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Hallux Rigidus/Cartiva experience anyone?
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Hey all,

I used to post a lot on this forum a few years ago, but now check in once in a while. Anyone on here have any experience with Hallux Rigidus (big toe arthritis)? Been dealing with it for over 3 years and have managed to keep running, etc. with adjustments to my shoes, inserts, etc., but it's getting worse.

I see a new treatment using an artificial cartilage product called Cartiva and I'm just wondering if anyone has any experience getting this done. I need to keep running and surfing to keep my sanity, but would love to know if anyone has been able to resume running at or close to their previous levels WITHOUT PAIN following this surgery, or even a chielectomy, which is the more traditional approach to this problem.

Thanks in advance!

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My business-eBodyboarding.com
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Re: Hallux Rigidus/Cartiva experience anyone? [TriBodyboarder] [ In reply to ]
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Good to hear from you Jay! Not here as often either ... We must go back over 10 years now.

Cartiva looks promising with recent studies (I think they go to about 5 years out now). My organization (large, 650+ physician multi hospital group) does not approve it yet (nor do many insurance payors) since still "investigational". Also, the company that makes/markets it is relatively small and the price is high. Word is they are looking to be acquired/bought by a larger player. It will likely become more readily available then.

Easy enough to do (basically a cheilectomy as you eluded to with an extra step). I'm only interested in that ALL implants fail eventually and I need to have a plan for people when they do. Total joints do great (even if they fail and need replaced again) in the hip and knee. So-so for shoulders and ankles. Not so great for the big toe joint. When this fails, fusion after is much easier. The real question is whether or not it will provide some increased benefit over a cheilectomy and that is hugely patient dependent.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Last edited by: rroof: Oct 15, 17 15:44
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Re: Hallux Rigidus/Cartiva experience anyone? [TriBodyboarder] [ In reply to ]
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It's not exactly the question you were asking about but here's my Hallux Rigidus story: I had a stem cell + PRP injection in one of my big toes almost a year ago. I was promised nothing by the orth doc at Emory; he made it very clear that with so little surface area, the likelihood of less pain/greater flexibility was pretty slim but since I was having injections in one of my knees anyway, he was willing to try.

I don't want to overstate the results but the short version is, for me, stem-cell+PRP has made a big difference. Where there was too much pain to block out pre-injections, I can now still functionally train. I'm trying to be smart, which means not overdoing it..

I had never heard of Cartiva. Good to know there's another option beside joint fusion. Best of luck...
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Re: Hallux Rigidus/Cartiva experience anyone? [rroof] [ In reply to ]
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Hey Rod,

Thanks so much for the response. Glad to see you're still solving the foot problems of STers here!

Still sort of trying to manage this problem with inserts in my shoes, etc. I am a daily surfer and still running 5 days/week, so the thought of sitting on my ass for an extended period doesn't...pardon the pun...sit well with me, so I've been putting off getting anything done, but as you know, this problem doesn't just "go away" like other issues I've had in my 12 years in endurance sports.

The insurance quandary isn't something I anticipated, so I'll have to give that a check. Again, thanks for the advice, and I'll keep ya posted!

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My business-eBodyboarding.com
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Re: Hallux Rigidus/Cartiva experience anyone? [TriBodyboarder] [ In reply to ]
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I can give a personal report on several accounts. I've been doing triathlon since 1983. 20 years ago I had a cheilectomy, it gradually got worse. For the past three years I have had bone-on-bone pain. Early September 2018 I had Cartiva implant. I expect I do more endurance stuff than most patients who have the procedure. My surgeon told me to to three months for running. This is what I reported to my orthopedist:


  • Day four I was walking up and down stairs which I found easier than walking on flat ground because I can keep my foot flat on the stairs.
  • Day six I was able to use an elliptical trainer with my feet flat with no trouble at all.
  • Day eight postop I used a stationary bike, again with my foot flat in the boot.
  • Day 13, I was able to do a one-hour outdoor bike ride. Riding the bike with my foot flat in the boot is painless.
  • at four weeks I ran 1 mile, slowly and carefully, running has improved, I am 11 1/2 weeks postop now and up to 1/2 a marathon. In planning on doing a marathon December 9.
  • I started using my clippin bike shoes at week eight but it is still painful. I have speed play petals, I just ordered a part that will allow me to shift my foot forward so the force is away from the ball of my foot.

