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Tuesday, February 11, 2014

Tuesday's Question of the Week: Hallux Rigidus

Hi, Dr. Blake, 
It is almost a year later since I first wrote you, and I wanted to update you.  I went to a podiatrist who said I had to have surgery and gave me a cortizone shot which did absolutely nothing. I then managed to get in to see a podiatrist whom works with our local celebrity Orthopedist in Birmingham, Alabama. He took xrays (nobody has even suggested taking an MRI) and pronounced surgery the only option... total fusion. I wouldn't be able to do anything for 11 weeks....WHAAA??? It's my right foot so (unless I purchase a British car) no driving. I can't remember how much of the 11 weeks I'd be almost completely immobile because the whole conversation sent my mind reeling.
Dr Blake's comment: Typically, you are totally off your foot 10-12 weeks with a fusion of any joint, since it takes time for the fusion to take. You can use Roll ABouts and Crutches, but no weight bearing. Then, you start the 3 months of gradual to full weight weightbearing with some physical therapy. So, 6 months after surgery, you typically are close to where you were before only with no pain in the big toe joint. 

I have tried contrasting baths which has offered lessening of pain somewhat, but not much. I am definitely pronating and the old hips and knees are sure to suffer. I have also gained at least 10 pounds in a year due to lack of movement. I will definitely increase my Vitamin D intake and head out into the sunshine, but wondered what else I can do.
a) Do you know a physician/podiatrist/witch doctor in this area that won't immediately head for the default setting of fusion?
Dr Blake's comment: Try going to the AAPSM website and look for podiatrists in your area. Typically these are podiatrists who are sports minded and less surgically minded. At least a starting point!!

b) Where can I get the best (and hopefully not too $$$$) orthotics? 
Dr Blake's comment: AliedOSI labs in Indianapolis, Indiana. They are a big national orthotic lab. Talk Kathy Dubois and mention my name and your need to locate someone near you. I think this is a good starting point. She is wonderful!!

Kathy Dubois
Territory Consultant

c) Is there otc pain med (gel) that would help? (what in the world is Blumjk..must I go to Norway to get it?) 
Dr Blake's comment: See if you can get Voltaren 1% Gel prescribed which you apply 3 times a day, along with Icing 10 minutes 2 times per day. There are many compounding creams/lotions that may help more, but you have to experiment and they tend to be costly. 
d) Should and where can I order a boot to calm ornery toe joint down?
Dr Blake's comment: Definitely, these boots need to be part of your wardrobe when the joint gets flared up. As soon as it does, go to the boot to calm things down. Wear 3 days longer than you think you need to. My current favorite is from Ovation Medical.

The idea of a fusion sounds insane and having read a lot from your blog; it sounds like the surgery is just the BEGINNING of more problems.
Dr Blake's comment: I am not as sour on big toe joint fusions as I use to be, but the patient must be very carefully selected and informed on all the choices/possibilities. There is no going back, so that bothers me. It completely, and suddenly, eliminates all big toe joint ROM and that bothers me. It is the sudden loss that I find the body has a hard time dealing with, not the gradual loss as you naturally go from Hallux Limitus to Hallux Rigidus. That being said, we are adaptable creatures. We can do this, but it can be a great challenge. I have never seen a study, although it probably exists, to look at the common body compensations and resultant problems after big toe joint fusion. Fuse if it must be fused, but make sure every i is dotted and t crossed before making that decision. 

The last doc said I have only 10% movement in my toe (and only 60% in my left foot...EEGAD, et tu, Brute?!?!) 
Dr Blake's comment: I just love you and your humor. Good for you, because you have to be able to laugh at the situation, yourself, and anything else that tickles your fancy!! If you have only 10%, or 6-8 degrees, fusing the toe is less traumatic to your body than if you had 30 or 40 degrees. 

The pain is obviously pretty severe because coming from a physician's family, we, of course, never ever seek medical advice unless we are at death's door. 
Dr Blake's comment: Amen!!! 

From the first orthopedic visit over three years ago, where the doc said take Moebic and then return for surgery when I can no longer stand it (NO mention of boot, orthotics, otc gels...said there was nothing I could do.) ,to the podiatrist who loves cortizone and surgery to the Sports Med guy who insists on total fusion; I'd say I wish I had sought help earlier, but it looks like everyone would have opted for a "wait and see...and suffer" approach anyway.

I do not want this surgery, Dr. Blake. If there is anyone in the Alabama or Georgia area (how bout the entire Southeast) you could recommend, I would gladly limp over.
Dr Blake's comment: Please look up Drs Perry Julian and Edward Lopez. Let me know what they say. Good Luck. Rich

Thank you so much for this blog. It's giving people hope and probably years of surgery/pain free feet!

Jane (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.