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Tuesday, September 7, 2010

Hallux Rigidus: Initiating Conservative Treatment

The following is part of an email sent to me from Dina. All reference to her personally has been eliminated to secure her privacy.

Dear Doctor,
Yesterday night I found your site and was stunned. You are a doctor I am desperately looking for but unfortunately I do not live near you. I read all your words about Hallux Rigidus in a loud voice to my husband. Every word of your professional and ethical statements fits my dream about a podiatrist whom I can trust. This is the first time in my life when I am having a serious health issue like this, and I am 65 years old.
Three weeks ago I was diagnosed with Hallux Rigidus, and I saw two doctors. Both of them spent with me 10 min. trying to schedule an immediate fusion surgery for my right foot (most troubled) and barely looked at my left foot where I started to have tingling between 3rd and 4th toes a few days ago. One of those doctors gave me a cortisone injection and the same night I ended up in an emergency room screaming from pain. I am only 110 pounds though, and I have an extremely healthy life style and nutrition. I studied classical ballet and only two weeks ago I said good bye to my morning ballet barre (and to almost three dozens of my cute shoes). I have a loving husband of 40 years together, a wonderful married daughter and a beautiful grandson but I feel like my life has been shattered. I see no exit out of my situation because I would never give myself for a surgery on my feet.
I fully understand that I cannot have you as my doctor but I am grateful for the chance to write to you because your professional philosophy and approach for treatment is exactly what I imagined when I first went to see my foot doctors. However, I only saw two businessmen, and not two doctors.
Thanks a lot for reading my desperate letter, and you have my deepest respect for being such a doctor, a real doctor whom I can only remember when I was a little girl. I grew up backstage and saw many podiatrists who did not have an adequate equipment but they treated all ballerinas with a great success...


Dear Dina, Thank you so very much for your email. For my readers sake, I have chosen your email for educational purposes as there is so much to discuss. Please either post a comment on the blog, or email me privately for followup questions/concerns. First  of all I want you to email me the answers to the blog post on Medical History so I have a better understanding of your problem. You discussed 3 weeks of pain, but is that when it got real severe only?

So, if you read my post of Hallux Rigidus, we must calm the joint down. I would either call around to Medical Supply companies in your neighbor, or order online a Anklizer-type removable boot (google Anklizer and many online suppliers await). This is normally accompanied by an Even-up for the other side. You may be in that for the next 3 months so better start today. This is highlighted in my post on stress fractures.

And also go to, follow the orthopedic link, and look for a small removable boot like the SP Walker from Aircast.

Here is the link for my readers to the original post.

So, you are wearing your cast and EvenUp, and now you should be feeling that you are moving in the right direction. We need to calm the joint down with various anti-inflammatory measures--three times a day you remove the boot to ice of 10 minutes or do 20 minutes of contrast bathing. You must see what makes it feel better. See the separate posts on these routines.

But, of course you need a doctor to manage this. I am the past president of a great organization of gifted podiatrists who practice Sports Medicine. You need to not find a doctor who thinks of him/herself as a surgeon, but a doctor who thinks that they are a sports medicine doctor. The philosophy is totally different. Most sports medicine doctors do surgery, but think of it as the last resort. Please read my post on What is Sports Medicine?

When a patient calls me from out of town, and needs a referral, I always have them go to two or three sources. First of all, to find the local American Academy of Podiatric SportsMedicine member. Secondly, I have them use  to see what patients are saying about that doctor. Thirdly, other sources to be used are local sports medicine physical therapists or running clubs. Hopefully, you can find a new podiatrist/orthopod, to help you down this road.

Once the joint is calmed down for 2 straight weeks, you can begin to wean out of the cast gradually. There is a skill in doing that. After one month in the cast, you really know if you are getting the job done and the joint is calming down. You may also be getting treatment on the other foot for what sounds like Morton's Neuroma. If the inflammation is slow to respond, the doctor may put you on a course of oral cortisone (called a Prednisone Burst), or other anti-inflammatory medicine. Remember that  anti-inflammatory medication (like Advil) can retard bone healing, so you want to relie more on icing and contrasts if possible.  This is when physical therapy may be very appropriate to calm a joint down. Physical Therapists know how to calm a joint down better than most, although a good accupuncturist can help also. 8 treatments of physical therapy prescribed by even your primary can help alot after 1 month of casting.

So, there is so many approaches that we can use to help you Dina. Do not give up faith in the medical profession. I see such dedicated people out there. I remember with one my injuries, I got 5+opinions to gather the knowledge to help myself. See my post on Second Opinions.

Let's have another chat after you got the ball rolling on this stuff. 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.