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Thursday, May 06, 2010

Are you familiar with the Austin Youngswick Bunionectomy/Osteotomy?

One of our Samoan hosts: Same age as me, a lifetime of hard
labour on a razor sharp volcanic lava flow.  Tougher
feet than the lot of us!
Hi Mr. Moller,
You may not remember, but a while back I inquired about your toe manipulation video with regards to my functional hallux limitus. I just went back to the Podiatrist to discuss the surgery option with him and asked him about your method. He said that he doesn't think that it will work because he said I have a longer than normal first metatarsal, which is a deformity essentially, and it causes the jamming of the joint.

The procedure he would like to do is called an Austin Youngswick Bunionectomy/Osteotomy. Are you familiar with this? He said he will go in and cut out some bone out in order to shorten the first metatarsal to the correct length, and then a screw is
used I guess to hold it in place.. What are your thoughts on this procedure?
Hi Mike,
Yes I do remember you and I am familiar with the general thrust of the procedure you refer to.

What is "normal".  Have a look at the feet to the left and the metatarsals appear to be similar to yours. In fact, even the feet of my son look suspiciously similar.  So do Alofa's, by the way.  But they are not booked in for surgery.  Are his feet "normal"?  Click on the photos and have a closer look.  Who defines "normal" and by who's standards?

Here is the problem I have with all of this (without ignoring your pain and need for relief). While the health system is suffering near collapse, we are spending thousands of dollars adjusting the position of a sore toe on a "normal" foot. Surely there are more pressing needs in the World?

My video this topic has had over 50,000 views, so far, which blows me away. There are obviously a lot of sore feet in Modernity.  My partner, Alofa is Samoan. In the island of Samoa nobody has surgery for hallux rigidus. as far as I know.

An obvious alternative to expensive, risky invasive surgery is to go the Samoan way: Barefoot.  Please refer to the photos above from our most recent stay in Samoa to see where I am coming from.

While barefoot may not be a practical option in your modern occupation that is dissociated from Nature, surely there are footwear choices that you can get away with that allow you to replicate being barefoot most of the time?  For example; in my office I have to dress smart.  Most of the hours of the day I wear only a pair of smart white sports socks (and pants, shirt etc) and keep a pair of slip-on shoes handy.

I just think there is something wrong about surgically intervening to forcefully try to correct the harm caused by imposed requirements to conform to the artificiality of modern society.  It is my opinion that modern society should conform to the natural needs of each and every individual.

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Mike C said...

Yes, I've done extensive reading on the whole barefoot comeback. The problem is that when I walk barefoot, or even in shoes now, more often I hear and feel the popping of the joint such as when you crack the knuckles of your fingers. Walking barefoot makes this happen more. I think there is a "normal" foot structure because if mine were normal, then I wouldn't have this issue. There's no denying that the condition itself exists, it's a deformity and it's causing my foot not to work as nature intended. Do you not agree that this condition is caused by too long of a first metatarsal as described on this page?:

If that bone is too long and that's what's causing the jamming of the joint, how does your procedure address the bone that is too long?

Believe me, unnecessary surgery is the last thing I want, but the way the condition was described to me, I don't understand how the manipulation can fix it?

Gary Moller said...

Thanks for responding Mike. Do not get me wrong: My intention is to help you find a solution to your foot pain.

I do not believe the condition exists of itself - it is a product of the modern lifestyle.

Now, there may be other factors at work, including medication side effects, and dietary factors such as a lack of magnesium and too much calcium. Stress exacerbates these with the result there is deposition of calcium in joints. The big toe is the first place this process is obvious, especially if there is repeated trauma.

Mike, have you tried the toe manipulation? It has worked for countless sufferers regardless of 1st metatarsal length. But make sure it is done properly and given time.

Incidentally, I am not aware of a single podiatrist anywhere that practices this procedure but plenty who do not hesitate to bag it out of ignorance. This is a shame because they have only drugs, orthotics and surgery to offer.

MIke said...

So you believe that deformities from the norm (norm meaning what the majority of people have for a bone structure/relative size, etc) are not the cause for something such as hallux limitus?

I don't take any medications, eat better than the majority of the population, and don't have a ton of stress.

I haven't tried the toe manipulation because I don't know where to go to have it done, or what qualifications to look for to be confident someone will understand what is supposed to be done.

Can you refer me to anyone here in the USA that you know has had the toe manipulation performed on them?

Gary Moller said...

The driver behind your foot pain is more a combination of many years of restriction of modern footwear, possibly some slamming of the toe into a toe box which is common in many activities such as boxing fitness, tennis. Diet is a factor - excess calcium in the diet (This applies to at least 80% of people in Western societies) and gradual loss of peripheral circulation - the toes show this first.

Surgery may give some relief but may not deal any way with any underlying health issues that may be quietly percolating away.

I am not a fan of running on pavement barefoot - or just about anywhere if one has not carefully conditioned the feet beforehand, btw..

With regards to the toe manipulation and sensible changes to footwear it would be absolutely irresponsible in my opinion, for a health professional to recommend a patient undergo invasive surgery without first giving these healthy alternatives a good year. If there is no progress then, sure, go with the surgery but only if it is really necessary.

The toe manipulation has worked for many.

Gary Moller said...

Can I recommend a therapist: Here is my standard reply which I send to those who write:


If the joint is beginning to develop spurring/ossify, then this is the time to commence mobilising it. If you leave it be, then the odds are that the toe will simply fuse completely and you don't want that.

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.

Before you start
I recommend that you commence before the massage/mobilisation with a few weeks of glucosamine with fish oil and the Active Elements Tissue Salts. You should also be taking 2,000mg of non acidic vitamin C daily and 6-8 capsules per day of MSM. It is essential that your body has the nourishment to capitalise on the effects of the mobilisation; hence the nutrient supplements.

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.

Iook at getting a pair of Formthotics Shock Stop heat moulded inner soles and wear them in your shoes all the time. These will support the foot and the toe while not restricting movement.

Continue the nutrition for as long as there is any pain and then for at least a month after.

While the intention is to help and not to sell you things, here are the links to what you need and delivery to the US and similar places is usually about 2-4 weeks and the prices are definitely competitive:

Active Elements
Get 2.1 and 3.1 and take 4 of each per day

Fish oil with glucosamine
Take 4-8 caps per day

Take up to 8 caps per day

Shock Stop

Vitamin Ester C
2,000mg per day (This is the non acid form - you must not take too much acid foods while there is joint pain)

Scrutinise your diet ensuring that everything that goes into you is as close to natural and unprocessed. Include fresh red meat, preferably grass fed and foods high in dietary sulphur like fresh garlic.

Please go on a healthy "Health Kick": No junk food, go easy on the coffee, alcohol and no artificial sweeteners, preservatives etc. Aim to be medicine free if you are not already. Please prepare your meals at home using raw, natural foods.

Wayne said...

the cancer society would have a fit, no shirt on him in a tropical outdoor environment! but hang on, his skin looks fine! and he looks like he's living a primitve lifestyle, oh look theres some coconuts, coultd that be a clue to his good looking skin for a man of his years??