Hallux Rigidus: Some Answers

I had my two week post-hallux rigidus diagnosis follow-up appointment today. I got answers to some of the questions I posed on Tuesday and a secondary diagnosis.

I'm using Tuesday's post as the framework for today's post, inserting answers and updates into the original text with red italics.

How Have My Toes Felt Overall? 

Dr. Gordon will want to know how my toes have felt over the last two weeks:

• The cortisone injection has definitely helped with the pain
• Cortisone injections can be repeated up to 3-4 times a year safely, but it is better to avoid them if possible
• The dancers pad helped relieve pressure
• Can add them to orthotics
• I'm overly aware of my toes now - they are starting to feel almost claustrophobic in both shoes and socks
• I frequently want to stretch them and try to separate them from each other
• Toe separators are unlikely to be helpful
• I suspect hallux rigidus is developing in my left big toe as well - it has limited mobility and a visible callus on top
• It very well could be; fortunately both feet will be getting the same interventions (e.g., shoe modifications, orthotics) to protect against progression

How Did My Toes Feel When I Ran? 

He will also want to know how they felt when I ran:

• I had an awareness of my big toe - not pain - just sensations that suggested I needed extra protection for it
• Orthotics can help with this
• My 2nd toe felt irritated...hot? inflamed? bruised? I'm not sure how to describe it, but it seems to be taking the brunt of my subconscious adjustments
• New Diagnosis Alert! I have "capsulitis of the second toe" 
• My left foot went numb, probably neuromas flaring
• Orthotics can help with this

Activity Adjustments?

I have questions about whether there are things I should change:

• Is it okay to walk around barefoot, or should my toes be more protected?
• I should avoid being barefoot
• What adjustments do I need to make for yoga, which can put a lot of pressure on toes?
• It is okay to be barefoot for yoga; use my judgment to modify exercises that put pressure on toes
• What adjustments do I need to make for strength training exercises like lunges and planks?
• Again, use my judgment to modify (or find alternatives to) exercises that put pressure on toes
• Is it okay to use my standing desk at work or should I not be on my feet so much?
• It is okay to use my standing desk as long as I am wearing appropriate shoes and not experiencing pain

Recommended Self Care?

I'm wondering about what I can do to support my toe and keep the condition from progressing:

• Are there toe/foot exercises or stretches that are recommended? Or that should be avoided?
• The joint of the big toe can't be strengthened, this is a structural condition. Condition can't be improved by "toe yoga" and it could actually be worsened
• Does icing help? How often/when?
• Fine to ice, not necessary, though. 
• Should I consider taking Glucosamine/Chondroitin/MSM?
• While there is no definitive evidence that this will help, there is a lot of anecdotal evidence indicating that it might. And there is no harm in taking it.

"Regular" Shoes

I will report that I have taken significant steps towards more appropriate footwear:

• I'm getting rid of about three dozen pairs of shoes - high heels, tight toe boxes, many that I can't even actually squeeze my toes into any longer. 
• (yes, this was as hard as you would think it would be...so many pretty shoes...impractical, but pretty)
• I've found several pairs of wide toe box, rocker bottom, supportive shoes by Alegria and Naot
• Dr. Gordon was familiar with Naot and said they were a great choice

Running Shoes

I've been running in Saucony Guides in size 6 wide, but I don't think they are quite the right match for me:

• I now know that my foot is a size 4.5, not a size 5 like I've thought for years, so 6 may be too big. 
• As I worked through shoes for my neuromas, I went from a 5M to a 5.5M to a 6M to a 6W...I'm going to try 5.5W out for a bit.
• I've tried on Altras and love the extra toe space, but I'm unsure about the zero drop (the Guides are 8 mm drop)
• Does Dr. Gordon have any recommendations for running shoes?
• No other suggestions for now, see how the new Guides feel with the orthotics 

Orthotics

While I've been using SuperFeet green, I recognize that it is probably time to spring for custom orthotics.

• Unfortunately my insurance does not cover them
• bummer, and increasingly the case
• What adjustments would be included?
• Turf toe plate? Something else?
• Dancers pads?
• Anything that will help my neuromas?
• both metatarsal pads & dancers pads are recommended

I was scanned for orthotics today and I will get them in about 3 weeks. The last time I was fitted for orthotics (which I didn't end up getting), molds of my feet were made. This time, I put my feet on a fancy 3D scanner.

my scanned foot
I find it interesting that my 2nd toe doesn't seem to touch the glass

3D scanner

mold of my foot from 2014

I have my next appointment in 3 weeks when I will get my orthotics.