Hallux Rigidis - What the heck?

[the_iceman]

I just came from the doctor today, a podiatrist actually, which I saw in order to get a second opinion. I have chronic joint pain in the big toe of my left foot most likely started from a soccer injury 35 years ago. I was told it was joint wear and there is nothing that could be done. I know how to live with chronic pain but I also know it wears you down over time.

I have been doing shake down cruises with my loaded pack of mostly 6 miles at a time and always end up with foot pain. Hence the second opinion. Today’s diagnoses after x-rays is Hallux Rigidis. Basically a fancy couple of words for stiff toe joint. But it my case I have a bone spur and a flaked off chip floating around in the joint.

Two options:

1 - Surgery – 2 weeks to schedule and 8 weeks to heal enough to hit the trail.

2 – Suck it up, get biothtics to stiffen the sole of my boots and a shot of jungle juice in the joint which will probably last around 2 or 3 months. Get another on the trail.

The problem is I waited too long. My whole life is planned around a March 5th start date. If I do the surgery then I will have to delay a month IF and only IF everything goes as planned. I have had surgery on both knees and a shoulder in the last few years (I play rough) and I heal really quickly. The last surgery we did the knee and shoulder on the same day to save time and I only missed a day of work.

Has anyone had this type of surgery just before a hike? If so, what was the recovery like?

[Mother's Finest]

If you expect to be on the trail this year, do not have the surgery. Also, you must take into account that this type of surgery is not always successful. you may end up with less range of motion then you currenlty have, more pain and more problems.

The foot is the base of your structure. If you can avoid surgery at all, do so.

You need a high-quality orthotic. You also want to be in the strongest/stiffest soled boot possible. A boot with a mild rocker forefoot will help to relieve pressure on the joint as well. So think more mountaineering type boot rather than ultra light trail runner.

as for the orthotic, you may be comfortable with your doctor fabricating one for you, or you should find a Certified Pedorthist. www.cpeds.org (http://www.cpeds.org) to locate one near you. As with anything else, ask questions and you must feel comfortable with the practicioner.

best of luck.

peace
mf

[Spock]

iceman,
Consider getting another opinion. Podiatrists are not MDs and the quality of their service can vary a lot.

[Blissful]

You might try locating a sports specialist too - I was told I'd never hike again on account of my ankle injury several years back, I went to a MD that runs marathons that helped me get back on the right track (and get hiking again). Better if you can get a sports MD that is also an athlete. I called my local running shop and asked for their recommendation for a sports MD.

[Blissful]

But honestly the two options given you also sound legit. I guess it depends when you want to go and what you are willing to endure. But I know too that surgery isn't always successful (I had a friend with metatarsal pain who still suffers even after surgery to remove that part of the joint. She can't run or anything).

[the_iceman]

This guy is top notch and into sports related injuries as well. He also comes highly recommended as one of the best in the area. I could go to the guy that did my knee and shoulder but I would have to wait 6 weeks for a slot just to get an opinion. I have faith in this guy.

He has also treated a couple of thru-hikers who went the ortho's and juice route. They jumped off the trail in MA to come see him for another shot before the Whites.

The good news is the joint is actually in pretty good shape aside form the spur and chip.

I can walk thru the pain even without Vitamin I. The issue is can I or will I want to walk with the pain for 160 days? Can I do it without pissing and moaning the whole way? Will the inserts and ibu be enough to get me through?

At least with the pain it is a known entity. With the surgery who knows? I did talk to 2 patients in the waiting room who had the same thing done and they were pretty happy 3 weeks post.

It is one hell of a roll of the dice either way.

[Mother's Finest]

you need a proper orthotic to stop the cause of the problem. surgery or not, you will continue to develop this issue without re-aligning the foot.

i am confident that you overpronate. this causes the first ray to rise up and stops motion in the mpj joint. an orthotic should control your pronation and drop your first ray, allowing the mpj joint to function correctly. ask your doctor about that one.

good luck brother.

peace
mf

[the_iceman]

I have ordered the orthotic's already and will have them fitted. The main problem is the debris floating in the joint. I don't think that will go away by itself.

The orthotics will keep me from flexing that toe joint which will keep the debris from grinding. Alignment is not really the problem. It is the buildup of crap at the joint and chips in the joint.

[Mother's Finest]

One other tip, once you get the orthotics, or even now, start taking some type of supplement to help your body build new cartilidge. Shark cartilige, glucosimine, something like that.

Your body will repair itself if you correct the root cause.

peace
mf

[4eyedbuzzard]

I have been doing shake down cruises with my loaded pack of mostly 6 miles at a time and always end up with foot pain.

