Getting to the "Root Causes" of ill health (updated 12/08/14)

The following is correspondence from a man in his 30's who had mysteriously developed bilateral non-traumatic arthritis in his big toes. I get a lot of inquiries from readers about toe arthritis. Traditional solutions for this painful injury usually consist of orthotics, steroid injections and even surgery. But what is the root cause? Why would an otherwise apparently healthy person who is health conscious, develop arthritis in both feet for no apparent reason?

When it comes to health, I regard a person's feet as being their "canary's in the coal-mine". If something is amiss in the body, it may be the feet in which the first symptoms show. While treating the feet may be necessary, doing so while ignoring the systemic possibilities is a bit like killing the canary so that one can ignore the methane buildup in the mine.

In the following case, careful questioning and history-taking all pointed to the possibility that he was being chronically poisoned by dental infections. My advice was to urgently seek the services of a dentist.

My brother, the dentist, and my sister, the dental nurse, will both be very proud that their brother gave such sound advice!

You will gather, from the correspondence that follows, that it is very early days and it will be some time before we know if this man's sore feet are, in fact, being caused, or being made worse, by dental infections. We do know that dental abscesses can be systemically debilitating and are associated with conditions such as heart disease and it just so happens that there is a close link between heart disease and arthritis with infection being the commonality.

I'll let you know how he fares and if he recovers sufficiently to avoid surgery.

Gary
(The correspondence that follows is published with permission from the writer)

________________________________________

Hello Gary,
Well it appears your instincts were correct Gary. I saw the dentist today and he explained that I have a gum infection which is triggering a systemic inflammatory response. Additionally that tooth that is bothering me is actually two teeth that are fractured and both will need crowns. He says there is a point of no return with teeth being savable and I am very close to that point, he feels imminent treatment is necessary so I do not lose the teeth. He also wants to refer me to a surgeon to have the root canal extracted as he says it has failed, and also there are negative health effects due to the presence of the metals. All of this combined is putting enormous stress on my immune system and he believes that will manifest in various ways throughout the body (arthritic joints for example).

He also felt (as do you) that if left unresolved this could escalate into a full blown autoimmune problem and major health consequences moving forward. Apparently that has already begun to happen to some degree as I've suffered with this for around 2 years now (the root canal is even older dating back to 2001); I have escalating health issues and symptom now whereas I have always been perfectly healthy and lived a healthy lifestyle previously.

Most unfortunately for me at this time is that I cannot afford the dental treatments or the full array of blood tests, and I'm not sure taking the HTMA test matters much with these other unresolved issues going on. I will contact you again once I have been able to properly resolve these issues and take all of the suggested tests, and although that may take some time it is most definitely my top priority.

Thank You Gary for your excellent assistance and professional advice! I look forward to resuming with you when possible.

As it turns out, dealing with the gum infection is rather easy. The stressed teeth (fractured & root canal) obviously need other treatments but there are some simple things we can do to deal with the infection. The dentist said that the way you cure the gum infection is by using an interdental brush and baking soda:
https://www.dentalpro.co.jp/en/product/howto/interdentalbrush.html

Baking soda alkalizes the mouth raising the PH level which kills the bacteria. You should be brushing with baking soda anyway to keep the mouth alkaline, especially if you have low saliva as often occurs as a side effect of many pharmaceutical drugs. But regular brushing with baking soda will not solve the gum infection. You have to use an interdental brush to get the baking soda underneath the gum line. So what you do is make a paste with baking soda and water and then apply to the interdental brush and get inside the gap between the teeth and the gums all around the entire mouth. Also when you brush your teeth normally with baking soda using a regular toothbrush you should brush at a 45 degree angle and brush down into the gum line as well, as a preventative to gum disease. 

He also said that a far more effective approach then using a regular toothbrush at a 45 degree angle is to use a sonic toothbrush as the vibrations cause superior gum penetration that is most effective and cleaning underneath the gum line:
http://www.sonicare.com/

He said that is all it takes, and I am doing all of this now and will let you know how it goes.

