I saw your video and writings about this condition. I was recently diagnosed with this condition after an x-ray. The doctor told me he didn't seen much, if any, arthritis, but he said I have developed some bone spurring around the MTP joint. I agreed to try a cortisone shot. It helped for about 1.5 months and now the joint is becoming more painful again. He said that the spurring could continue to worsen if I don't get it taken care of surgically.
My question is whether you would agree, or would the manipulation technique you talk about help even with the presence of spurring? If you believe that manipulation would help, how would I go about finding a professional that knows this technique?
Gary Moller replies:
Mark, your experience of coritisone injections is pretty typical of many active people: fast relief that does not last. Please read my growing list of articles here about the shortfalls of this kind of treatment.
The best way to deal with your kind of toe problem is as follows:
- Deep tissue massage and mobilisation of the affected joint and all the joints above and below as well as the rest of the foot and the lower leg. Do the other leg as well. This takes about an hour and should be repeated weekly for at least 6 sessions and probably ongoing.
- Replacement of tissue salts that strengthen the ligaments, joints and bones (CaFl, SiO2, CaPO4) - Active Elements 4.3
- Do a course of glucosamine and chondroitin with MSM taking the maximum dose on the label for 3 months and then reduce to an ongoing maintenance dose.
- Walk often barefoot on soft grass, in sand and in mud to flex, extend and strengthen the structures of the feet.
- Wear shoes that do not slam the toe box against the toes. This means lacing the shoes tight at the top and quite loose at the toe box part. If the feet slide about, change to a better pair of shoes. You could experiment with open shoes and sandals.
- Do alternative exercise to ones that slam the feet and toes - swimming, aquajogging, cycling, kayaking for example.
- Any Government accredited massage training institutions and ask for a recommendation of somebody in your area.
- If you have a professional or semi-professional sports team in your area, speak to the coaching staff and ask their recommendations. Ask top athletes you know of for their recommendations.
- Ask friends and workmates.
Effective deep tissue massage can be intense and painful at times and may leave you feeling quite sore for a few days after; but there is a difference between this kind of robust treatment and outright hurting you - this is a fine line that you and your therapist need to negotiate with care and skill.
As far as the spurring is concerned, the mobilisation involves pulling the joint surfaces apart and then gliding, rotating and bending the joint. The bone spurs which are at the very margins of the joints may get "ground" a bit and this can be agonising; but no damage is being done to the all-important articular surfaces of the joint. After several sessions, there should be a noticeable reduction in pain when this procedure is carried out. Not doing this, painful process risks the joint becoming completely immobile.
If surgery is finally required, nothing has been lost and much gained by having stronger, healthier feet going into surgery and the peace of mind of knowing you did your best with less drastic measures.
Do you have a question?
Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.
I wrote Gary about 6 months ago regarding Hallux Rigidus. I had very large bony growths on top of each great toe. Prior to starting Gary's recomended course of action my podiatrist stated I had little cartilidge left in between the joit. He stated I would need to "fuse" the joint together. At 32 this seemed unnacceptable. I followed the manipulation and dietary recomendations of Gary. I was not able to "grind down" the bony growths and did have to have surgery on both to remove the bone spurs (cheilectomy). HOWEVER, by allowing the blood and nureiets to re-enter the joint space which had been jammed up for years and years I avoided a fusion. I will continue Gary's manipulation post surgery and get about barefoot as much as possible. In my case it saved my running, I only wished I had started it earlier!!
Best of luck,
Matt from USA
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