If it hurts now after six mile shakedowns, I doubt its going to feel better after double to possibly triple that on the AT day-in day-out, especially throwing in environmental factors. Just MHO, but I'd go with the orthodic, the steroid injection, Ibuprofen, glucosamine, and anything else I could throw at it.

[tha]

Iceman, I am going through this with my ankle. I have total faith in my doctor, but the darned ankle was torn up so badly (broken in 20 places) that the options were just limited. I was making great progress, but with a ginormous orthotic. As I made progress, I got eager for a smaller ortho even though the one I had worked fine. I was using a Vasque mountaineering boot ( heavy, heavy!!!) but had great results. Now that I have switched orthotics, my knees have blown out, and I'm not going anywhere for a while. "If it ain't broke..."
However, OTOH, a competent surgeon, more often than can remove floating chips. That is not brain surgery. I have had that and it worked great on my thumb.
Regardless of your decision, I would try to contact a really good physical therapist before you leave. They can often help strengthen muscles you might not know are important and teach you to walk in a different, less demanding way.

Best of luck. I know how you feel.

[the_iceman]

I just spoke with the Doctor again tonight. Bottom line, the chip is not going away. I may make it without surgery but in his opinion I would be 100% by 8 weeks after the surgery if I did the right things the first 2 weeks post surgery. Either way I will need surgery. If I do hike without it the junk could start to tear up the joint and I would be worse off. Also, our health plan here is better than we will probably have in Florida. (I am in the process of moving pre-hike)

Not doing anything for the first 2 weeks will be hard for me. I walked the day after knee surgery and I was on ladders 3 weeks after shoulder surgery.

I spoke with my wife and the plan is to do the surgery here in MA and then head to the house in Florida after the post op visit. There I cannot go to clients (they are all in MA) or do stupid things (when my wife is watching). The doctor said swimming is the best thing I could do once the wound is healed. I guess I need to install a pool heater.

This will change my start date from March 5 to April 5th. Maybe I will lose the 19 oz jacket in my pack and a few more pounds from my waist.

My daughter was going to start with me on spring break but she will get an Easter Break. If we fly her into Atlanta she can still hike from Springer to Neel's Gap with me.

So close and now this.

[Blissful]

Sounds like a good plan though. And yep, less gear too. Nice spring weather. Should be great and you will enjoy it more. If I had the option, I would go in April, but I can't (my son has to get back in time for college) :) Take care.

[Poison]

Icemanboston,

This topic is pretty much up my alley. I thru-hiked this past year with the pain of hallux limitus, simaler if not the same thing as you have. I think that you are definitely making the right decision. Have the surgery. That will increase the range of motion/decrease the pain in your big toe joint.

I hiked the whole trial with big toe joint pain on a scale of 2 to 6. I still had a good time but I would like to do it again without any pain, so I can enjoy the walking more and put in some more big mile days. It was frustrating to be in great shape but my big toe joints slowing me down.

I plan on having the surgery you are speaking of this April, and to do the Long Trail in the summer.

My advice: Don't get stressed out about it. If you have the surgery, 8 weeks of recovery puts you at the end of March. You can use the first hundred miles or so to get your feet used to trail life. If you are going slower than expected, you can always flip flop. Enjoy the walking and if you have pain, a good anti-inflammatory will definitely help.

Good luck!

[Kerosene]

Ahh, another hiker enduring chronic injuries from soccer. I can relate.

If you don't get the surgery then you're likely to have other problems as other parts of your body try to accommodate the pain and altered gait. Do the surgery and simply start out in April or even May. Remember, there's nothing that says you absolutely have to finish in one summer, and even then, a lot of people finish in 5 and a half months (May 1 to October 15).

However, I'm sure you realize that at the ripe old age of 54 you will heal much s-l-o-w-e-r than an 18-year old. Make sure that you verify that the 8-week recovery is for a man of your age with your metabolism. I tore my MCL last year (soccer injury of course) and the ortho said that I'd recover in 4 weeks if I was 18, but it took me 4 months even with diligent PT.

When you do get out there you'll also probably have to start a lot slower than you'd really like given that your whole body will still be recovering from being immobile for so long.

[handlebar]

Iceman,

I had the surgery to correct hallux rigidus called a dorsal chielectomy about a year before my hike. There is no way I could have made it without the surgery as the pain would cause me to lose strength while stepping down on that foot and the trail is much more difficult than a staircase. As I recall the 8 weeks to rehab is realistic. Mine was done by an orthopedic surgeon on an outpatient basis at the orthopedic center with the highest reputation in OH. I wore a aircast boot for about two weeks and walked on crutches for a week right after the surgery until the stitches were removed. I don't recall having any particular rehab.

My doc did advise me to wear a heal lift (that leg was short due to a skiing related fracture 30+ years before), and I did wear an orthotic that corrects over-pronation.

