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Wednesday, October 2, 2013

Hallux Rigidus: Email Advice

Dear Dr. Blake,  How very kind of you to give of your time and knowledge on your blog and actually answer all of us poor folk!
I will be brief.  I crushed my foot June, this year.  5 bones have healed, but I am not quite weight bearing yet, due to the trauma to nerves, tissue.  No bones were broken in my big toe but it is stiff even after several weeks of physical therapy.  My surgeon says it is HR and showed me a bone spur on top in x-ray which is, he says, the cause of the lack of motion.  The joint looks OK.  I have read that these spurs can result from trauma which it must have because I had full use of my toe before the accident.  The Dr. wants to remove the spur and some of the bone beneath it to give room for the toe to bend up.  If he sees that the joint is not in fact good when he does the surgery he would then do a joint replacement. 
1.   Is that the only way to remove this spur?  Is this a reasonable solution?
Dr Blake's comment: From trauma to surgery, this is too fast a progression. I would wait one year minimum before entertaining a surgical approach, unless the pain was out of control, and/or you have more information for me other then a bone spur and stiffness. Have the physical therapist continue to work on it pain free. Start doing the joint mob on the video below twice daily. Let me know how painful the joint is, and we can discuss spica taping, orthotics, shoe selection, Flector patches, PT modalities, topical meds, injections, dancer's pads, etc. 

2.  I will ask the Dr. and PT, but would like your opinion.  Am I making the spur worse working at increasing the motion with physical therapy, forcing the toe to bend more?  
Dr Blake's comment: Yes, gradually increase ROM pain free. If there was just scar tissue, PTs are wonderful at pushing through pain to achieve better motion. But spurs imply subtle cartilage damage, and need a more gentle approach. In this scenario, I never recommend pushing through pain (although I am sure that there are skilled practitioners who can do it). 

3.  Is there more a podiatrist can do for me? 
Dr Blake's comment: See my comments above on taping etc. The best you can do is gently get the joint moving, while creating more and more activity painlessly which will stretch out the soft tissue. Gradually advance your activity from walking to running etc. As you attempt more activity, treatment options come up from your podiatrist, PT, etc as you try to do the activity and not produce a pain response over level 2 on the pain scale. You are advancing from the Immobilization Phase of Rehabilitation, through the ReStrengthening Phase, into the Return To Activity Phase, and this all takes good individualized thoughts to help you through. I sure hope this helps you. Rich
Thank you,  Jill (name changed)

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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.