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Saturday, May 30, 2009

More about toe pain - Hallux rigidus/limitus

Aloha Gary,

During a google search of "Hallux Rigidus", I came upon your video demonstrating how manipulation can fix it. I've had the condition for about 20 years, the original trauma having occurred while stubbing my right big toe while running on the beach. I've been an avid marathon runner for many years, but have had to gradually give up long distance running because of the pain (arch area as well as the big toe...right foot only). I finally went to a podiatrist who fashioned orthotics for me, but my foot hurts more the days after wearing them. He says I need a titanium hemi implant of the toe joint, which shows up in X-Rays as having severe calcium deposits...essentially the joint is non-functioning. I've considered having this surgery, but after reading about others' experiences with this, some of them have worse pain after the procedure. I can walk fine, but I miss running! I do not want my condition to deteriorate. I've been icing the area. Do you know of any trained therapists in the Honolulu area who are proficient in your manipulation technique?

Thank you,

Gary responds:
Surgery may be necessary but only after all conservative options have been thoroughly explored and exhausted.  There is no going back following surgery.  And it can be expensive and the surgery may not be the end of it.  Here are several things you can do, some or all of which may assist:
  • Ensure your vitamin d levels are optimum - 120-160nmols.
  • Take a quality glucosamine, chondroitin and MSM supplement.
  • Take 2,000mg of vitamin C daily.
  • Complete the Active Elements assessment on this website and purchase the tissue salts that are subsequently recommended.
  • Get blood tests for measures like your haemoglobin and ferritin levels and ensure all are in the upper levels of healthy ranges.  Get liver and kidney function tested.
  • You may benefit from a liver and bowel detoxification (I recommend the Herbal Detox Programme).
  • You may be better off discarding your orthotics and replace with a pair of Formthotics Shock Stop which you can get off this site.
  • Once you have the above measures in place for at least a month, try a course of toe mobilisation.  Do this weekly for a month by which time the residual pain should be beginning to abate.
Any manipulation/mobilisation should be done by an experienced massage therapist, osteopath or chiropractor.  At the same time, listen carefully to the advice of your Dr.  Remember that I am not present, so my advice must be carefully and cautiously considered.

Can I recommend a suitable therapist?

I do not know of a suitable therapist near you.  Ask around.  A good place to start is to contact the trainer of a professional sports team in your area.  Conditions like "turf toe" are common and always being treated by a team's physiotherapist or massage therapist.  Please keep your primary physician informed of what you are doing and please heed his or her advice.

How often?
Only mobilise the toe once a week and do so for at least 4 sessions. The pain of the procedure should diminish by about the 3rd session and recovery should be quicker and residual pain should be less as well.  It is important that the person doing the procedure tractions the toe to gap the joint before actively mobilising it.  The entire lower leg and foot should be thoroughly massaged, as should the healthy leg.

Pain medication
Do not use pain killers to dull any pain associated with the procedure.  Use pain to guide how much work to have done on the toe at any one time.  

Pain killers are therefore not to be used while doing this therapy.

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