Hallux Rigidus: Email Advice

Hello Dr. Blake,

I have been reading your very helpful blog for the past month.  It has shed much light on my condition which has become the holy grail of my life....finding how to reduce pain from hallux rigidus. I have the perfect storm of feet:  extremely flat feet, extremely long toes,  and over pronation.  Ran for 17 years 7 without orthotics then got some really hard plastic ones made in the early 90's and stopped running in 2001 but not due to foot pain....which is amazing.  My knees were tallkng to me and so I stopped to preserve them.  Now, I bike, inline skate, and wish to start rowing. I am 58 and have done tons of exercise, cardio, racquetball, hurdles, stepping for the past 33 years.  My weight has always been appropriate for my height. 

This four year saga has had me visiting more than six doctors in the Green Bay/Milwaukee area.  Most let me walk out without any orthotics.  Now I possess two pair and don't know which is best.  

Dr Blake's comment: When you walk with the orthotic devices, see which one transfers your weight through the center of your foot as you push off the ground. It is the same principle when you buy new shoes. See if you can tell when you put on various shoes and walk around the store if you can tell which ones keep you more centered. 

The first pair was created by a pedorthist who works with sports injuries. From a styrofoam mold I stepped into he created a pair with a full Morton's extension for my severely affected left big toe joint.  For the right foot he put in a "barely there" Morton's bump.  I weaned into these across two weeks.  Was able to finally walk without limping (which I had been doing for more than 2 months).  But my joint was still really sore.  So I found a local doc who gave me an injection (not cortisone but instead something that stays in the joint).  This helped substantially but there is still soreness.This doc also made me  orthotics to wear in shoes...so they stop at the fatty pad under the ball of my foot.  He also made a small cut out so my left big toe joint could "move: a bit.  He felt the Morton's extension orthotic would make my toe joint fuse.  Is this true?

Dr Blake's comment: If you have Hallux Rigidus, your joint is fusing. Your job is to make this process less painful, and thus, less disabling. It sounds like you are creating a variety of protected weight bearing options which these various orthotic devices. When you add a variety of potential shoes, occasional dancer's pads, occasional use of spica taping, carbon graphite plates, removable boots for 1-2 weeks if there is a substantial flareup, you should be able to gradually increase your function. 

My dilemma:  which orthotic should I be wearing?  And my second pressing question is this:  Is it possible to have a bone spur on the side of my big toe joint, where it meets my second toe.  That is where it is most sore not directly on top of the joint.  

Dr Blake's comment: I hope I somewhat answered the orthotic question. I will assume that they all will have a positive roll in various shoes, etc. The spurring on the lateral side of the joint is very common. If that is the most painful area, experiment with toe separators to widen the gap between the big toe and second, or bunion taping (a version of spica) to also produce that separation.

Thank you for your time and consideration.  I truly believe it is possible to find the correct orthoitcs and shoes that will stabilize my toe/foot so my condition doesn't worsen.  My arthritis in my toe joint is very minimal.  

Dr Blake's comment: I see a lot of patients with painful big toe joints, with a diagnosis of hallux rigidus, when they have normal big toe joint motion. This is a different injury than Hallux Rigidus, so have someone measure your joint dorsiflexion so a proper diagnosis can be made. 

Sincerely,

Jo Anna