could speed up the damage. Begin cortisone only when you have resigned yourself to a joint fusion if it doesn't work. Sure hope this information helps you. Dr Rich Blake

I appreciate any help you can give. Thank you again!
Jennie (name changed) from Alabama

6 comments:

  1. Hi doctor thank you for the Spica tape video. Can you share what brand tape you are using? Thanks!!!

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  2. I use Kinesiotape, Rocktape, or 3M Nexcare Waterproof. Rich Blake The first two are easier to put on, but the 3M product provides a little more stability.

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    Replies
    1. Thanks i jsut got some tape and will be following your video for a turf toe. One more for ya- do you recommend deep water jogging for injuries of the first toe like turf toe or sesamoid injuries? Or can that cause more damage ?

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    2. Deep water jogging with turf toe places a lot of pressure on the joint from the water, even if you do not move your toes much. It would have to be pain free, but may not hurt until 2-3 hours later. Perhaps a skilled aquatics person could help you like Susanne at www.watergym.com. You could use your water aerobic shoes while jogging and they would probably help you remember to relax the joint. Dr Rich Blake

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    3. Wow I'm really glad you told me this. Otherwise I would have gone to the pool and possibly injured myself further. Is there Amy cardio I can do with a turf toe injury ? Thanks again Dr. Blake.

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    4. Patients with Turf Toe live on the bike. You can always put the weight in the arch of the pedal, lower the seat and the tension slightly, and ride for hours. Dr Rich Blake

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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.