I'm sure this is a more aggressive rehab than recommended. The most important thing is to be careful not to jam your toe into anything, that could push the implant into the bone, so you would lose the gap between the bones. I'm not risking surfing yet, it would probably be safe at three months but there are other things to do. I'm hoping to be back to climbing but figure I will wait until six months postop. The website for the product says maximal improvement is around six months. My surgeon said he has patients improving all the way up to one year.

My flexibility is good, already better than preoperatively. I still have pain but the pain is different than what I was having before. Most of the pain is on the ball of my foot and the inside of the foot adjacent to the ball of the foot. There is still some swelling which apparently is normal. I am hoping the pain is part of the postoperative process. I figure in three months I'll know much better what to expect long term but at this point I'm impressed.
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Re: Hallux Rigidus/Cartiva experience anyone? [trireallyhard] [ In reply to ]
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Thanks for the feedback! I'm in a Facebook group for the Cartiva implant as well as a Hallux Rigidus FB group and there is a ton of feedback there, mostly negative, about Cartiva failures. Granted, folks that have had success probably leave the FB group and mostly don't report back, but lots of stories about people who have had no or little pain relief.

I'm still managing 4 1/2 years into this problem without surgery, but it's definitely impacted my ability to run long distances.

Good luck with your continued recovery!

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My business-eBodyboarding.com
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Re: Hallux Rigidus/Cartiva experience anyone? [TriBodyboarder] [ In reply to ]
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hello

the question might be stupid, but does using very rigid forefoot shoes help ?

Thinking of shoe with carbon plate (such as Nike Vaporfly) or quite thick and stiff midsole with rocker (such as Hoka Bondi)
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Re: Hallux Rigidus/Cartiva experience anyone? [Pyrenean Wolf] [ In reply to ]
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I use Hoka Bondis and use some inserts to offload that big toe joint.

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My business-eBodyboarding.com
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Re: Hallux Rigidus/Cartiva experience anyone? [trireallyhard] [ In reply to ]
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What grade level did you have 1-4, I thought I read that this procedure was not appropriate for level 4 patients?
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Re: Hallux Rigidus/Cartiva experience anyone? [pokey] [ In reply to ]
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I've been using Hokas. Presently the Clifton 3, I bought a whole bunch of them. I have a fairly wide forefoot. Very happy with my Bont cycling shoes but I want to get the pressure back further behind the ball of the foot.

I will have to check out Facebook. I don't know exactly what grade it was at. I still had decent motion but constant pain, it got to the point that I was sleeping with a cast shoe or lightweight runner to keep pressure off of the toe. It would always get better when I would start moving it in the morning.

Mark
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Re: Hallux Rigidus/Cartiva experience anyone? [trireallyhard] [ In reply to ]
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I did the Honolulu Marathon Sunday, at 3 months, 3 days post op. I don't recommend it, I had pain that i could manage with precise foot control. about 4 hours after the race it felt better than prior. Time 4:36 for a 62 yo but I hope to be faster next year. I think it is helping to use it but do avoid impacting the end of the toe on anything that could jam the implant into bone.

mb
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Re: Hallux Rigidus/Cartiva experience anyone? [trireallyhard] [ In reply to ]
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Here's an update, I am now eight months postop. I did a short triathlon about a month ago and it went fine, I wish I would've trained more for it!

I have very little pain running. Most pain is after a ride while taking off my bike shoes. It seems like the stiffness in the foot while riding leads to the pain.