I also started using this new product called "My Magic Mud" which uses charcoal, bentonite clay and other things to absorb toxins and clean the teeth.  http://www.mymagicmud.com/ It is important to note that baking soda and My Magic Mud are used in place of toothpaste. That means that toothpaste is not used. Apparently toothpaste is very problematic and should not be used for a variety of reasons. An interesting online search might be something along the lines of "problems with toothpaste" or something similar.

And of course it is always a good idea to go in for a regular professional dental cleaning. Normally that is recommended every 6 months but I am going to go every 3 months to ensure I stay on top of this and keep my mouth healthy.

I will keep you posted on my progress!

PS: Here is an interesting video of my dental hygienist speaking with Dr. Mercola on dental hygiene:

Dr. Mercola Interviews Carol Vander Stoep about Dental Hygiene 

https://www.youtube.com/watch?v=wY7Ior5p960

Gary: And here is another Mercola article and video on the topiv of dentistry:

http://articles.mercola.com/sites/articles/archive/2013/02/24/invasive-dentistry-benefits.aspx

Note: the image of this man's hair tissue mineral analysis test arrived shortly after submitting this article for publication.

The elevated Fe/Cu ratio is confirmation of a chronic infection, most probably dental.

The high K relative to Na is indicative of being in the exhaustion stage of stress.

According to Dr David L. Watts, elevated tissue iron occurs during a chronic infection, most often dental abscess. The sequestering of excess, during infection, iron occurs in joints, as well as other tissues such as the spleen. 

Iron is pro-inflammatory when in excess in the body.

The inflammatory effects of excess iron in joints may cause non-traumatic inflammation, pain and - presumably - degeneration of the joint structures if left unchecked for long enough.

So, this person needs to concentrate on infection control and adrenal support, including taking a very long holiday in a secluded tropical resort with all of his cares catered for.

About this website 

The advice in these articles is given freely without promise or obligation. Its all about giving you and your family the tools and information to take control of your health and fitness.

Candida and Fungal Infections? Gary Moller recommends you explore this programme: Click Here!

I've been been having this constant pain in my big right toe

"I've been been having this constant pain in my big right toe. For 2 years now, my toe is quite stiff, i have some movement upwards and downwards is normal. But after doing a bit of running or too much walking, it can be painful. 

Last week, while in Romania, I visited Dr. XXX, who seems to be an expert on this field. And he said I have Hallux rigidus and that i will need to have surgery soon. He suggested shortening of the Metarsal bone. with the consequence, that I will not be able to run anymore after. And im a very active person that likes sports. Im 40 btw. He said i have the last stage of Hallux Rigidus. 

Since then, Ive been looking for alternatives to this problem and came across you site. Are you able to suggest a better solution? Thank you for your time. 

Regards XXX" (name withheld).

________________________________
Gary:
The video below has had over 155,000 views and explains part of the solution for a painful, stiff toe:
 


Here is some feedback:

"I appreciate the Gary Moller links, the Hallux Rigidus one from a while back was helpful. Unfortunately I don't get enough of the rehab treatments as I do the damaging jui-jitsu jamming treatments. But I think I'm getting enough to limit further damage. I went to a new chiro (after a long search for the best in the area) & he tended to think I may get away with it as long as I continue with the Moller techniques. He said as long as I did jui-jitsu I probably wouldn't be able to fully heal it, but he wasn't going to tell me to stop doing something I love. He just wanted to give out info so I as the patient would be informed & able to make a decision based off more info. Which I can respect & if it gets bad enough I will (reluctantly) lay off jui-jitsu to see if it heals. So far it only sporadically hurts when it feels jammed & I have to "pop" it back into mobility. Then it hurts for a few seconds never even up to a minute.
So far so good."

And

"The hallux rigidus/limitus treatments was what first led me to his website. I had that problem for many years and I finally bit the bullet and got the operation last year. Had I known about his program I might never have needed to do that.The hallux rigidus/limitus treatments was what first led me to his website. I had that problem for many years and I finally bit the bullet and got the operation last year. Had I known about his program I might never have needed to do that."

Technically, if you still have some movement in your toe, you do not have Hallux Rigidus - It is limited movement - not rigid.  But I do refer to "rigidus" as do most, because it is the popular term.  It is also the condition that leads to the invasive one-way only treatments, principally surgery.  Personally, I think I would rather have my big toe amputated than fused.  At least I might still be able to run!

