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Sunday, June 30, 2013

Hallux Rigidus: Email Advice

Hi Dr. Blake

I'm an active 52 year old female with end stage hallux rigidus. My condition was caused 27 years ago when my big toe was jammed into the joint playing soccer.

Each year I would assign a percentage to inconvenience the pain disrupted my daily life. Once the bump appeared about 2 years ago the percentage went up to 90%.

In the past 6 months I've had 3 opinions. Podiatrist wants to clean the joint then a joint replacement in 10 years, orthopedic 1 wants a fusion, orthopedic 2 (top doc in major east coast city) said joint destroyed and severely arthritic. Fusion is my only option.

Your blog is incredible and helped me ask great questions. No one offered spica taping which I just tried a few days ago with great pain relief.

I haven't seen much on what the risks would be if no action is taken. I understand the disease is progressive. Can the joint break.
Dr Blake's comment: No the joint can not break. It is gradually self fusing, but that produces both bone and soft tissue inflammation. The soft tissue inflammation can be controlled with icing 2-3 times per day, occasional cortisone shot or oral cortisone burst, contrast baths 3-4 times per week, spica taping to limit the bend of the joint, NSAIDs occasionally, bouts of PT or acupuncture, and activity modification. 
The bone inflammation is also helped by contrasts baths, possible off label use of a bone stimulator, physical therapy, off weighting the joint with orthotics and dancer pads, and occasionally use of removable boot, stiff hiking boots, carbon graphite plates. Hang in there and see if the above can help you get this calmed down. You were good to get the opinions, of course, if you have any surgery, you would have to get an MRI and possibly CT Scan to analyze the present situation better. Rich

I'm very hesitant to fuse. Although I was told its self fusing. Is it ok to let the body self fuse. I can tolerate the daily pain for the most part.

Thank you for dedicating your time to helping those of us living with this crazy condition.

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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.