Hallux Rigidus - Big toe joint pain

[The Dampener]

Found a really useful article on this topic.

http://www.podiatrytoday.com/article/2434?page=1

[NE1for10is?]

Originally Posted by The Dampener

How curious.

It is my serving toe (left foot). Which side of your big toe did you weight up? The inside or outside? And how on Earth did you figure that out?

It is the right toe for me. I figured it out by paying attention to when it hurts while I'm playing.

Also, there's something else that may help. Calluses build up along the inside of the big toes (on both feet) from tennis, and they get pretty thick and bulge out. This extra thickness puts extra sideward pressure on the big toe joints inside the shoebox. I have to literally shave them down every six months or so with a callus shaving tool you can get from a drugstore. It doesn't hurt at all, and it's surprising how much difference that little amount of extra side room in the toe box makes. You have to make sure to soak your toes in warm water for a few minutes before you shave them, as it makes it much easier to do. You'll have to repeat it every six months or so, or whenever you buy new shoes, because the calluses re-grow amazingly fast.

[jorel]

maybe its gout?

[The Dampener]

Originally Posted by NE1for10is?

Calluses build up along the inside of the big toes (on both feet) from tennis, and they get pretty thick and bulge out. This extra thickness puts extra sideward pressure on the big toe joints inside the shoebox.

Originally Posted by jorel

maybe its gout?

In all the reading I've done, trauma seems to be the greatest cause of Hallux Rigidus. I've seen gout mentioned. Apparently, a simple blood test can determine if that's the cause. But I've never seen calluses as the culprit.

It makes sense, however, that anything that hinders proper joint function could be a contributor. And I love how you guys think—focussing not just on the treatment but the source of the problem. When I went through the same process during a spell with tennis elbow, it was obvious to me that too many players focus on getting better without ever understanding why it happened to them in the first place.

I admit I'm preoccupied right now with getting better. And the fact that the condition is progressive has me worried about my future as a tennis player. I'll know more when I have my appointment on Tuesday. In the meantime, I'm grateful for the discussion. So, thanks.

[jorel]

im pretty sure agassi also suffered from gout and he did okay with it

[SB]

http://www.theaustralian.com.au/spor...-1226367415352


WHEN Lleyton Hewitt walks on to a Roland Garros court for his opening match at the French Open next week, it will be with steps rarely taken by a professional tennis player.

Hewitt has undergone radical surgery to prolong his career and remove the constant pain that has accompanied his every court appearance over the past two years, with two screws and a metal plate now locking permanently into place in the big toe on his left foot.

Hewitt's toe, chronically arthritic and misshapen after years of digging into hard courts to launch his service action, is now reconstructed and irreversibly fused. Whatever cartilage there was in the first metatarsophalangeal (MPT) joint has been removed and painful bone spurs shaved off. The toe no longer moves, but nor should it give Hewitt any more grief.

For the first time that he can remember, Hewitt is without pain when he begins each day. If his luck holds, he may even start finishing tennis matches the same way.


The dramatic change in outlook has prompted Hewitt to reset his remaining career sights on a full-time return to the tour this year, a competitive campaign next year, and perhaps beyond.

Hewitt's manager David Drysdale, although reluctant to discuss the medical procedure in detail, told The Weekend Australian: "The X-rays look like something out of Bunnings."

The toe fusion surgery, performed by Melbourne foot and ankle specialist Harvinder Bedi, is common enough as a remedy for degenerative arthritic conditions but extremely rare, if not unknown, for a tennis player still trying to earn a living on the professional tour.

When Hewitt was deciding whether to undergo the procedure, he was warned there was a significant chance he might not be able to play again. The biggest unknowns were whether having the toe set in place would allow Hewitt to push up into his serve or push off hard from his forehand in a baseline rally.

Hewitt opted to go under the knife anyway, reasoning he would need it at some stage for a pain-free retirement. Such was his frustration with the time he has been forced to spend off court in recent years, he calculated it was a risk worth taking.

The pay-off for Hewitt will begin in Paris, where he will return to the circuit two weeks earlier than he had planned. Although his expectations for Roland Garros are low - he has only been on the practice court for two weeks - the success of his rehabilitation has encouraged him to dedicate the rest of this year to restoring his lowly world ranking.