What is not addressed in this video is the nutritional, medical and lifestyle factors that may impact on the big toe.  The big toe is your canary in the coal mine: If it begins to die then you know you have a problem.  Your big toe is at the very end of your body: If there is anything amiss, such as lack of a nutrient, kidney disease or diminishing circulation, your big toe may be the first to warn you with cries of distress.

So, if you have developed an arthritic toe for no apparent reason, you need to consider all the possibilities that may be impacting on your health and vitality such as:

• Medications including, blood pressure, cholesterol, bone-sparing, mega-doses of vitamin D, asthma drugs, steroids, thyroid drugs and anti-depressants.
• Chronic infection, most often deep in the body and undetected.
• Toxins such as arsenic, mercury and lead.
• Deficiencies or excesses of nutrients such as vitamin D, iodine, calcium, all vitamins, protein and even salt.
• Excessive, chronic stress.

There are other factors such as long hours in rigid footwear, like work boots that do not allow the feet and toes to flex and extend as they were designed for (Joints thrive on "normal" movement).  As far as I know, hallux rigidus is as good as non-existent in societies where barefoot is the norm.

And, the main cause of your pain may not be arthritic: It may be tendonitis of the toe tendon, flexor hallucis longus.

If you want to take this further, I can help no matter where you are, so long as you have broadband.  Much can be achieved using Skype video technology.  Please complete this form, with payment and we will be in action!
http://www.garymoller.com/Consultation/Private-Consultation.aspx

About this website 

The advice in these articles is given freely without promise or obligation. Its all about giving you and your family the tools and information to take control of your health and fitness.

Candida and Fungal Infections? Gary Moller recommends you explore this programme: Click Here!

I developed intense pain in my large toe joint and reduced flexibility

I receive more inquiries about sore big toes than anything else.  My instructional video on the topic has had an astonishing 120,000 views.  Here are two emails received today:

"I have hallax limitus in my big toe. I still have motion but I have pain every day. I heard there is a massage I can do and vitamins I can take to rebuild that area. Can you help? "

And:

"Hello, I am a 42 year old woman living in Chicago, USA. I was watching your massage video on Alofa for her hallux rigidus condition. I similarly badly stubbed my toe while walking in June. Soon after I developed intense pain in my large toe joint and reduced flexibility. My orthopedist diagnosed it as hallux rigidus and gave me a steroid shot between my toes. It has made minimal difference. I feel I would benefit from the massga technique you demonstrated. I would be most appreciative if you could recommend anyone in the Chicago area (or even the mid west area of the States) who is certified and performs this technique?" 

An early photo of Priscilla Welch

Before I answer the questions in the emails above, let me give a little history about how I got around top pulling people's big toes....

I first learned this technique in the early 1980's.  It was around that time that NZ was a popular training base for "professional" runners for off-season training, a way to escape harsh Northern Hemisphere winters.  For, example, Japanese running squads trained in South Canterbury, while various athletes, like Dave Bedford, hung out in Auckland, trained hard, sun-bathed and drank lots of beer.

Some of these athletes brought their athletic trainers with them.  It was through my sister, Lorraine, that I was introduced to two of these trainers.  One was Dave Welch, husband of marathon champion, Priscilla Welch.  I can not remember the other who I met several years earlier than Dave.  As there were no training courses in New Zealand resembling anything like what these health professionals practiced, I paid each a Grand or so, plus expenses, to come to Wellington to teach me and my staff their methods (I was running and health and fitness consultancy service at the time).

One of the topics that came up each time was how to treat an impacted big toe, otherwise known as "turf toe", due to its being commonly suffered by athletes who play on artificial turf.  Back then, there were no fancy terms for this condition, such as "hallux rigidus", which simply means "stiff big toe" (why don't they just say what it is?).

The treatment we were taught was really simple:

Pull the Big Toe!

Sadly, with the big money involved nowadays with the manufacture and sale of mostly useless custom orthotics, lucrative cortisone injections and even more lucrative surgical methods to fuse the toe joints, the method I was taught has as good as been wiped from training curricula and deleted from the textbooks.

