Big Toe Bone Spur: Email Advice

Hello Dr. Blake,

I am very glad to say that searching on the Internet trying to find information about the problem I have I came across your blog. Thank God you have opened my eyes and gave me a better understanding of what I'm about to do.

I am about to have cheilectomy in my right big toe because I have developed a spur, which annoys me a lot when jogging. This is what my doctor here in Athens, Greece has suggested to me.
I am wondering if the simple movements on self-mobilization you are proposing for the big toe joint in your videos, might help and alleviate me from the burden of having the surgery.
Best Regards,

Dr. Blake's comment: 
     Yes, the conservative treatment can prevent or delay the course of surgery on the big toe joint. It is at least valuable information in the postoperative setting to see what helps take the pressure off the healing joint. Give yourself 3 months to see if it works. Self-mobilization is only one thing to try. My blog has been treatments for Hallux limitus which these spurs fall under. Try to skip the eyelet above the spur to help in any shoe you get pain. Try to place padding just to the bump, not over it. This is called proximal padding. I use 1/4 inch adhesive felt, but any soft material can be used in an inch square shape to tape down. Try spica taping to restrict the motion of the big toe joint. Try dancer's padding to off weight the whole joint from the bottom. Ice the area for 5 minutes twice daily for the next month to see if some of your pain is inflammatory, and not just mechanical. You can also experiment with shoes with bigger toe boxes depth-wise, or shoes with rocker to decrease toe bend like Hoka One One. Hope this experimentation helps you. Rich
PS. My wife and I have been to Athens, Mykonos, Delos, Paros, Naxos, and Santorini. Can not wait to go back in a couple of years. We want to see Crete and Rhodes for sure. Beautiful area. 

Initial Workup Hallux Limitus for potential surgery

This wonderful young lady (my age) presented to the office to discuss surgery on her big toe joints. She has a bone spur on the top of the joint that is painful to wear shoes (especially non athletic). A surgeon had recommended removing the bone spur in a relatively simple procedure by shaving the top of her joint. Where this may be perfect, I have had too many patients that have problems when the joint itself is damaged. Removing the spurs from the top of the foot removes bump pain, but can increase bending pain. The shaving procedures typically cause scarring of the ligaments on top of the joint permanently limited the range of motion further. It is rare that patients get more range of motion after surgery, typically less, so jamming of the joint with bending can occur easier. 

Here are the x rays that she brought into the first visit. We are now going to get MRIs to look at the internal nature of the joints and see if they are damaged. Can you guess what joint has more damage and what joint has less range of motion because of that fact from looking at these photos? First 3 are the left side, and the second 3 are the right side.

It is the left side that is worse in range of motion and pain, but the x rays really can not say that for sure. There are suggestions that both joint surfaces will have too much damage (osteoarthritis) to qualify for this bone shaving. The decision may be to implant or fuse. I prefer to implant these joints, since there is no going back once it is fused. The patient has over 40 degrees of range of motion now on the left and 55 degrees on the right.