If you're considering the surgery I would recommend it if your surgeon is experienced with the procedure and thinks it would help. I think it's helpful to have it done before the joint degenerates too much. I have less pain now than after the cheilectomy that I had in about 2005.

mb
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Re: Hallux Rigidus/Cartiva experience anyone? [TriBodyboarder] [ In reply to ]
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Hi Guys! I've followed this thread a bit over the years. I've struggled with this condition for the past 15 years. In college they told me I wouldn't run past 25. Here I am now with nearly 30 ironmans in the legs with a bunch sub 2:50. The past 3 years it's started to really bother me but with ART treatment and the right shoes its been manageable, however finding the right shoes has become harder and harder. Over the past few months I have been trying CBD called Prosafe. Former teammate and olympian Anthony Famiglietti had his hands in development as he too suffers from the same condition. See link

https://www.recklessrunning.com/

https://www.prosafecbd.com/

This in combination with Bont Cycling shoes, the Nike Flyknit (with carbon plate) has me running nearly pain free. I just bit the bullet and will try the 4% for races as the carbon plate seems to be supporting the big toe really well.

Most importantly, the day to day pain, post running, sleeping, walking, etc is just about gone. Quality of life is better due to not constantly having pain in the toe. The CBD also seems to be helping with swelling and movement, the joint is not nearly as jammed as in the past.

Perhaps some of these ideas might help others with this condition???

Scott DeFilippis
Professional Triathlete
Coach and Co/Founder
KIS Coaching
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Re: Hallux Rigidus/Cartiva experience anyone? [sdiycdiycdi] [ In reply to ]
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Thanks Scott! Seems like all of this is a bandaid for the inevitable. For me, I have the additional complication of being a very avid surfer who surfs about 250 days/year, and barefoot, walking on the beach is often when I have the most pain. Running is somewhat painful, but I am still putting in 30-35 miles/week, but miss the longer runs that are now just too painful, so a surgical option is attractive to me if it can eliminate the pain.

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My business-eBodyboarding.com
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Re: Hallux Rigidus/Cartiva experience anyone? [Pyrenean Wolf] [ In reply to ]
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Pyrenean Wolf wrote:

the question might be stupid, but does using very rigid forefoot shoes help ?

Thinking of shoe with carbon plate (such as Nike Vaporfly) or quite thick and stiff midsole with rocker (such as Hoka Bondi)

Two things have helped me with my Hallux Rigidus pain: a carbon fiber orthotic placed under the insole of any shoe that I'm wearing (running or otherwise) and, as strange as it may sound, a daily scoop of Great Lakes Collagen Hydrolysate (which I heard about on another message board). The collagen has had the biggest impact I think, because it has allowed me to get back to running.

I recently bought a pair of Hoka Carbon X's, in hopes that the carbon plate would keep my foot rigid enough that I would be able to run pain free. I'm not sure why, maybe it's the foam between the insole and the carbon plate, but I still have to use the carbon fiber orthotic in these shoes. That's just my anecdotal experience.
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Re: Hallux Rigidus/Cartiva experience anyone? [anitan1] [ In reply to ]
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I have been struggling with arthritis for 15 plus years now. In summer 2017 I had had enough and was struggling with other joint issues from altered gait .
I had a cartiva as I was terrified of fusion. Unfortunately the cartiva failed, the revision failed and though I regained motion in the joint, the pain continued—possibility worse than preop
I finally had fusion 7 weeks ago. I’m optimistic that I’ll be able to return to normal activities. So far no pain!
Think twice before having cartiva
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Re: Hallux Rigidus/Cartiva experience anyone? [edrennen] [ In reply to ]
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Really interested to hear if you’re able to get back to running after fusion. Please keep me posted. While I’m still experiencing improvement that I largely attribute to the collagen hydrolysate, I can’t help but wonder if someday I’ll need to consider a more aggressive solution.
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Re: Hallux Rigidus/Cartiva experience anyone? [anitan1] [ In reply to ]
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anitan1 wrote:
Pyrenean Wolf wrote:
the question might be stupid, but does using very rigid forefoot shoes help ?

Thinking of shoe with carbon plate (such as Nike Vaporfly) or quite thick and stiff midsole with rocker (such as Hoka Bondi)[/quote]

Two things have helped me with my Hallux Rigidus pain: a carbon fiber orthotic placed under the insole of any shoe that I'm wearing (running or otherwise) and, as strange as it may sound, a daily scoop of Great Lakes Collagen Hydrolysate (which I heard about on another message board). The collagen has had the biggest impact I think, because it has allowed me to get back to running.