Now, about the emails above....

Can I recommend a certified therapist in your area?

Sadly, I can not.  The reason:  Because I do not know of a single therapist anywhere, other than myself, who has had any training in this procedure.  The best thing to do is to find a therapist who is trained in joint manipulation, such as an osteopath or chiropractor, and ask them to traction and mobilise the affected joint. They should know what to do.

You will need to have this done once weekly for as long as it takes to notice lasting relief.  Give it three months and you should notice a benefit within 3-6 sessions (weeks).  However, mobilising the toe will not work if there are underlying drivers that are not treated concurrently, such as the damaging effect on joints of some medications.

Things you can do for sore feet in general

Please read this article and follow the advice:
http://blog.garymoller.com/2012/06/heres-some-simple-advice-to-get-relief.html

Supplements one can take for a sore big toe

Yes, there are some that I can recommend although it is wise to get some testing done first, such as a hair tissue mineral analysis (I can do this for you).  However, in the absence of testing there are some general things one can do:

Glucosamine and chondroitin

Ignore the arguing to and fro about the merits or otherwise: My experience over 15 years is it does help give relief to joint pain and it might even help reverse arthritic processes.

Magnesium and zinc

Both of these minerals tend to be in short supply in people with joint pain and poor healing.

What about calcium?

Excess calcium relative to magnesium may result in calcium depositing into soft tissues, including joints.  Unless you have a hair tissue mineral analysis that clearly shows you need more calcium, it is better that you avoid calcium while emphasising magnesium and zinc.

What about heavy metals like lead and mercury?

If these are present in the body in even the tiniest amounts, they can gradually destroy joints over the years.  The big toe is most vulnerable since it is the joint furthest away from the central circulation.  And it is a hard-working structure.  It will play up first.

If you have testing (the hair test is best) that shows the presence of heavy metals, contact me for advice about how to get rid of it safely.

Protein and fats

Low protein and fat intake can starve the body of essential base nutrients for the manufacture of strong and resilient structures.  Protein and fat are equally, if not more important for strong bones and joints than just about anything else.  It is important to dribble the protein into the body over the day and not concentrate it into a single meal.

My Super Smoothie, taken a cup at a time 2-4 times a day is perfect and contains the right mix of vitamins and minerals for strong bones and joints.  Add some coconut cream or blend in some coconut oil, plus a dessertspoon of flax oil.

Medications may destroy your joints

We are now seeing an explosion in arthritis that I associate closely with the use of steroids, especially those prescribed for asthma.  While it may take decades to be obvious, these drugs thin tissues, including bone and cartilage. 

Asthma medication

I am of the opinion that the reliance on asthma medication as the sole treatment if asthma to the exclusion of all else, is leading to disastrous long-term health consequences, including arthritis, fibromyalgia, tendinitis, thyroditis, adrenal fatigue, depression, anxiety and other nervous disorders.

The same can be said for other medications for osteoporosis, blood pressure, cholesterol and even birth control.

If you think your medication may be affecting your health, including your joints, consult your health professional.  You are welcome to contact me directly for an opinion.

Conclusion

There are safe and effective alternatives to fusing a toe joint or destroying tissue with chemical injections.  Such procedures should only be employed well after all else has been tried and shown to fail.

Therapies such as mobilising the toe, adding corrective vitamins and minerals, sorting out the negative effects of medications for other health conditions all take time - several months in most cases.  This requires a good deal of patience which can be difficult when in a society that has been conditioned to expect instant results.

So, please be patient.  Restoring good health is not an overnight thing.  There are no quick-fixes - or if they are they usually come with a BIG downside.

The good news about a stiff, sore toe:

Nobody has ever died from one!

_______________________________________

About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Here's some simple advice to get relief from sore feet

The Mollers: A collection of strong legs
and strong feet!

Perhaps the most frequent request for assistance I receive is from people suffering from some kind of foot or ankle pain.  These are for injuries like neuroma, sesamoiditis, toe pain including hallux rigidus, plantar fasciitis, stress fractures, reflex sympathetic dystrophy syndrome and Achilles pain.

