Tuesday, April 26, 2016

What is Hallux Rigidus & What Can I Do?

X-ray of my right foot, top view

  • What is hallux rigidus? 
  • What can I do about it? 
  • How will it impact my life? 
  • Let me tell you everything I've learned so far...

What is Hallux Rigidus

What is hallux rigidus? Quite literally, it means, stiff big toe. When cartilage wears away from the joint (due to injury or wear-and-tear), bones rub together. This can cause a bone spur to develop which prevents the toe from bending completely.

In my x-ray (above), normal cartilage is shown in my other toes as black spaces. In my big toe, that black space is mostly gone, showing that my cartilage is disappearing. And I am developing a bone spur bump (like a bunion) on top of my toe. I can bend my toe up comfortably, but it hurts to try to bend it down. This is likely due to degenerative arthritis and it's not reversible (gulp).


The American Academy of Orthopaedic Surgeons describes the symptoms this way:
  • Pain in the joint when you are active, especially as you push-off on the toes when you walk
  • Swelling around the joint
  • A bump, like a bunion or callus, that develops on the top of the foot
  • Stiffness in the great toe and an inability to bend it up or down
That perfectly describes what I've got going on right now. Running has gotten increasingly uncomfortable and my toe is now making its presence known even when I'm just sitting at my desk. Hence, my search for more accommodating dress shoes (read more here), and finally going to see a podiatrist.

If you think you might have hallux rigidus, go to a doctor now
The sooner the condition is diagnosed, the easier it is to treat. 
In advanced stages, this disorder can be disabling.

What Can I Do About It?

Short-Term

There were a couple of things we did today to reduce the pain and hopefully restore greater mobility to my toe.

Cortisone Injection

Dr. Gordon recommended a cortisone injection right in the middle of my toe bump. I've heard cautionary tales from my runner friends of the pain of the cortisone injection. My stomach knotted up in dread. But my toe's pain level was high enough that I was willing to endure the discomfort. 

Dr. Gordon applied a liberal amount of "freezing spray" to my toe to help numb the skin. Overall the injection takes about 20 seconds, and he let me know when we were halfway done. I reminded myself that I've given birth to a child, certainly I can do this! And although it was a little uncomfortable, it was nowhere near as bad as I expected it to be.

The pain could get worse over the next two days as a side effect of the injection, but after that it should improve overall as the inflammation calms down. 

Dancer's Pads

Dancer's pads go under the ball of the feet and reduce the pressure on the big toe joint. They are similar in concept to the metatarsal pads I tried before for my neuromas (read more here). Dr. Gordon put a pad on my foot and taped it in place. I am supposed to keep it dry and wear it for 3-5 days.


Limit Activity

We knew this was coming, right? Hopefully it won't be for very long. No running until the weekend (about five days), and then just a bit to see how it goes.

Paper from the exam room chair - thanks Jen for pointing it out!
It has nothing to do with the rest of this post but it made me laugh.


Longer-Term

In two weeks I will go back to Dr. Gordon and we will check on my progress. A lot of the long-term recommendations are similar to those I am already implementing for my neuromas (read more here). 

Shoe modifications

Shoes with a larger toe box are a must. High heels and flip flops should be avoided.

Orthotics

Custom orthotics are recommended. I explored them previously when I was diagnosed with neuromas, and they are several hundred dollars/not covered by my insurance. So I've opted to use Green Superfeet inserts in my athletic shoes. Dr. Gordon said he would be able to work with the Superfeet, likely modifying them with the addition of dancer's pads.

Medical & Physical Therapy

Medical interventions range from cortisone injections, use of non-steroidal anti-inflammatory drugs (e.g., ibuprofen), and supplements such as glucosamine-chondroitin sulfate. Physical therapy such as ultrasound or other modalities may be recommended. 

Surgery

There are some surgical options for severe cases. I'm not researching these because I am determined to stay off that path!

How Will It Impact My Life?

This last question remains to be determined. Clearly I need to redouble my efforts to find accommodating shoes for work. And in the weeks ahead we will see what this means for my running journey. I hope that it is just a small speedbump in the road...slow down, get over it, drive on!

Click to Tweet: What is Hallux Ridigus & What Can I Do? http://ctt.ec/cpnAb+ #runchat

Questions:
  • Have you had a cortisone injection? Where, why and did it help?
  • Have you used support pads like the metatarsal and dancer's pads?
  • Do you use shoe inserts? Over-the-counter ones or custom orthotics?
  • Do you have any advice for me?

14 comments:

  1. Well...I never would have guessed that, um, because I've never heard of it. I'm so glad you have a diagnosis. Now I hope you can find a solution that allows you to keep running but more importantly to be pain free.

