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Saturday, May 31, 2014

Hallux Rigidus: Email Advice

Hi, I was diagnosed with hallux rigidus a year ago.

 I'm a 40 year old male that was fairly active doing things like running, triathlon, ultimate frisbee.  I've see 3 different doctors about my toe, all recommended surgery saying it was advanced, but I'm still on the fence. 

 At this point, I'm able to run 3 miles once a week with minimal pain the day after.  I'm using a morton's extensions and very stiff running shoes.  Besides the weekly run, I ride my bike.  I would really like to get back into ultimate frisbee but I'm pretty sure it's what caused the problem as it's much harder on my foot than running.  

 I'd like to come up with a plan on how to get back to playing ultimate frisbee, even it it means having surgery.   Should i just start playing and hope my joint self-fuses?  Or perhaps the hard answer is that my ultimate frisbee days are gone, if I want to still want to walk normally when I'm 70.  

 Any advice you could provide would be appreciated.  I live in the south bay and would be willing to drive up to see you, do you accept blue shield ppo?  Finally, I do have a soft copy of my xrays if you care to take a look.   Thank you

Carl (name changed)

Dr Blake's response, 

     Thanx for the email Carl. Your ultimate frisbee days are over for now (hopefully temporarily), since it is just too hard to control the forces with all the cuts and uneven terrain. Typically, we get you comfortable at cycling first, then running, and then begin to introduce side to side stresses. The pain you have to avoid is the pain that comes on during a workout, that you ignore. And, any pain that begins to effect your gait can mess something else worse. Xrays are less important than MRIs and CT scans so I would progress your diagnostics to include these. Let us get a good 3D image of your big toe joint in 2014, and will be able to use these as baselines. Like any arthritic conditiion, you need to be icing for 10-15 minutes 3 times per day, no matter the workout, but especially as soon as you work out. This alone should enable you to do more. You need to learn spica taping and be great at it. This is for all your workouts. Most patients with Hallux Rigidus (less than 30 degrees of big toe joint dorsiflexion) feel better with dancer's pads, not Morton's Extensions so work on that. You will definitely need an orthotic to shift weight to the center of your foot and off the big toe joint. There are many times that athletes need a little different correction for cycling vs running vs ultimate frisbee so multiple pairs may be in order. Have someone measure the big toe joint, I have a video on that, to see exactly how much motion you have. It is hard, but typically doable to gain 20 degrees with anti-inflammatory, physical therapy, and self mobilization. So, if you are really 50 degrees (Hallux Limitus) not 30 degrees or less (Hallux Rigidus), that may help you. I hope this helps you some. 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.