I am looking for some injury advice. I have searched previous posts and internet, but can not come up with a solution/DX.
I have had big toe pain, right on the medial side of my big toe knuckle for 3 years now. Its wierd because I do not feel it while running or biking, but the second I take my foot out of my cycling shoe, I get pain in the toe and can not move it. It is extremely stiff and very slightly pointed down.After few stretches it goes away, but make the first 1/4 mile of my T runs very painful and slow. Its on the top of first metatarsal head, so it cant be a neuroma or my sesamoid bones, so what the heck is it?! I’ve tried different orthotics,tried relaxing my toes when I bike,nada! Thanks for any input.
Could be MTP arthritis or Hallux Rigidus…might need an xray to see if joint narrowing or bone spurs and then treat accordingly…
Yup, as our Jayhawk orthopedist mentioned, sounds like hallux limitus/rigidus - likely caused from 1st metatarsal elevatus (hence your big toe looks slightly “down” as you put it). All nice/fun things to Google …
Good luck!
What type of orthotic adjustments can I make to alleviate this? SHould I have a medial post/lift or should my orthotic have a depression by the big toe?
It is getting worse and now clicks when i dorsi flex it. Is this a sign of a spur?
Yes, as the DJD progresses, you will notice “crepitus” or a grinding, clicking or catching sensation in the joint. Most can often visibly see a dorsal bump and certainly palpate one.
No, you don’t normall want a 1st ray cut out. That will allow the 1st metatarsal to plantarflex, thereby increasing the ROM of the joint. This may be good, but if joint ROM is painful, it will now be worse. A Morton’s extension (lift added under the 1st ray) is used to sort of “pre load” the 1st MPJ, thereby limiting joint excusion/motion. depends on your symptoms, X-rays, etc.
At any rate, an orthotic will only help a little - you will eventually have to deal with the joint.
Good luck!
Hey TDOG, I have Hallux Rigidus as well. Mine is very advanced but yet I have almost no pain. I feel it a little when it isn’t warmed up but then it goes away, but it seems that everyone has a slightly different experience with it. I posted here a back in Feb about it and got a couple of recommendations of doctors in the NY area. I saw both and they seemed to know their stuff. I got orthodics and it helped a lot, but both of them said that a Chielectomy was not that big a deal. There were two versions of the surgery , one was to just remove the spurs and the other was to remove the spurs and drill and do some stuff to the joint to stimulate growth of new cartilage if I undestood correctly. Recovery seems to be anywhere from 8-18wks depending on how well you heal and stay off it just after surgery. I have decided to have it done in Nov, leaning towards the simpler one. Running is my only weapon, I am doing this because I think down the road I will have to anyway and I think I will heal better when I am younger . RRoof, if you are reading this do you have an opinion on a Chielectomy, It was your guy in NY who said it was not a major thing but I always like other viewpoints. TDOG, hope this info was helpful. Good Luck
Cheilectomy is not that “big a deal”. Nice because you preserve normal joint anatomy/function - just cleaning up all that you likely saw on your X-rays to allow the full excursion of the 1st MPJ (which is needed for the most part in running!)
However, I always tell patients the definition of minor surgery is “surgery on someone else” :-0 Whether or not any subchondral drilling is performed depends upon what is found during surgery. You can’t really “grow” new articular cartilage, but his does stimulate fibrocartilage - which is certainly better than bone on bone.
Most people are walking fairly comfy after about 2 weeks - swimming in 10-14 days. Back in regular shoes in 4-6 weeks. Running comfortably various a lot, but most all by 12 weeks. I do several of these, but only about 15-20% are runners.
Good luck!
Thanks a lot for the response. The info helps, and I made some notes. Take care.