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    1. Me neither! More proof that "Dr. Google" does not know all. Thanks for the good thoughts :)

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  2. Wishing you a speedy recovery as you get over this speed bump! I had a cortisone injection once (in two places, I think) for my plantar fasciitis. It helped initially, but then did not. Most likely because I did more than I should have too soon. (And I've since learned to recognize a flare up and treat it myself!) My friend Carol just had an injection in her foot (can't remember exactly where) but she is doing GREAT!

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    1. Thanks for the good wishes and for the reminder not to do too much too soon. When you have a flare up what do you do to treat it? Rest, ice, foam rolling? Carol commented on my FB page about her prognosis (and shoe suggestions!) and it was very encouraging :)

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    2. Oh great! For me - a little rest, but definitely ice, and not really foam rolling, but I use a lacrosse ball, or just my hands and massage the tight spots on the bottom of my feet. And I'll wear a compression sleeve on the bad foot/leg. Also, massage / trigger point on my lower legs / calf muscles, which is part of my problem. I use this one website for tips on things to try: http://www.do-it-yourself-joint-pain-relief.com/achilles-tendon-pain-relief.html
      Again - hang in there, and don't rush it.

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    3. Great tips - thank you for all of the support and ideas :)

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  3. Kim sorry to hear that you are having such serious foot troubles!!

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    1. Thank you Deborah! I keep reminding myself of all of the MRTT ladies that we've seen go through all kinds of serious issues - both running-related and not - and come out stronger on the other side.

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  4. You just perfectly diagnosed my problem. I was pretty sure this was the issue (I'd read about it on another blog), but thought if I buried my head in the sand I could ignore it! Is it bad that I plan to wait until after Ragnar Richmond this weekend and my Spring Chicago Half Marathon in late May before I see a doctor?

    BTW, tell Rick that my hubby got a pretty good picture of him crossing the finish line at the Loudoun Half. I'll send it to you after he finishes editing pictures from that race.

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    1. Oh no! I'm sorry to hear you are dealing with toe pain, too. How about if we split the difference and you go to a doctor after Ragnar but before the Chicago half? If I had it to do over again I would have gone a couple of months ago when I first started to suspect something was going on. Have a great time this weekend - I can't wait to read about it :)

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    2. Soooo, I saw my doctor on Thursday and I have stage one hallux rigidus on my left foot and stage two on my right foot. They are sending off one of my two pairs of orthotics (I paid $450 per pair and insurance didn't pay a penny) to have them refurbished with a more stable forefoot so the toe can't move as much. I bristled when he suggest I buy a whole new pair... Anyway, we discussed the steroid shot for me, but since I'm not in a lot of pain, he recommended we hold off. He said to continue my yoga, lunges, running, etc. as long as I don't experience pain while doing those movements. I go back to see him a couple of weeks after my refurbished orthotics come back and I've had a chance to give them a try. How's your HR doing?

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    3. Oh, Deb, I'm so sorry. I was hoping for better news for you. :(

      My HR is doing okay. I think one of the biggest factors in managing it is the shoes you wear day-to-day, and fortunately you've got the perfect job for that! I got rid of most of my shoes (so sad!) and I'm repopulating my closet with orthopedic choices that work for my job. So that's helping a lot.

      I got orthotics on Thursday ($600, no insurance help, ouch). You can see the pads and adjustments in the post I just published. I'm eager to run in them but trying to be patient with the break-in period.

      I've been running short distances over the past couple of weeks with no problems. Went back to yoga last week & it was good - I did put KT Tape on (turf toe application) to be on the safe side. I'm still a little reluctant to start doing lunges/planks etc and accidentally put too much pressure on my toes. Baby steps :)

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  5. I just found out that I have this too. When I push off, I have pain. What kind of running shoes do you wear?

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    1. I'm sorry to hear you have this, too.

      I've been running in Saucony Guides for the past few years, but that was pre-diagnosis. I'm still sorting out whether or not I need to make a change.

      If I stay with the Guides, I will either get custom orthotics or have my podiatrist make adjustments to the superfeet inserts I'm currently using. I need something that provides extra protection for my big toes. I see the podiatrist next week and will explore what he thinks is the best course of action.

      I've been wearing Altras just to walk around in (with the superfeet inserts). They have a wonderfully wide toe box. I know several people with toe problems that run in Altras. They are a zero-drop shoe, though, and the Guides I've been wearing have an 8 millimeter drop, so that would take a lot of adjustment.

      If you find shoes or modifications that work well for you, please let me know about them. Sharing information about what works is so helpful. Good luck!

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