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gblauer
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Apr 2, 2008, 5:54 PM
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Anybody been diagnosed with this? My big toes on both feet are really screwed up, although I had a surprising range of motion. The doc wants to "clean up the joint" by removing bone spurs etc. I am concerned about:
1) Recovery time (it seems like it's going to be a LOT longer than the 4 weeks the Doc is suggesting)
2) Treatment effectiveness (will it really work or just cause more pain in the end)
Is there any other treatment besides surgery? I have a LOT of pain in my right foot, somewhat less pain in my left. I want to climb for at least 20 more years...what's an obssessed, addicted climber to do? What will happen if I do nothing?
As always, thanks for your input.
(This post was edited by gblauer on Apr 4, 2008, 1:26 AM)
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irregularpanda
Apr 2, 2008, 5:57 PM
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gblauer wrote: Anybody been diagnosed with this? My big toes on both feet are really screwed up, although I had a surprising range of motion. The doc wants to "clan up the joint" by removing bone spurs etc. I am concerned about: 1) Recovery time (it seems like it's going to be a LOT longer than the 4 weeks the Doc is suggesting) 2) Treatment effectiveness (will it really work or just cause more pain in the end) Is there any other treatment besides surgery? I have a LOT of pain in my right foot, somewhat less pain in my left. I want to climb for at least 20 more years...what's an obssessed, addicted climber to do? What will happen if I do nothing? As always, thanks for your input.
People always get a 2nd opinion with mechanics, but never with doctors..... go get one. I don't know jack about this issue specifically, but if you get multiple professional opinions on this, you're bound to find a doctor who is communicative and informative.
Also, at least you don't have cancer, TB, HIV, malaria, or Hep C.
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gblauer
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Apr 2, 2008, 6:02 PM
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Getting a 2nd and 3rd opinion tomorrow and the day after that!
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linvillelover
Apr 2, 2008, 6:23 PM
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irregularpanda wrote: gblauer wrote: Anybody been diagnosed with this? My big toes on both feet are really screwed up, although I had a surprising range of motion. The doc wants to "clan up the joint" by removing bone spurs etc. I am concerned about: 1) Recovery time (it seems like it's going to be a LOT longer than the 4 weeks the Doc is suggesting) 2) Treatment effectiveness (will it really work or just cause more pain in the end) Is there any other treatment besides surgery? I have a LOT of pain in my right foot, somewhat less pain in my left. I want to climb for at least 20 more years...what's an obssessed, addicted climber to do? What will happen if I do nothing? As always, thanks for your input. People always get a 2nd opinion with mechanics, but never with doctors..... go get one. I don't know jack about this issue specifically, but if you get multiple professional opinions on this, you're bound to find a doctor who is communicative and informative. Also, at least you don't have cancer, TB, HIV, malaria, or Hep C.
or AIDS
ps... good advice. get another proffesional opinion
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onceahardman
Apr 2, 2008, 6:50 PM
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Hi gblauer...
Bummer. Short answer: No, I have not been diagnosed with this, but have treated it, and similar conditions. Longer answer: All is not necessarily lost. I'm sure climbing shoes don't help. I'd recommend going with something with a bigger toe box, as opposed to anything pointy. Hopefully this doesn't interfere too much with your present style. Also, ALWAYS bring approach/descent shoes, (also with a big toe box) , don't walk downhill with climbing shoes if at all avoidable. Keep the toenails trimmed short. (Don't laugh too much-more than once, I have seen this as a primary cause of toe problems).
According to this, stiffer shoes may also be helpful:
http://footandankle.mdmercy.com/.../hallux_rigidus.html
A good manual PT may well be able to improve your ROM with some mobilizations. Ultimately, there are only two choices, try to get it moving better without surgery, or have the surgery, and then try to get it moving. Nothing is lost by going conservative first (non-surgical).
One thing is clear, though. Something has to change. Do not expect to do the same thing, and to get different results. Also, check the shoes you wear in your non-climbing life. We climbers like our shoes tight. Go looser in your workday shoes too.
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superevolved
Apr 2, 2008, 7:38 PM
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I have it. It stopped me from climbing for a time. Go find the best foot ortho dr you can. I have had great relief from a carbon fiber insert and cortisone to the joint. Climbing is difficult though. But pain relief is great. PM me and we can talk more. Ali
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gblauer
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Apr 4, 2008, 12:18 PM
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onceahardman wrote: Hi gblauer... Ultimately, there are only two choices, try to get it moving better without surgery, or have the surgery, and then try to get it moving. Nothing is lost by going conservative first (non-surgical). One thing is clear, though. Something has to change. Do not expect to do the same thing, and to get different results. Also, check the shoes you wear in your non-climbing life. We climbers like our shoes tight. Go looser in your workday shoes too.
This is totally depressing. I went for another opinion yesterday. I do have good ROM in both toes. The problem is that I have pain. We are going to start conservatively, but, if it's inevitable that I will need surgery, why live with all of this pain for so long?
The doc told me that I should take NSAIDS (1000 MG) per day, I should have orthotics for my everyday shoes. Eventually, I will beg him for cortisone shots and then I will be begging him to do surgery. I will be out a minimum of 3 months.
