Hallux Rigidus and a man with Parkinson's Disease

Gary, I am a 55 yr old man with Parkinson's Disease (PD) (diag. in 2004) who just had knee replacement surgery (left) in Dec. of 08 and have been diagnosed as having Hallux Rigidus in my right great toe by an orthopedic surgeon who is a foot specialist.

I have always been an athlete (college football) , backpacker, golfer for my entire life, but due to the PD (my right side is the affected side). I have had to cut back or cut out a lot of my activities due to complications caused by the PD. My changed gait caused an already arthritic left knee to deteriorate more quickly , thus the need for the replacement. I am doing real well with that, but my right great toe has gotten worse thru the last 6-12 months due to my shuffling gait where I tend to walk on the balls of my right foot. I can still move my toe up and down some, but not much and it is swollen.

I used to take Glucosamine Chondroitin for several yrs and felt it helped but wasn't sure if it was just in my head or if it really helped. Also, due to the cost of the meds for the PD, something had to go, so a couple of yrs ago, I stopped taking it.

I am reluctant about having the toe surgery and was wondering what to look for to find a good massage therapist in order to persue that course of action and what else would you recommend I consider? "M"
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Gary responds:
Additional information - medications:

• Mirapex .75mg for Parkinsons
• Stalevo 75 mg for Parkinsons
• Lisinoprol 20 mg for high blood pressure
• Mobic 15 mg anti imflam.
• Used to take high doses of Q10 for PD

There is a possibility that there are a couple of associations going on between your joint pain, blood pressure and Parkinsons. While it is not advised that you stop any medication, please talk to your doctor about the following suggestions, including questioning the need for taking the blood pressure medication. The priority is managing the PD. Blood pressure medication may be one medicine too many because one can easily lose control of the drug interactions. Most cases of blood presssure can be managed without the need to resort to drugs.

Try to keep the drugs regime as simple as possible - You have a war on your hands: One of the big lessons of the 2nd World War was not to fight on more than one front at a time.

Vitamin D deficiency
There is an association between Parkinsons and vitamin D deficiency. While it may be associated with causation, it does not mean it is a cure. Restoring vitamin D levels to "optimum" may slow its progression; but this is conjecture. Then again, the only side effect of restoring vitamin D is good health, so why not do it! Low vitamin D is also associated with cardiovascular disease (blood pressure) and joint softness, including osteoporosis and arthritis - to name some. You can take 4-6,000,iu of natural vitamin D while going to your doctor and getting a 25 (OH)D blood test (send me the results for interpretation).

Check your homocysteine levels
The medication you are on to treat your Parkinsons is known to increase homcysteine levels. There is also an association between homocysteine and Parkinsons. Homocycsteine indicates oxidative stress which is closely linked to degenerative diseases including joint destruction. If levels are even slightly elevated, take a drink of Nutralife Loadup Fruitful Greens and/or Berry Brights three times daily and take a quality daily B multivitamin like Nutralife Ener B (you can get these off this website.

Check your footwear
With Parkinsons there is a tendency to shuffle. Ensure your shoes are sturdy enough to protect the toes from stubbing and that there is ample space in the toe box. You could try replacing the innersoles with Formthotics Shock Stop which you can get off me. These are heat moulded using a hair dryer to shape your feet.

On this issue of shuffling: take up activities like Tai Chi and social dancing. Rhythmic dancing may be just what you need to keep you out of the shuffle habit. Try marching using music and call "Left-Right-Left!" loudly to keep timing with the beat. Stride out really long. Heel to toe jogging/walking on a rebounder, again using a beat may help. Take car ewith balance. You can obtain additional exercise on a exercycle or rowing machine.

Lift a light weight daily several times from ground to stretch above your head. Breathe deep. It is most important to maintain upper body strength, to stretch open the rib cage and to counter the tendency to slump forwards. Sit up straight.

Mobilising the toe
Once you have addressed all of the above and given them a few weeks to kick in, you may consider the exercise of progressively mobilising the toe. Please do so with the guidance of your doctor. Please read the articles about toe mobiliation that I have written by clicking on the label words at the base of this article. Among other things you will read my advice about finding a suitable therapist in your area, plus more advice about nutrition and supplements for artritic joints.

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