"The aim is certainly to play out the rest of this year and get his ranking up again and then have a good 12 months, hopefully injury free, where he can have another crack at it," Drysdale said.

"He has played spasmodically because he has had different injuries over the last three years so in some ways, it has actually protected his body. He has had time off. If anything he might be able to play a little bit longer."

At age 31, Hewitt has spent the past two weeks practising up to three times daily against former Davis Cup teammate Todd Woodbridge on a clay court at Kooyong.

As recently as four weeks ago, Hewitt had next month's grass tournament at Queen's locked in for his return to the tour, in preparation for Wimbledon and the Olympics, which are also being played at the All England Club. In a recent interview, he explained that his better-than-expected recovery from surgery and Australia's Davis Cup draw encouraged him to push hard towards Paris.

"Once I knew that the next Davis Cup tie was going to be most likely on clay in Germany. I probably pushed the boundaries a little bit more," he said.

It normally takes between six and 12 months to make a full recovery from toe fusion surgery.

Hewitt's speedy recovery will improve his chances of making inroads at Wimbledon, the tournament he won 10 years ago. It will also bolster Australia's chances of beating Germany and returning to the Davis Cup World Group.

[The Dampener]

From what I understand, the fusion is kind of a last-resort surgery for those enduring unbearable pain.

I don't know how viable the procedure is for those of us rec players wishing to keep playing tennis.

I wish there were more tennis specific literature on the topic. I wish there were more folks here who have gone through this to share their thoughts.

[SB]

Originally Posted by The Dampener

From what I understand, the fusion is kind of a last-resort surgery for those enduring unbearable pain.

I don't know how viable the procedure is for those of us rec players wishing to keep playing tennis.

I wish there were more tennis specific literature on the topic. I wish there were more folks here who have gone through this to share their thoughts.

I just thought it was interesting, about Hewitt. I hadn't heard too many other stories about pros with this, although you'd think they would have it. Maybe not until older.

I have it, and had a joint replacement. Right toe, right-handed (so it does bug me serving). I didn't choose arthroplasty, I was in surgery for cheilectomy/osteotomy, and while in my foot, doctor discovered that I had no cartilage left, so changed his mind and put in an implant.

It was ok for a while, but then that joint closed up, too, and I have a lot of sesamoid pain on top of that. (Arthritis in the sesamoids, plus my ski boot guy told me that it happens in toe surgery a lot, because things get aligned a little differently than they were, so the sesamoids start taking more of the brunt. )

So I'm not really much better off, and now I have a lot of pain on the ball of my foot, too, which means I can't play tennis for very long.

My advice: if you have this, get treatment immediately. Do not wait until it's really bad, because then you could be screwed as far as being able to do anything about it. There are things they can do early to delay progression.

Also, don't rush into surgery, but if you need it, find the best doctor you can. Foot surgery is sort of a mixed bag, doesn't always work that great.

[The Dampener]

Wow, SB, a replacement?

Everything I've read about joint replacement is that it's still kind of experimental.

Thanks for the advice. What you say echoes a lot of what I've read. I have an appointment to see a DPM next week (on the request of my sports injury doc), and I'm a little nervous about him possibly rushing me onto the table.

[PeteD]

That's quite a story about Hewitt but my experience is you are better off, if you can possibly manage, giving your own body a chance to heal itself. Another poster mentioned Alleve, and there are other anti-inflammatories which seem to work better on specific people. The pills, trying different shoes and inserts, trying stretches and massaging the area (this also works for some and not for others) and backing off on your activities, give your own body a shot at doing what it needs before you operate.

[The Dampener]

Healing isn't really an option. Hallux Rigidus is a progressively degenerative condition.

The measures you suggest may slow the progression, but everything I've read suggest they mainly "buy you time." Trouble is, the are so many variables in play, there's no way to determine how much time.

[SB]

Originally Posted by The Dampener

Wow, SB, a replacement?

Everything I've read about joint replacement is that it's still kind of experimental.

Thanks for the advice. What you say echoes a lot of what I've read. I have an appointment to see a DPM next week (on the request of my sports injury doc), and I'm a little nervous about him possibly rushing me onto the table.

