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Tuesday, September 18, 2007

Podiatrist tells Gary off - Hallux Rigidus has been misdiagnosed

Dear Gary Moller, My name is Daniel Bagnall and I am currently practicing Podiatric Medicine in Australia.

I would just like to alert you re: your treatment for Hallux Rigidus (fix it by manipulation), that this patient of yours has been misdiagnosed. I’m sorry to be so blunt but as a practitioner I find it very frustrating when the incorrect terminology is being used on the internet, please take the time to refer to the medical literature before posting such material:-

Normal dorsiflexion ROM at the 1st MPJ is 65-70 degrees ROM, this can clearly be observed at precisely 4:00 min in your video, pause and observe the position of the hallux, is the hallux flexing <65-70 style="font-size:130%;">
Gary Moller responds:

Thank you Daniel for pointing out that there appears to be no reference to the use of manipulation of hallux rigidus in the literature. This is one of the reasons why I produced the video. You will note that I advised in the video that this procedure be done by a professional (I assume from your writing in protest that you are not trained in this procedure).

I was first taught this technique about 25 years ago when undertaking a course in deep tissue massage by a sports massage therapist who made his living working almost exclusively on Olympic class middle and long distance runners mostly in the United States. At the time he was considered by many athletes to be the best. The simplicity and the effectiveness of this method in dealing with "impacted" toe joints, as we called them back then was astonishing. These kinds of toe injuries are common in runners and can be crippling to the point of being career-ending. I have never seen a failure of this procedure. Of course we are usually dealing with these injuries early (About Grade I-II).

You will also note in my accompanying advice with the video the use of nutritional supplements such as glucosamine and MSM to assist healing. I doubt you will find anything about this in the literature on hallux rigidus either; but that does not stop be advising the use of these supplements because they help expedite recovery.

As the literature (erroneously) states, this condition is progressive. The treatment offered in the literature does nothing to prevent progression which I find appalling. I can tell you that the condition is reversible in addition to being progressive, if gotten to early. This mirrors the view given to many other conditions. Take blood pressure for example: the usual medical approach only deals with the symptoms and the condition inevitably progresses. In most cases the condition can be reversed. As with the sore big toe, the sooner one intervenes with effective treatment, the more complete the recovery.

In the case of the woman in the video, you need to remember that her toe had already been manipulated several times. The toe in the video demonstrates remarkable restoration of mobility (She is naturally hyper-mobile in her fingers and toes btw).

If I was to obediently follow the guidelines in the literature, this healthy and athletic woman would be subjected to needless and costly medical treatment and eventual disfigurement by deliberate joint destruction surgery - the inevitable outcome of this kind of "progressive injury". We commenced about three months after the injury (So it was hardly acute!) and recovery has been quick and uneventful (other than the pain of the manipulation).

This procedure works very well on little toes as well.


Wayne said...

all too often hte professionals will say how there are very fixed approvded ways of dealing with a problem, i had chronic fatigue, was sent to a psychiatrist who said the problem was entirely to do with my past and i needed therapy , BS
it had nothing to do with that. I was told by a virologist to stop running as it was a bad activity. looking at his office decor he was about half a century in the past, it makes me furious, so often the official line later is found to be BS, like using cortisone. i defied the odds and i can now run long distance again, going against whatever advisce i was given and finding the real answers myself, answers in line with what i"ve read from Gary. if it works for you then you may well be better informed than the professionals. specialists are so narrow minded as Gary has pointed out, the advise you get for a specific problem can vary massively depending on hte modality the professional practices because they can only see their part of the picture and can't see things holistically, my mother has suffered chronic health problems that were managed by pharmaceuticals or should i say mismanaged, and i watched her health steadily decline and my trust of qualified medical professional declined accordingly, by and large your average GP is a legalised drug pusher, make sure any medical professional you consult, gives you leeway and options on what you are able to do in the way of treatment and they should hand over as much control as possible to you in the end empowering you to be alarge part of the healing process, never ever hand over total control for your treatment to anyone, because if they are wrong then you could end up in more trouble than you started with.
I suffered years of ridicule from most people i know for the regime i embarked apon to cure myself, i wa a laughing stock for the diet i ate people tried to persuade me to eat "normally" get some meat into you, fatten yourself up, some good dairy food as well.
i worked out what worked for me and i stuck with it, end result my health is far better then hte people who ridiculed me who used to be in excellent health.
when you are young your genetics are one of the biggest determinants of your health as you get older that takes a back seat to the determinant of the lifestyle you are leading and how many insults you heap apon it.
the pharmaceutical companies dont care about your health if they did they wouldnt charge the criminal prices they do , in a lot of countries the established medical profession create further health problems by the additional stress they place apon the patient from the horrific prices they charge on top of the exacerbating of peoples health problems long term from the poisonous pharmaceuticals they pedal, just look at the disastrous experiemnts they carry out, on human volunteers. the statistics for adverse drug reactions are horrendous

Gary Moller said...

Wayne's experience and strong feelings are common to those I encounter on a daily basis.

There are usually several pathways that one can take to get to the same destination, some more valid than others. I try to assist people with deciding which is the best path to head down.

As Wayne said "the advise you get for a specific problem can vary massively depending on hte modality the professional practices".

I attempt to provide a critical overview of all the available options which are often many and can leave a person confused. Often the wrong path is chosen with occasional disastrous consequences, such as opting for surgery when a simple procedure, nutritional supplement or lifestyle change should have been tried first.

A principle that I also stick to is to favour interventions that do not close out other options. For example: the toe-pulling, if not successful does not preclude surgery. Surgery, on the other hand, precludes future toe-pulling.