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 

September 

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!!