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Saturday, May 9, 2015

Big Toe Joint Pain from Running: Email Advice

Hello Dr.,

I do not know if this email is still active, but I wonder if you could give me some advice.  I am a 27 year old active male who, for the last 7-8 years has had big toe pain in my left foot.  It seems to exacerbate on exercise and calm down when I rest it.  It doesn't seem to be getting worse, although it does tend to be quite tender after running.  I have no bone spurs that I can feel, and retain the same ROM as the other foot.  I had x-Rays about 7 years ago when I noticed it and the podiatrist suggested the usual hard sole shoes and orthotics, which I didn't follow through with.  Should I be treating this like a sore joint and avoiding exacerbating activities, or should I be looking into surgery?  If it is the latter, which surgery might retain maximal functionality of the toe ultimately?  I appreciate your time and your response.

Dr Blake's response:
     Thank you so very much for your email. In a situation like this, you have plenty of time to find 3-5 things that help you de-stress the joint and perhaps slow down the joint breakdown. You are way too young to do joint surgery, and there is no surgery out there that makes the joint better. You can make a toe straighter, you can remove bone spurs that get in the way of motion, you can fix or remove broken bones, but unless we had more info, you can not make the joint better by cleaning it out. 
     What typically makes big toe joint better are biomechanical changes (shoes, pads, orthotics, activity modifications), anti-inflammatory measures (icing, PT, contrast bathing, topical and oral meds), immobilization measures (cross training, plates, spica taping, stiff sole shoes, removable boots) and getting further information (xrays, MRIs, bone scans, CT scans).
     My goal for you would be to try one thing a month for the next 7 months (like icing for 10 minutes twice a day). Definitely use the KISS principle: Keep It Simple Stupid by using the least invasive things first. Find 3-5 modalities that help somewhat (10-20%) and make yourself a cocktail for less pain. Hope this works for you. Rich

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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.