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Tuesday, October 21, 2008

Advice sought about toe pain (Hallux Rigidus).

"Hi Gary
I am a physician and also a runner. I have pretty awful rigidus on the left but I don't want to give up running. In fact, I'd like to do an ultramarathon in 2010.

All of the surgical options look crappy. None of the shots, NSAIDs, diet control, etc have been useful for me.

Gary replies
Have you seen my video on toe manipulation? I learned this technique during a course in massage therapy by an American massage therapist to running greats like Arturo Barrios and other US athletes back in the 70’s and 80’s. 

This kind of toe injury is a common problem in long distance runners and more commonly nowadays in activities like boxing fitness classes due to the repeated slamming of the big toe into the shoe's toe box.  I should point out that the toe being manipulated in the demo video is in the final stages of recovery, since it had already undergone several sessions prior to making the video.....

Funny isn’t it: I have had no end of podiatrists writing in and complaining about this video.  A few are outraged.  The professors in podiatry say there is no real cure for this kind of toe pain other than surgery; I go and do a course with one of the best sports massage therapists around and he matter of factly responds to the question with a quick demonstration that consists basically of pulling the big toe! Granted most cases of Hallux Rigidus are not really Hallux Rigidus, so the Professors are technically right; but then again they are also wrong, if you get my drift.  Hallux Rigidus is the final stage of a progressive disease process and 99% of the cases I encounter are not true “Rigid Toe” – there is still some joint movement and these cases (Hallux Limitus) do respond positively to mobilisation.

The massage/manipulation can be very painful to do but the results can be dramatic within just a few sessions. It is really important to have several days recovery between sessions and to give it about 4-8 sessions to show improvement. In mild cases, one session is sometimes enough.

Surgery is the last resort and cortisone is such a crude instrument – bit like a US precision bombing raid – too much collateral damage to surrounding structures. I have had too many people come to me several months after cortisone injections with permanent damage.  Cases include a mate who’s entire plantar fascia avulsed a few months after a cortisone, ending a promising middle distance running career.

Go here to read my articles about cortisone and prepared to be shocked.

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1 comment:

Marion Hauser - Caring Medical Prolotherapy said...

Gary: So great to see others sharing the notable downsides of cortisone! It seems to be the first line of defense for many doctors, when it can be so detrimental in the long term.

We have an article here on the problems with cortisone, if it's of interest:

Cortisone vs. Prolotherapy

Will look forward to future thoughts!