Hello Dr. Blake,
I feel very fortunate to have found your blog. I recently suffered a Jones
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!!