Sounds like you are resigned to getting this fixed. If it sets you back to Apr 1, you'll still have plenty of time to hike this year based on my experience (I left Mar 15, but had to rehab hip tendonitis for 3 weeks after Partnership Shelter).

[tha]

Iceman, I think you made the right call. Heck, I'm older than you (and most rocks) and that is what I would have done. Hang in there and keep the faith, pardner!

[tha]

P.S. I am leaving in March of '08 myself. If worse comes to worse, join us at Springer or Amicalola.
My hiking buddy and I first hiked on the AT in March of '63. We have been planning to go back ever since then.

[Blissful]

However, I'm sure you realize that at the ripe old age of 54 you will heal much s-l-o-w-e-r than an 18-year old. Make sure that you verify that the 8-week recovery is for a man of your age with your metabolism. I tore my MCL last year (soccer injury of course) and the ortho said that I'd recover in 4 weeks if I was 18, but it took me 4 months even with diligent PT.

Yeah, getting old is a pain. My ankle injury took a year to really heal and I still get tendonitis bouts at times. My 16 yr old injured his ankle. Healed in a couple of weeks.

[The Solemates]

I just came from the doctor today, a podiatrist actually, which I saw in order to get a second opinion. I have chronic joint pain in the big toe of my left foot most likely started from a soccer injury 35 years ago. I was told it was joint wear and there is nothing that could be done. I know how to live with chronic pain but I also know it wears you down over time.

I have been doing shake down cruises with my loaded pack of mostly 6 miles at a time and always end up with foot pain. Hence the second opinion. Today’s diagnoses after x-rays is Hallux Rigidis. Basically a fancy couple of words for stiff toe joint. But it my case I have a bone spur and a flaked off chip floating around in the joint.

Two options:

1 - Surgery – 2 weeks to schedule and 8 weeks to heal enough to hit the trail.

2 – Suck it up, get biothtics to stiffen the sole of my boots and a shot of jungle juice in the joint which will probably last around 2 or 3 months. Get another on the trail.

The problem is I waited too long. My whole life is planned around a March 5th start date. If I do the surgery then I will have to delay a month IF and only IF everything goes as planned. I have had surgery on both knees and a shoulder in the last few years (I play rough) and I heal really quickly. The last surgery we did the knee and shoulder on the same day to save time and I only missed a day of work.

Has anyone had this type of surgery just before a hike? If so, what was the recovery like?


There is no way I would have the surgery. I understand your problem...I have oncoming arthritis in my right big toe...and I'm only 25! I would wait as long as possible, would have to be in immense pain before I would have the surgery. Things like this many times do not do well in surgery.

[maxNcathy]

Sorry to hear about this.
A prayer can help so I will say one for You now.
Sandalwood

[Mother's Finest]

before you have the surgery, go to www.solesupports.com (http://www.solesupports.com) if you do elect the surgery, this is still the absolute best, most cutting edge orthotic being made right now for post op so your problem does not occur again.

if you can find a practicioner in your area that is affiliated with these guys, it is the way to go.

either way, best of luck on your feet and your hike.

peace
mf

[orangebug]

If you have confidence in your real world doctor, go with your plan and stop second guessing. There are no guarantees in life. Cyber-medicine is often worth what you pay for it.

Git 'er done.

[Poison]

Bumping this thread up.

Iceman- Did you end up having the surgery? If so, are you on track for your start on the AT?

I had the hallux limitus surgery last week. What they did was shorten the bone before my first metatarsal, so now I get more upward range of motion in the big toe. It was called the Waterman osteonomy or something along thoe lines. I think that this is different than your surgery because it involved no bone chips. My cartilage is fine, and a full recovery is expected after 6 weeks.

This problem plagued me on my whole thru-hike last year. I hope that your surgery allows you to have a pain free hike. I would love to go back and do it again without the aggravating big toe pain. I hope to do the Long Trail in August so I hope I'm ready.

[H2O_Buffalo]

It frankly sucks, but I had little choice. I have lived with chronic joint stiffnes and pain for 8 to 10 years. I probably waited too long to get the work done, but the long term benefits make the choice, IMHO. I am 50 and had I fixed this five years ago, it would not have been so bad.

My podiatrist IS an MD, in spite of some posts seen here. She is and was great and really knows what she is doing.

I had a titanium implant put into the joint after about an hour of Dremmeling away bone tissue that had accumulated over the years. Before the surgery I had 15 degrees of upward flex in my joint. I now have 67 degress after PT. The chronic general walking pain is still worse than it was before, but when the joint is bumped or twisted, I have less discomfort, plus the added flexion.

Feel free to PM me to discuss this further. I have recent first hand experience and would be happy to share further.

Laffing, this is sort of my own comeuppance when I take my signature quote to heart...