What you may have noticed when reading the list of medical conditions is the heavy wording such as "reflex sympathetic dystrophy syndrome".  I immediately have a problem when I see these heavy pieces of professional jargon.  The problem is that what often comes with the big words are complex and costly treatments that may fail to see the wood for the trees.  Sometimes the solutions are ridiculously simple, like throwing away those expensive sports socks!

These drastic and costly treatments are often unpleasant, uncomfortable, often with unpleasant side-effects and some are one-way streets with no turning back once entered.

For example; that quick-fix cortisone injection into the ankle may result in a catastrophic tendon rupture several months later.

Regardless of your foot problems, there are some simple things you can and probably should try before escalating to more costly and invasive treatments:

Have a daily foot bath

Get an oval plastic bucket that your feet can sit into comfortably, fill it with tepid water and add half to one cup of Epsom Salts (magnesium sulphate).  Soak the legs until the water is about blood temperature (about half an hour).  The best time to do this is when the feet are achy such as first thing in the morning or after a long day on your feet.  It can also be a wonderful prelude to an exercise session.

Fit a pair of Formthotics Shock Stop Inner soles

These are heat moulded to fit the contours of your feet, while not restricting natural foot function.  You might have to search around for them.  (I have them available for about $55/pair).  I have these in all my shoes and just would not be without them nowadays.

Wear thin socks

Lorraine and Gary Moller
Barefoot for most of our lives.
Love the fashion!

Thick sports or tramping socks can prevent the circulation of blood to the sole of the foot, especially when combined with tight shoes and/or overly soft innersoles (innersoles should be quite hard - not spongy).  Conditions associated with thick socks and tight shoes include heel pain, forefoot pain, sesamoiditis and neuroma.

Get on the internet and Google search for "How to lace a running shoe" where you will find excellent illustrations of how to lace shoes without restricting the circulation to the feet.  

Get your feet massaged

There is nothing like a firm and loving massage of the feet after a long soak in a tepid Epsom Salts foot bath! Have this done once a week, including the calf and shins.

Get your toes pulled

Toe joints are like any other joint: Designed for movement.  If they were not, they would be rigid.  Toe pain is often the result of lack of movement and the toes being squashed into restrictive shoes.

Google search the internet for "Gary Moller Youtube toe" and you will see an instructional video about how to mobilise sore toe joints.

Get about barefoot

Use your feet as intended - without footwear.  Walk on a sandy beach, on a grassy field and get about barefoot around the house.

Are your feet turning to stone?

Secondary school.  Barefoot other than one boy
and the teacher.

Too much calcium is present in the circulation of 80% of the people I test while magnesium is deficient.  When there is an imbalance between calcium and magnesium, the excess calcium will tend to precipitate into the soft tissues, including the joints.  This is the process that leads to osteoarthritis and hardening of the arteries (arteriosclerosis).  The earliest signs of this calcification and loss of circulation is felt in the feet and sometimes the fingers.  Reducing calcium in the diet, while increasing magnesium intake can do wonders over the long term for foot health.

Is your medication hurting your feet?
Many medications, such as those to reduce blood pressure and cholesterol, may be the cause of your foot pain.  If you think this may be a possibility, please talk to your doctor.  Do not hesitate to seek a second opinion.

More reading:

http://blog.garymoller.com/2006/08/what-can-i-do-to-stop-getting-numb.html 

_______________________________________

About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Stiff toe (Halux Rigidus) Inquiry

I just wanted to let you know that your video on manipulation of the large toe for hallux rigidus has helped me a lot. Pain is way down. Before I couldn't even walk without a shoe that had a carbon graphite orthotic in it.

As I wrote on your youtube page, I also started to wear MBT shoes, which have a rocker bottom that really rests the toe as well.

My only question is, how often, and for what duration should the manipulation be done?

Thanks again,
Stuart S....., M.D.
_________________________________
Gary:
I think the "Rocker Shoes" are a great idea and well worth trying.  Especially now that they are widely available.

The toe "manipulation" should be done about once a week - no sooner and not much later.  Just long enough for things to settle between sessions.  The benefit should be obvious within 4-6 sessions.

