Dr Blake's response:
Silvia, thank you so very much for the email, and sorry it took me a long time to answer. You have the classic symptoms of Stage 3 Turf Toe, with complete rupture of one of the main ligaments in your big toe joint (which gives you the constant thickness of the big toe joint, and unending swelling and bruising. The bruising is from repeated partial healing, and then re-tearing of the delicate ligaments). I am glad the x rays are fine, although the MRI may show some bone issues. Can you speed up the MRI so the soft tissue diagnosis can be made sooner? When the tear starts to heal, the tear begins to slowly not look like a tear, only scarring/fibrosis, and the MRI can be read incorrectly. Daily I would wear the boot and spica tape. In the evening, take the tape off so you can freely contrast and massage. The massage is very important to decrease the nerve hypersensitivity which can have a mind of its own. You should be able to have your dancer's padding inside the boot (sorry the image is so blurry).
- Create a pain free (0-2 pain level) environment with some form of immobilization and/or protected weight bearing.
- 3 times daily use topical anti-inflammatory measures with icing twice and one session of contrast baths (you don’t have to tell anyone about your rubber ducky in in the bath!!).
- Learn how to spica tape the big toe joint for times you want to immobilize (see my video at YouTube entitled drblakeshealingsole Spica Taping).
- Learn how to make dancer’s pads for any shoe or boot to off weight the big toe joint. One eighth inch adhesive felt can be purchased from www.mooremedical.com for this purpose.
- Learn if arch supports are necessary to transfer weight to the arch and middle of your foot. You can try the Red Sole inserts sold online or at stores like REI.
- See if you can get xrays and an MRI to look at the health of the joint internally.
- Purchase a carbon graphite plate that can be used in some shoes under the insert to limit the joint motion for some activities.
- If you were started in a boot to obtain a pain free environment, purchase an Evenup to keep the spine level and avoid back issues.
- From the day you begin treatment, begin strengthening your feet, and lower extremities. Avoid pain, but this approach will lessen the deconditioning. This can be mean a lot of core work, some cardio on stationary bikes, and specific foot exercises approved by the health care provider (as long as they do not hurt is the general rule).
- Use adhesive felt on the top of the foot (typically 2 layers of 1/8th inch or just ¼ inch) from www.mooremedical.com next to the bump at the top of the big toe joint, but not over, in any shoe that it helps take pressure off.
I just got back from my appointment with him at our local fracture clinic where he examined my foot (stealthily while making conversation) finding good movement in my joints (which I hadn't moved in weeks!), and said much the same thing that you've been saying all along: get the foot moving again! He said (as you did) that the blood pooling, residual swelling, pain and stiffness are largely a result of non-weight bearing and immobilization. He also said that too many patients are referred on the basis of x-rays. He said "treat the patient, not the x-ray" and said the only time he would consider fusing a joint is if there was a considerable lack of function. He said even a poorly healed or even non-union fracture of the the small bones of the foot can often pose no significant problem for the patient even when they appear "like corn flakes on the x-ray". Anyway, all this is to say that he advised me to start remobilizing right away (contrary to the advice of my sports medicine doctor who had asked me to remain non-weight bearing for three more weeks). The surgeon said prolonging immobilization can cause weakness leading to secondary injuries. I'm very eager to start rebuilding my leg muscles and foot strength and reclaiming my life. I sincerely like my sports medicine doctor, but don't know why his advice was so different from yours and the surgeon's. It's hard to contradict a doctor's advice as a layperson. I wish I hadn't remained non-weight bearing for so long out of fear of delaying the fracture healing. In any case, I'm looking forward with optimism.
I just purchased a pair of Wolky sandals, a new brand to me. The model called Jewel has three adjustable velcro straps (which is wonderful for someone with a very high arch like me), a fairly rigid sole with rocker front, and a removable cork foot bed into which I've put my own cobbled- together foot bed with strategic offloading padding. They are far more attractive than typical orthopedic shoes and your other patients might find them very helpful: http://wolky.com/shoes/jewel/.
It feels wonderful to be transitioning to real shoes again. I believe I will be walking without pain or crutches very soon!