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Saturday, September 7, 2013

Big Toe Pain: Inter-Phalangeal Joint---Email Advice

Hi Dr. Blake! 

     I am a 32 year old female whom recently started getting sharp stabbing pain under my big toe (not the large joint but the one in the first bend of the toe).

     I was diagnosed with an elevated first ray in my left foot and slight elevation in my right. I have some Hallux Limitus in the left so far, along with Hallux Valgus.
Dr Blake's comment: When the big toe joint has some limitation, then movement may be increased in the joint in front of (your painful area) or in back of (in the arch). 

Here are some of my questions:

1.  I am wondering what you would recommend for my particular condition?
Dr Blake's comment: You need to experiment with circumferential taping of the toe across the sore joint 24/7, padding either below (to bring the ground up), or to the side (classic dancer's pads), icing 2-3 times a day, figuring out if there are shoes that make it feel better (more padding, less flexibility, or more flexibility, etc), and cut out for the next several months activities that irritate it. I would at least get xrays to evaluate the area. 

2 Should I have surgery to avoid getting arthritis in the joint? (this has not happened yet)
Dr Blake's comment: I hear about preventive surgery, but I personally think that is mainly an oxymoron.

3. What brands of shoe would you recommend? 
Dr Blake's comment: You really have to play with this one. You have 5 parameters to deal with in a shoe, and some combinations will be the best. Set no preconceived notions. The 5 parameters are: padding, flexibility, width, toe box space and length. 

4.Can I still wear sandals so long as they have a back strap? 
Dr Blake's comment: Sandals, like any footwear, are fine if they do not increase the symptoms. Listen to your foot. 

5.I did stop trail running, as I don't want to end up crippled in my old age. I really appreciated coming across your site. No one seems to pay attention to this problem and it is terribly life-altering. I am devastated and having a hard time coping. I used to love running and being very active, so this is quite the blow, esp at such a young age. I appreciate any help you can offer. The doc hasn't told me how severe my condition could get. I do have my x-rays. Could I send those to you and get your opinion?
Dr Blake's comment: I would be happy to look at your films. Send to Dr Rich Blake, 900 Hyde Street, San Francisco, Ca, 94109. This problem does not tend to be that difficult to treat, so I guess I need more information from you. Try to send me 20 historical bullet points to review: How long, swelling, redness, duration after stop working out, etc, etc. Hope this helps some. Rich

Best,

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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.