While I refer to "Rigidus" this is hardly correct.  I have yet to see a real case of the toe being completely rigid.  In all cases, there is a little or a lot of movement regardless of degree of pain.  But I use the word "Rigidus" because that is the most common term used and what people search for on the internet.

_______________________________________

About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.  Please give me your support by subscribing to my free email updates. Please shop at my Online Store. Please encourage your family and friends to do the same. While we may not always be able to compete with the big operators on price, we aim to more than compensate through personal service!


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Do you have a question?  Email Gary: gary@myotec.co.nz. Include any relevant background information to your question.  Please be patient and be aware that I may not be able to answer every inquiry in detail, depending on workloads (My paying clients take precedence!). I will either reply by email or, most likely, by way of an article (Personal identifying details will be removed before publication).

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

Stiff toe manipulation really does work!

Dear Gary Moller,

I just want to thank you for your video on manipulating hallux rigidus. Twenty-three years ago, when carrying my first child on my front, my right big toe became very painful. A podiatrist said it was because I have short toes and high arches so that the toe gets jammed when I walk, and prescribed orthotics. They helped a bit, but I eventually stopped wearing them and just tried to get really wide-toed shoes for my running and walking.

A few months ago I decided to learn to racewalk for a particular marathon, and the rolling stride looked like it might be a problem because of my toe. So I was looking around on the net and discovered your video, went to a local chiropractor and told him about it, and after 4 bouts of his manipulation the change was amazing. I continue to work on the toe myself and have hopes that one day not only the occasional pain, but also the enlargement of the joint will be gone completely.

So thanks very much for what seems like a very common sense and literally hands-on treatment for a long-term injury that may have resulted originally from a mere stubbed toe!

Best wishes,

Mary, USA

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Advice sought about Stiff Big Toe (Hallux Rigidus) in active people - runners and other athletes

Thank you for posting about this topic! This is exactly what I have and have been dealing with for several months now. Sadly, I didn't understand the source of the pain and had just tolerated it for several months before finally mentioning it to my chiropractor. She has been working with me for the past couple of months to try and get it under control. I believe the pain originated from a severe stub that has gone unattended.

I just started taping the arch of my foot about two weeks ago, and purchased a golf ball which I roll my foot over to try and dig into the joint as much as possible. It hurts like hell, but am trying to be very dilligent. Every night I massage the area & try to maneuver the toe as much as possible. It has not stiffened at all and is still quite mobile, but it is extremely sore the more active I am.

I had a question regarding my level of activity. I do some type of cardio 3 - 4 times a week at the gym (elliptical, treadmill, etc.), take dance classes, and ride my bike daily to and from work. I notice the pain in my right big toe subsiding when I'm less active, but have not wanted to cut back on my exercise, as I work a fairly sedentary 9 - 5 job. Would you recommend laying off the amount of activity or stepping it up? I don't want to exacerbate the problem any further.

Thanks again so much for your blog!

Sincerely,
Sarah
__________________________________
Gary responds:
It is probably best to only do massage and manipulations that stir the toe up once a week only. Daily is too much. Anything done between should be gentle and restorative in terms of encouraging healing. Stir it up more often than once a week does not allow healing and strengthening.

I would be inclined to reduce any exercise sessions that cause toe pain to just three times per week or to do only exercises that are painless for as long as it takes for the toe to fully heal. Avoid activities that have the foot slamming forwards such as often happens in aerobics classes, martial arts. Running on one's toes, rather than heel to toe may injure the toe joint.

Aid healing with a supplement that supplies gluocasamine and chondroitin like the ones here.

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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"
_______________________________
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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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,

"D"

_________________________

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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Big Toe Pain Massage and Manipulation - More positive feedback

Dear Sir, I am a 36 yr old male who broke my toe when I was 10yrs old. . After x, rays, fish oils, needles, 4 yrs of hell . I am excited to sit here this Sunday night and see your sight{there is a God}. I think your manipulation thing helped straight away. I'm so so happy. Thank you so much Mate
Tony

____________________

Gary

I continue to receive criticism (almost entirely anonymous) from some foot experts about my posting of a "how to" video on this common foot problem.  The fact is this simple technique which is rubbished by those who think they know what is best really does work for many people who might otherwise face needless drugs, surgery and other medical interventions.  If it does not work, nothing is lost - then one can get on with the surgery with a clear conscience that the conservative methods have been tried and exhausted.