I am very unhappy.
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8flood8
Apr 4, 2008, 12:57 PM
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you could try accupuncture. its great for relieving inflammation. and pretty relaxing too.
another thing i would try is see if there is a MIGUN franchise near where you are.
its a massage table that give you infared light therapy.
(killer for anti-inflammation) and a pretty relaxing massage as well.
sorry about the news you got. Get your lemon squeezer out.
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gblauer
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Apr 7, 2008, 7:41 PM
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onceahardman wrote: One thing is clear, though. Something has to change. Do not expect to do the same thing, and to get different results.
Onceahardman...you are totally right. Something has to change. I have consulted with 3 doctors (including the guy that handles the Pennsylvania ballet). They all say the same thing: I have arthritis in both big toes, there is nothing that can be done. I am having orthotics made for my shoes and I need to figure out how to get a stiffer climbing shoe to take the pressure off the joints.
Any suggestions?
Thanks,
Gail
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caughtinside
Apr 7, 2008, 7:51 PM
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gblauer wrote: onceahardman wrote: One thing is clear, though. Something has to change. Do not expect to do the same thing, and to get different results. Onceahardman...you are totally right. Something has to change. I have consulted with 3 doctors (including the guy that handles the Pennsylvania ballet). They all say the same thing: I have arthritis in both big toes, there is nothing that can be done. I am having orthotics made for my shoes and I need to figure out how to get a stiffer climbing shoe to take the pressure off the joints. Any suggestions? Thanks, Gail
Hi Gail,
With regards to stiff shoes, I recently got a pair of Scarpa Spectros and they are fantastic. They are really stiff along the big toe edge but still maintain flexibility and smear better than any other stiff shoe I have tried.
I had a pair of 5.10 newtons which were really stiff but had no sensitivity at all, same with the 5.10 southwests.
good luck.
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heavydude
Apr 8, 2008, 11:14 AM
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Hallux rigidus is generally caused from an excessively long 1st metatarsal bone. The length prevents normal plantar flexion of the metatarsal head during propulsion. This prevents the hallux from moving smoothly around the joint surface when walking. The other cause is poor foot function , such as pronation, which has the same effect.
If the cause of your arthritis is from poor foot function/mechanics then an orthotic can work well, as it can restore normal joint function. If it is caused from a long 1st metatarsal then it is harder to treat. However there are some simple tricks like putting 2mm of firm material under the other four metatarsals, effectively shortening the 1st met. Success depends on how bad the arthritis is. Try glucosamine + chondroitin supplements to help repair the damage.
In the mean time look for shoes that have a rigid sole that also rocks, that is curved like a rocking chair, like a very good hiking boot, this reduces the need to extend the big toe joint when walking.
Regards
Paul
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gblauer
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Apr 8, 2008, 12:59 PM
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heavydude wrote: Hallux rigidus is generally caused from an excessively long 1st metatarsal bone. If the cause of your arthritis is from poor foot function/mechanics then an orthotic can work well, as it can restore normal joint function. If it is caused from a long 1st metatarsal then it is harder to treat. However there are some simple tricks like putting 2mm of firm material under the other four metatarsals, effectively shortening the 1st met. Success depends on how bad the arthritis is. Try glucosamine + chondroitin supplements to help repair the damage.
Paul...you are right, I have very long metatarsal bones. They are making me orthotics now, but, I have a question. Will the orthotic impact the other metatarsal heads as you suggest above?
SHould I try and find a climbing shoe that will accomodate the orthotic? The guys at evolv will make me a super stiff shoe, is that all I should think about? SHould I try and get the orthotics into my climbing shoes? Do you think glucosamine + chondroitin could actually help reverse the damage. (According to the docs, my toes are pretty arthritic. walking in regular shoes hurts my feet.)
Thanks, Gail
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heavydude
Apr 9, 2008, 1:26 AM
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While walking, regular orthotics only function to control the rear and mid foot during impact to midstance (when the foot is flat on the ground). As soon as you lift your heel they stop working. Hopefully the alignment that occurs in midstance lasts through the propulsive phase.
The usual procedure with H. rigidus is to extend the shell of the orthtotic forward under the big toe, effectively splinting the joint. Called a 1st ray extension or Mortens extension. This typically forces people to become apropulsive or causes them to push-off over the lesser toes. Something that typically happens anyway with H rigidus. This type of orthotic seems to work well for the really restricted big toe joint.
I add what is called a met-pad (for all the other mets but not the big toe joint) to the standard orthotic shell by putting on a full length top cover and glueing 2-3 mm of dense EVA under it, The top cover flexes during propulsion, like shoes do. What it does is tricks the foot into thinking that all the bones are the correct length. This can be added anytime. If your orthotics have a 1st metatarsal extension try it for a while, it can always be ground off later and the shell modified. Sometimes these modifications take some fiddling to get right and lots of podiatrists won't bother with that. Treatment really depends on how much damage has already been done to the joint.