Yeah, I think it is. That's what Cigna said, too, when they refused to pay for it. I did not go into surgery expecting that outcome, but I think I signed that thing that says "Yes, Doctor, do whatever you think necessary." We hadn't really discussed it before. I was not even 40 when this happened. I have it from both parents, genetic jackpot! My dad had the replacement, so did my aunt, and my mom is treating it with orthotics. (But they were all pushing 70 when symptoms became severe.)

Alleve, no. That's what I tried in my early 30s, thanks to a dumbass doctor. I didn't know what I had, he said I had a bit of arthritis, take medicine. And so I did, and played a lot of tennis, and it just trashed the joint.

So ... find a really really good doctor, and maybe a couple more, and try everything you can. My current doctor (not the one who did the surgery) has experimented with microfracture in the toe, and transplanting one's own cartilage from the knee, and says he is seeing a lot of success. But that is still experimental too, and it's 12 wk non-weightbearing (no driving!), which I can't do right now.

Don't just grin and bear it, because it gets worse and worse, making it very difficult to run or hike or play tennis....

[The Dampener]

Thanks, SB. I see the DPM next Thursday. I should know more then.

I did get my X-rays, and even my untrained eye can see faint areas that look like excessive bone growth at the end of the metatarsal. Zoinks.

[The Dampener]

Here is a highly informative podcast on the topic of Hallux Rigidus. It's a panel of several DPMs all discussing the various ways they go about treating the condition.

http://podbay.fm/show/335584123/e/13...43?autostart=1

[The Dampener]

Finally saw the DPM today. Phase 4 Hallux Rigidus.

So, I get to undergo...

1) Decompression osteotomy (for the limited joint space)
2) Cheilectomy (for the bone spurs)
3) Chondroplasty (to stimulate cartilage growth if possible)

Fun. Oh, and no tennis for at least 4 months. Sigh.

[NE1for10is?]

Originally Posted by The Dampener

Finally saw the DPM today. Phase 4 Hallux Rigidus.

So, I get to undergo...

1) Decompression osteotomy (for the limited joint space)
2) Cheilectomy (for the bone spurs)
3) Chondroplasty (to stimulate cartilage growth if possible)

Fun. Oh, and no tennis for at least 4 months. Sigh.

I would definately recommend seeking a second and even third opinion. It's amazing how different doctors can recommend different options for the same diagnosis. I got three radically different options for my heel bone spur problem and chose the option that seemed to make the most sense for me and as it worked out it was the right choice.

[The Dampener]

NE1,

After seeing the DPM, I went back to my sports injury doc and showed him my x-rays. Before I even said a word about my visit with the DPM, he said surgery was necessary.

There wasn't much hemming and hawing by either of them. They both pointed to the exact same areas on the x-rays and made similar comments.

Have any of you out there undergone these same procedures?

I'd love to know what's ahead of me, both in terms of general recovery and my prospects on the court.

[Chas Tennis]

Originally Posted by Chas Tennis

One of my friends, not a tennis player, had a bunion and had to have surgery.

http://en.wikipedia.org/wiki/Bunion

A tennis friend of mine, who is in his 30s, had a small broken bone in the area where the big toe connects to the foot. There was no acute injury and it probably developed over time. This injury location is common especially to those who stress the foot such as ballet dancers. He is very fast around the court. He played on it in pain for a year or so. He is getting surgery next month and also has a torn tendon in that area.

My friend's injury was to his sesamoid bone. This injury is a common foot injury of the bones leading to the big toe. He just got surgery. The sesamoid was removed. During surgery it was discovered that the tendon had completely detached and retracted to/toward the heel. The Dr described the injury as the worse case that he had seen. The tendon was surgically reattached to other toe bones. Full recovery is not expected.

The sesamoid is a rare type of bone not connected to other bones by a joint. The knee cap/patella is also a sesamoid of similar function. (Sesamoids have tendons on each end and function to change the direction of force applied to one end as an adjacent joint, like the knee joint, changes joint angle.)
http://orthoinfo.aaos.org/topic.cfm?topic=A00164

Illustrations-
https://www.google.com/search?q=sesa...w=1334&bih=722

Sesamoid Problems and a Possible Cause Sesamoiditis (inflammation)
http://www.orthogate.org/patient-edu...-problems.html