Please keep the feedback rolling in Folks!

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I have had a very sore 1st metatarsophalangeal joint for some time

Hi Gary, I was interested to watch your you tube video regarding hallux limitus/rigidus manipulation, & I've also had a read of your blog regarding the same condition.
I was wondering, can this manipulation technique be of benefit even if there is no loss of movement in the joint?

I have had a very sore 1st metatarsophalangeal joint for some time. X rays show 'mildy reduced spacing' in the joint, but no bone spurs etc. The joint however has become somewhat bigger than on the other foot.

So I suppose I'm wondering whether your technique could help me (get rid of the pain) even though I've still got full range of movement and no visible bone spurs.

Is there anyone you've come across that you recommend in Melbourne?

Thanks for your time,

Will

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Sore big toes - the manipulation is working!

Hello Gary,
"Amazingly I now have approx 40 % in my left toe and approx 60 % in right range of motion in both big toes (up from 10%) implementing your technique. My great toes were so jammed that my shoe size has actually increased from 12 to 12 1/2 (US mens). The toes are still very sore when flexed. As you can see years of calcification has formed bony growths on the joint forcing the toe to face inward on left toe.

Two questions would be :
1. Should I take a longer resting time to allow for the soreness on top of the joint to dissipate so I can resume running (right now its to sore to even walk much)
2. Would you recommend a spacer or yoga toes at night to allow straightening of the toe or perhaps something else.

Either way I am very pleased with the new Range of motion and am very grateful"
Matt
_________________________________
Gary:

Matt, continue to take your time, mobilising the toes about every 4th day with the time between to ensure they settle and get a little stronger.  The intention is to encourage the laying down of healthy joint tissue, so a balance between stress and recovery needs to be struck.  About 4 days should be about right.

If the pain is anything more than slightly uncomfortable, then I would tend to avoid the offending activity and give preference to activities like cycling and aquajogging for as long as it takes to become pain free and then ever so gradually reintroduce the dodgy activities.  You could look at fitting a pair of Formthotics "At Work" heat moulded innersoles.  These add enormously to foot comfort while reducing impact.  Or you could wait for a wonderful new Formthotics Innersole called "Shock Stop" which I will have available in about one week from now.  The name says it all and the advance samples are impressive.

Take a quality joint food daily for as long as there is any joint discomfort.  I would recommend a small maintenance dose be kept up indefinitely thereafter.

While I have never used the joint spacers myself, I have had many favourable reports over the years.  I see no harm and plenty of potential benefit in using them; but bear in mind that it may take the best part of ten years to see any permanent benefit because the deformities you have are bony.  Walk about bare foot every opportunity you have.  Walking on a sandy beach is great for spreading the feet and strengthening the muscles and ligaments.

Please keep us informed as to you progress, thanks.

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.

Thoughts?"

___________________________________

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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Painful Marathon Runner's Toe

HI,

I hope you can help me. Here's background info 42 years old 5'4" 125lbs. I had bunion fixed on right foot in 1994. Started to wear orthodics. A few years later big toe joint stiff got a shot of cortizone. A couple years after that I beg the foot Dr. to bend it back and got another shot of cort. 

I always exercised but did not start running steady till about 2004. I had a kid gained weight and started running. I lost 50lbs and here I am today. I have run 4 marathons and put my body through challenges . This past year while training for boston my big toe joint was really bothering me. I sought out the help of a chiropractor and acupuncturists both helped me get throught boston with out that much pain. 

I got my 3rd shot of cortizone in June. I figured the last shot lasted 12 years that this might work. Well it lasted about a month and the pain is getting worse. It bothers me! during the day on top in the joint area and when I run it bothers me under the length of the big toe. I am planning on running boston again this year 2009. What I have read is no speed work or hills. I need to do this so that I can run a 3:50 at boston. I am also a competitive runner. I run the local race series. I do ice after long runs and take aleve.

Could a PT help with this problem? I want to get help before it get worse and my training has not yet started for Boston.