I recently bought a pair of Hoka Carbon X's, in hopes that the carbon plate would keep my foot rigid enough that I would be able to run pain free. I'm not sure why, maybe it's the foam between the insole and the carbon plate, but I still have to use the carbon fiber orthotic in these shoes. That's just my anecdotal experience.[/quote]
I would agree with this as good mitigation for Hallux Rigidus or lesser metatarsal overload. I would add that carbon fiber in the midsole of shoe (next%, carbonX) or plate insole is not necessarily needed as prior/current shoes such as Saucony Mirage, Hoka Bondi/Clifton, Altra Paradigm, Nike Pegasus...all will significantly reduce flexion at the Metatarsophalangeal (MTP) joints as they are on the stiff side of the flexibility scale.

Many runners do not like these shoes for their lack of flexibility, but for folks looking to reduce stress on the MTP joints, bending stiffness is the critical feature in a shoe.

If you find this is not enough I would suggest speaking to a good orthotist or podiatrist about custom orthotics and possibly a Morton's extension for Hallux Rigidus or a good carbon plate orthosis to cover all the MTP's.

Cheers!
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Re: Hallux Rigidus/Cartiva experience anyone? [ktm520] [ In reply to ]
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My 2c. I had surgery almost 10 years ago at about age 35, and figured my tri days were over. My problem wasn't that I couldn't run, but I couldn't walk. Running didn't hurt, but getting shoes on or off would cause the joint to seize. When I couldn't get ski boots on, I had to go to the doctor. So I focused on bike racing for a number of years, and now I'm thinking about taking up tri again. I'll keep the running to a minimum, I've got a run background, so I shouldn't need huge miles for improvement, and I'm mostly MOP anyway. But I've been largely pain free without any additional supplements or treatment since. I'll give some of the OTC stuff mentioned here a shot anyway.

See your bike fit. https://bikefitr.appspot.com/
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Re: Hallux Rigidus/Cartiva experience anyone? [ktm520] [ In reply to ]
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ktm520 wrote:
anitan1 wrote:
Pyrenean Wolf wrote:

the question might be stupid, but does using very rigid forefoot shoes help ?

Thinking of shoe with carbon plate (such as Nike Vaporfly) or quite thick and stiff midsole with rocker (such as Hoka Bondi)


Two things have helped me with my Hallux Rigidus pain: a carbon fiber orthotic placed under the insole of any shoe that I'm wearing (running or otherwise) and, as strange as it may sound, a daily scoop of Great Lakes Collagen Hydrolysate (which I heard about on another message board). The collagen has had the biggest impact I think, because it has allowed me to get back to running.

I recently bought a pair of Hoka Carbon X's, in hopes that the carbon plate would keep my foot rigid enough that I would be able to run pain free. I'm not sure why, maybe it's the foam between the insole and the carbon plate, but I still have to use the carbon fiber orthotic in these shoes. That's just my anecdotal experience.[/quote]

I would agree with this as good mitigation for Hallux Rigidus or lesser metatarsal overload. I would add that carbon fiber in the midsole of shoe (next%, carbonX) or plate insole is not necessarily needed as prior/current shoes such as Saucony Mirage, Hoka Bondi/Clifton, Altra Paradigm, Nike Pegasus...all will significantly reduce flexion at the Metatarsophalangeal (MTP) joints as they are on the stiff side of the flexibility scale.

Many runners do not like these shoes for their lack of flexibility, but for folks looking to reduce stress on the MTP joints, bending stiffness is the critical feature in a shoe.

If you find this is not enough I would suggest speaking to a good orthotist or podiatrist about custom orthotics and possibly a Morton's extension for Hallux Rigidus or a good carbon plate orthosis to cover all the MTP's.

Cheers![/quote]
Resurrecting an old thread...

I have been having issues with my big toes for a few years now. I gotta say, the Carbon X has been a lifesaver for me. The combination of the stiff sole, and the heavy rocker in the forefoot work well for me. My only gripe is that I wear out the areas in the forefoot where there is minimal outsole covering the ends of the carbon plate relatively quickly.
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