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Tuesday, July 31, 2012

Hallux Rigidus/Bunion: Email Advice

Hello Dr. Blake, 

I found your blog page while researching how to find help for treating my right foot.  Back in April I finally made myself go to the school doctor about what I thought was just a bunion on my right big toe...she referred me to a podiatrist/foot surgeon in the area who diagnosed it as hallux rigidus, and said my first metatarsal is too long from genetics and that it is a very degenerative disease and I am looking at surgery in the near future to clean out the bone spur, break, shorten, set that long bone and then recover....and do it soon for the left foot which is already catching up and the spur is visible without an x-ray!  He said I'm facing at least six surgeries by the time I'm 60, three in each either foot!  He said to call him when I was ready to proceed with the necessary surgery. 

Dr Blake's comment: Since you sound young, did you ever have trauma to that joint? It is extremely rare to have advanced arthritis at a young age, but something does not smell right. But please continue the story.  

I have put off said surgery and tried to just deal with the daily pain with Ibuprofen, but as I maxed out the OTC dose on it and began experiencing stomach problems from it.
Dr Blake's comment: You normally get more local anti-inflammatory dose with a 10 minute ice pack three times per day, with occasional anti-inflammatory drug, and with topical medicines like biofreeze, zyflamend, traumeel, etc. 

 I made it to a different general practitioner (now that I graduated college in May, the university student health center refuses to let me go back to my own who originally referred me to foot doc. #1.  They refuse to even send that referral to a different doctor for a 2nd opinion, and asked me why I didnt' go to the first one!?)  This new GP looked at my foot, listened to me, and switched me to Aleve (naproxen sodium) which seems to be working better, but even on twice daily prescription strength regimen, I am still in pain!
Dr Blake's comment: So, where is the pain? In the joint? On the bunion bump? Generalized around the front of your foot? And do you have a bunion also?

  She referred me to a different Bone and Joint specialist in her network.  I also reported several other joints that have become very painful, including my left wrist, and the base and middle joint in my left forefinger, and the base of my left thumb.  Several days I just collapse in pain when it feels like EVERY SINGLE JOINT in my whole body hurts suddenly and severely!  I am concerned this may all be related...
Dr Blake's comment: Before anyone touches your feet, you should get an arthritis doctor (rheumatologist) to work with you. You do not want a lab test ordered unless you are with an experienced doctor who is wise and can interpret the results. Lab tests have false positives and false negatives, so the whole picture must be looked at carefully. You do not want a label if you really do not have the disease. 

.so I heard that rheumatoid arthritis now has a simple blood test...but the new GP did not want to do it on my first now if I want to get it, I have to go back to her and pay out of pocket again, because my oh so wonderful student health insurance ends, July 31st!  So now, unfortunately, I will be "self-pay" and need to pay out-of-pocket for any surgery, treatment etc!  It keeps adding up!  Foot doc #1 wants $500 just to come talk to him about surgery, and if he has to do any x-rays the cost is more!  Other foot surgeons want at least $250 just for an initial visit, etc.  

Dr Blake's comment: There are many great doctors at teaching hospitals around the country who will work within the system to provide you great affordable care. Are you near a big city that has such a program? You must be willing to go along with all the red tape of any buracracy.

So, I am intrigued by your ideas about non-surgical treatments for hallux rigidus.  I am finding that idea echoed in some of the studies I've seen online...Please contact me with any info you may be able to share with me on the issue.  
Dr Blake's comment: The blog is full of tips for treating hallux rigidus conservatively, but you must go through phase one of rehabilitation first: The Immobilization and Anti-Inflammatory Phase. Yes, you must create a pain free environment. Every step you take that causes pain can be keeping it angry and inflammed, and delaying healing. You can buy the Anklizer Removable Boots online relatively cheap, you can go to shoes stores and see what type of shoes help a lot (like possibly Dansko clogs, or stiff hiking boots), learn to spica tape and apply dancer's pads. Ice, Ice,and Ice some more 10 minutes at a time. None of this will break the bank while you search out medical help. 

I live in North Carolina, near Charlotte, so do you know of any good doctors who share your opinion for non-surgical treatment of hallux rigidus?  Or who may be able to provide a reasonably affordable RA screening in my area?
Dr Blake's comment: A colleague Dr L. Douglas Milch, Asheville, North Carolina, could probably tell you who to go to in Charlotte. Please use my name as a reference when you call. Good luck and email with answers to my questions and any photos or xrays, etc. 

I actually spent last summer volunteering with the Lighthouse for the Blind and Visually Impaired out your way, in Napa, CA at Enchanted Hills Camp.  While I love the area, I doubt I could move out there permanently for treatment!  

Thank you so much for your time and consideration.

I look forward to hearing from you!

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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.