Because orthotics only really work when the heel is on the ground, putting them into climbing shoes doesn't really do much when actually climbing. A very stiff soled shoe would assist when pointing, however you would be looking at something like a mountaineers boot to fully reduce pressure on the big toe joint. A shoe that doesn't flex the joints in the big toe would also help.
Glucosamine + chondroitin have been shown to give better pain relief than celebrex or vioxx. and is a good treatment for arthritis.
Shoes that roll when walking, like hiking boots, are very good at relieving pain as well. Don't wear shoes with anything of a heel over 1inch high
Hope this helps,
Paul
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gblauer
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Apr 9, 2008, 1:31 AM
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Thanks Paul, please ignore my PM. I will show your response to my doctor.
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UttarUkaalo
Apr 9, 2008, 1:19 PM
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NSAIDS are a blessing but 1000mg seems a little high.. A friend of mine took 500mg a day to treat gout and spondolysis. He got chronic GastroInt problems along with upper GI bleeding. It helps if you take something like Controloc to counter it though. Just something to be aware of I suppose..
Also I agree that Glucosamine works well. I've been taking it regularly to help an old knee injury and it has shown marked improvement.
(This post was edited by UttarUkaalo on Apr 9, 2008, 1:22 PM)
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grantjk
Apr 9, 2008, 4:32 PM
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Hey Gail
I had surgery on my right big toe joint about 15 years ago for what I assume is the same problem, and it was probably the most successful medical intervention I've ever had. As I recall, the surgery involved opening up the joint, shaving bone off of both sides to create space, cleaning up damaged cartelige, and drilling little holes in the bones, which the surgeon said might encourage new cartelige to grow.
My recovery was pretty quick--I was told to do range of motion excercises as soon as I could, and to do as much activity as I could tolerate. Definately my kind of advice; I was playing basketball within a couple of weeks and climbing soon after. It was a bit painful initially, and I couldn't really blast off my big toe for awhile, but I hadn't been able to that before the surgery anyway, so it didn't seem like a big deal. I'd say I was fully healed within 6 weeks, and have had no further problems with it. The only problem is my right foot is now a half size smaller, so fitting shoes is kind of a challenge.
Good luck with whatever you decide to do, and feel free to ask me any other questions. Grant
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gblauer
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Apr 9, 2008, 5:43 PM
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What is controloc? Also, the 1000mgs is making me crazy. I feel terrible taking it. I have backed off to 880 mgs. Hoping that I will feel better.
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UttarUkaalo
Apr 10, 2008, 6:57 AM
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Controloc is a gastric medication that treats stomach ulcers and similar. A couple of my stock broker friends take it.
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gblauer
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Aug 14, 2014, 3:57 AM
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It's been five years since my surgery. Thought I should post an update:
I had double cheilectomy staggered two weeks apart back in 2009. During my down time I worked with a trainer to build overall body strength so that I could get back to climbing as soon as possible. I can distinctly remember when I tried climbing the first time; my toes were screaming. So my resourceful husband built some steel shanks that he taped to the inside of my shoes. I called them my "spoons". I felt like I had a spoon in each shoe, preventing my big toes from bending. It worked and I was able to regain my climbing fitness. As I progressed, I needed to fine tune the spoons. Mitch made plaster molds of my feet and turned those molds into latex molds which were used to make carbon fiber orthotics for my climbing shoes. he modeled them after these:
http://indianabrace.com/...lluxrigidusPain.aspx
I purchased shoes 1/2 size larger since the orthotics take up volume. I have been climbing on the orthotics ever since (he made me several pair. Each pair seems to last 2 years or so). In the gym I am leading 11's, outdoors I am doing slab, overhanging, face climbs. Nothing really bothers my feet until the end of the day. Then everything starts to hurt (aging sucks doesn't it?) I have been very diligent about my footwear. I only wear rocker shoes or dansko shoes. (other than my approach shoes. I have carbon fiber orthotics like the x1 blades in my approach shoes, with a metatarsal hapad). I think my choice of footwear has significantly diminished the rate of decline in my toes. At first, I was certain that I was headed for a fusion. Now, I think I may just get away without having more surgery. I am fairly comfortable in my rocker shoes and I do a LOT of walking all day.
If you can't do the orthotics, I recommend working with Yosemite Bum Resole. They will make a stiff midsole on your climbing shoe that is really stiff. I cannot use my orthotics in that pair of shoes, they are simply too stiff to climb. Find a stiff shoe to begin with, then have Yosemite Bum add even more stiffness. I think the key is to keep your unfused toe from bending.
I have continued my work with the trainer (I think overall strength and fitness are critical to good climbing technique) and I keep my body weight very low. I figure the less strain on my joints (did I mention that my fingers are also arthritic?) the longer I will be able to climb.
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satch
Aug 17, 2014, 2:41 AM
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I have a similar condition, with arthritis in my big toe from an old injury. The Dr recommended wearing hard-soled clogs and hiking boots with a pronounced rocker in them. He said to wear nothing but these two shoes/boots. The pain went completely away.
The clogs are Dansko, the boots are La Sportiva Trangos, although now I wear the Deltas. These have kept the pain at bay for 15 years. Down Dog (yoga) seems to help too.
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