I do not want surgery. I have consulted 2 Dr.'s one said they could Fuse it but I would not be able to run marathons. The other is just scraping the spurs out. I was told I have bone spurs and arthritis or are they the same thing??

Christine (painfully running)
___________________________

Gary responds:

Christine, one cortisone is probably one too many.  There are three lines of action that you may take from here:

• See a massage therapist with the qualifications and experience to stretch, mobilise and massage the affected toes and all of both feet and the lower legs.  Your thighs and butt muscles would probably also benefit, given the amount of running you have done in the past.
• Start a course of glucosamine and chondroitin with MSM (you can get these from my website store) and continue at the maximum label dose for at least three months
• Find out if you have a tissue salts and other nutritient deficiency by completing the Active Elements Assessment.  Please take time to provide the additional information about diet and the rest.  Any deficiency will result in weakened body structures that fail to heal.

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Runner saves his big toe - a happy ending.

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 cartilage left in between the joint. He stated I would need to "fuse" the joint together. At 32 this seemed unacceptable.

I followed the manipulation and dietary recommendations 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 nutrients 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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Where can I find someone to massage and manipulate my sore toe joint?

"Hi Gary,
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?

Thank you."
Mark
_________________________
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.

Where do you find a suitable massage therapist? If you live in Wellington I might be able to help. If not, then you have to shop around. You need a person with strong hands; but with the training and experience not to hurt you. I recommend, as a first start in your search, that you contact:

• 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.

like any other kind of hands-on therapist, just how good a massage therapist is , is very much to do with your personal taste, their experience and style. You need to shop around and be prepared to stop and move on if it is obvious that it is not for you.

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.



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Hallux rigidus - metatarsal-phalangeal-joint pain (Turf Toe) - Treatment Advice

Dear Gary
I just found your webpage online as I was researching Hallux Rigidus.

I have already been to an orthopedic surgeon and was looking for a foot and ankle specialist next. I tried the ice, rest, and motrin remedy without success. I have also recently received a cortisone injection into the MTP joint on my right foot with some acute relief. Unfortunately I still have pain on a daily basis and my workouts and running have suffered.

I am a nurse so therefore am on my feet most of the day. I only wear heels when I go out socially. At this point I am still taking Ibuprofen for pain, icing my foot and taking Fish Oils in the amount of 2000-4000mg/day.

I am hoping you can offer me some additional advice or relief so I can be pain free and can get back to my usual pattern of exercise.

Sincerely, Jana
______________________________
Gary Moller comments:
Jana,
Please have a look at my video about this topic here. You will need to find an experienced massage therapist near you who can do this procedure.

Before doing this, I recommend that you address any possible underlying nutritional deficiency that may be contributing to the development of the disorder and its failure to recover through natural healing processes that would have been the norm when you were younger.

For, example; if you have been on a low fat diet (most women are) and working indoors and not getting a lot of sunlight, then it is highly likely the you have steadily run out of the fat soluble vitamins, essential fatty acids, many minerals and even some essential amino acids. Deficiency in even one of these nutrients and the bones and cartilages soften and healing will be compromised. If you work night shifts as a nurse, it is also possible that you have disturbed your circadian cycles which may mean that you are not producing enough growth hormone each night for repair and regeneration. This one reason why shift workers score so poorly on just about every population health measure one cares to look at.

Big toes can be "canaries in the coal mine" and may indicate the very early signs of the body declining in health for whatever reason. This can explain why treating the toe in isolation of the whole person may be doomed to fail.

So, the first step is to complete the Active Elements Assessment. When you do so, please detail your health and injury history, exercise and occupation background. List all medications and supplements you are taking and explain why and for how long. Please include a list of everything that you have drunk and eaten over the previous 24 hours.

If you are able to purchase a set of Salter 9106 Body Composition Analysis Weighing Scales from a store near you, or off my website store (Currently on Special), then you will be able to send me the breakdown of your fat, bone, water and muscle. This is extremely useful information for me to work with.

I will then get back to you with a number of recommendations, bearing in mind the limitations of dealing with you remotely. Please ensure that you continue to consult your doctor as you go.

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