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Sunday, September 27, 2020

Big Toe Joint Pain after Immobilization: Email Advice

Hello Dr. Blake,

I feel very fortunate to have found your blog. I recently suffered a Jones 
Fracture and had
 surgery to implant a titanium screw in the 5th metatarsal in early July. 
The first x-rays from the 
break also showed mild great toe arthritis (I had some pain in the toe, 
but no problems putting weight on it at all). The most recent x-rays from 
show the 5th metatarsal healing well, but significant arthritis in the great 
toe, and now it 
is painful to push through (I am wearing Hoka shoes now and having an
 orthotic made). 
My podiatrist/surgeon immediately suggested a joint fusion of the great 
toe despite the 
fact that the recent surgery and non-weight bearing recovery was quite 
traumatic for me, 
and I still have movement in my toe and am in physical therapy. I would 
love any insights 
you may have as to why my toe arthritis may have worsened so much 
while in a boot, and 
most importantly, if you could suggest any doctors in the 
Seattle/Bellevue, Washington area 
who are more in-line with your way of approaching Hallux 
Limitus and Hallux Rigidus. 
Thank you so much for your time and wisdom.

Dr. Blake's comment: My job is so easy when I can sound smart using 
common sense. You
do not need a big toe joint fusion, at least for now, and hopefully not for
 a long time. Immobilization 
for whatever the reason causes joints to freeze up. Arthritic joints love motion, 
not excessive, but they love to 
move since it helps them to lubricate. Email me how you are doing in 3 months 
and attach this post 
so I can refer to it. But, what to do now?
The Hokas with their rocker sound great. The orthotic can be helpful or 
not at this stage, if not, it may be 
helpful later. Learn about dancer's padding and spica taping and experiment. 
Do not let the physio try to increase range
of motion, it tends to backfire. The goal is to reduce pain, not increase range 
of motion. You can review 
my video on self mobilization which may help. Ice 3 times a day for 10-15 
minutes to cool off the joint. 
Again, non weight bearing does not help, so gradually try to find the amount 
of day to day walking you 
can do and keep the pain down. Since I would rather you walk 10,000 
steps aday than not, this is where 
the shoes, orthotics, dancer's padding, and spica taping come into play. 
What helps when?
The PT can do iontophoresis to the joint to calm it down if you can get 
a script for it. 
I would rather you back in a walking boot for 2 months, with the emphasis 
on walking, then not walking. Give me
an update soon. I will try to find someone in Seattle. It is a great place 
with good podiatrists. Rich
Good luck!!

1 comment:

  1. Hi there! I work with Dr. Blake and he asked that I take a look and give my thoughts as well. I agree with Dr. Blake in that you don't need to rush into a fusion of the big toe joint quite yet, and that your arthritic symptoms likely flared after being immobilized for so long for your 5th metatarsal fracture. While I do enjoy performing surgeries, I always want to make sure the conservative management has been exhausted and that surgery is the last option. If you're in an acute flare up you may need a period of the walking boot to allow the inflammation to cool down, as well as consistently ice, take ibuprofen/anti-inflammatories, or even consider a steroid injection. After the acute phase, if we can limit motion at the joint to prevent another flare with modified shoe gear (rockerbottom/stiff soled shoes, considering carbon foot plates), orthotics, splinting, then you may be able to avoid surgery completely. I hope you feel better soon! The fusion will always be there as an option, you're not burning any bridges by attempting conservative management first.


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.