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.

My Big Toe is very sore, sometimes swollen

"Could you help me please, My big toe is very sore, sometimes swollen and has very limited movement.

This has developed over the last couple of years and has now got to the stage I can not play 9 holes of golf.

I have have been to my specialist and he recommends surgery to fuse the toe bones together I'm not happy about this, have you a solution.

I had a number of heart attacks... and on the usual heart medication."

Anonymous

Medications as follows

Asperin 100mg

Dilitiazem 120mg twice day

Metaprolol suffocate 47.5 mg 

Simavistin 80 mg 

Omeprazole 40mg

Oxybutynin chloride 5 mg

Male, late 50's. Worked as a tiler up till about 10 years ago.

_________________________

Gary:

The big toe is your "canary in the coal mine" and is your early warning that not all is well elsewhere in your body.

In this case, the medications being taken for several years must be highly suspect.  The Simvastatin and Oxybutynin are both known to cause joint pain, swelling.  While drugs must undergo rigorous safety trials before release, I am not aware of any requirements that there be similar testing of the safety of mixing these very same drugs.  Each drug comes with its own set of side effects and the potential complications when these are mixed can be mind boggling.  In my opinion, prescribing six different medications is hazardous to health.  I accept that there is a good reason for prescribing each of the above; but this is an example of one drug leading to another: Omeprazole is prescribed to offset the digestion upsets of an earlier medication, as is oxybutynin.  This kind of progressive prescribing, while justified by the prescriber, is a slippery slope downhill, leading to further health problems such as the sore toe.  Chopping the toe may give relief to the current pain; but does not deal with whatever may be going on inside.  What will be next?  The other big toe?  The ankle? Liver problems?  Kidney?  You need to go back to your doctor and discuss the possibility that your sore toe is being caused by one or more medications.  I really do think you need to stop the suspect drugs.  See what your doctor has to say.

Lead is present in many
 materials used by tradesmen.
Lead damages arteries,
bones and joints.

Please read these articles about statins.  You will gather that I do not have much time for this class of drugs.

Please read these articles about "sore toe" of which there are over 30.  Massage and manipulation of the sore toe is an option; but not before the cause of the pain and swelling is first identified and then rectified.  You could start taking some of the supplements recommended in these articles - supplements like glucosamine and chondroitin.  While you search for the underlying causes.

Tradesmen who work with solvents, chalk, paint and timber are exposed to many toxic substances, such as lead, cadmium and arsenic, that build up in the body, wreaking metabolic havoc over the decades.  Years after exposure to these toxins has ceased, they remain in the body, rusting away the insides.  These toxic elements may contribute to conditions like heart disease, arthritis and even Parkinsons to name a few.

Good health, including resolution of the toe pain, getting up at night for a pee and so on, is not found through drugs and surgery, although these may be necessary for short term relief and survival.  The key to good health for life comes from identifying all of the underlying biochemical drivers that are leading to a progressive breakdown in health.  This is done with a Hair Tissue Mineral Analysis and then acting on the results and recommendations.

This article about arteriosclerosis is a good example of how good health is achieved by use of the Hair Analysis programme.  The Hair Tissue Analysis is not a substitute for medication that has already been prescribed; but it does help people chart a course to good health.  As health improves one of the wonderful benefits is being able to progressively reduce, or cease medications - but those are decisions to be made between you and your doctor!

The first action is to order a Hair Tissue Mineral Analysis and then get going!

_______________________________________

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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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!


Your email address:

Powered by FeedBlitz

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).

I would like to try manipulation for a stiff toe problem

Gary

I would like to try manipulation for a stiff toe problem. However, I am concerned that this may just cause further damage to the cartilage/joint and/or speed up the arthritis. I have read that rest is the best thing. What do you think?

I damaged my toe about 8 years ago which set off this problem and have periodic bouts of pain, which last a week or so and then can clear up for a couple of months. My doctor says the range of movement is good enough that it would not classify for surgery on the NHS in the UK (I could go private but I am not keen on surgery in any event). I am 57 and pretty active e.g. running, walking.

Are there safer alternatives to a cortisone injection in the ankle?

Permanent harm caused by a cortisone injection
into an ankle

Hi. I just read your article about the dangers of cortisone injections in the ankle and I have decided no to do it.
The results of the MRI scan show a build up of fluid in the ankle. I have a defect in the cartilage, a hole probably caused by a small loose bone but the doctor does not know what cause the accumulation of this fluid. I understand the injection would take the pain away but is not better working on the cause? What other safe treatment are available? Thanks
_________________________________
Gary:
Despite the resurgence in popularity of the cortisone injection in recent years, nothing has changed with regards to the risks of this therapy.  These risks are real and definitely not imagined.

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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I have a bone spur and arthritis on the same toe I was operated on

Hi

I have what may be another bone spur on the same toe I was operated on; as I also have arthritis on the same toe. What therapy can I do to relieve the pain. Also is it possible for a bone spur occur again after an operation? I am also very active. And frustrated. I have recently taken up yoga. Anything you can help me with greatly appreciated. I of also thought of trying acupuncture. Any thoughts. Thx again Karen

_______________________________

Gary responds:

Karen, please bear in mind that I am making the following comments without seeing you in the flesh.

Surgery may not be the longterm solution if the original cause of the irritation that causes a bone spur has not also been removed - wearing tight shoes for example.

There is often other factors at work of the physiological kind. There may be something amiss with your body chemistry which may be causing an excessive inflammatory reaction to stress or an inability to heal quickly and completely. Your connective tissues may be getting excessively soft, thin or hard, affecting bones, tendons, ligaments.

Longterm use of medications such as those for blood pressure, steroids for asthma and arthritis and drugs to "prevent" osteoporosis must all be considered as causative factors of what you are describing.

If it is not something as obvious as shoes, these less obvious factors must be explored and addressed for other therapies, including exercise, to be effective.

I can help further if you were to complete a hair tissue analysis and supply me with a detailed health history, including medicines.

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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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Feedback about rehabilitation following a toe injury

I hyperextended my right big toe and fractured one sesmoid bone. I did not receive any treatment for this injury for over 7 months because the toe gradually improved and then only bothered me with heavy physical activity. Then after several months it started to get worse.

I saw a foot doctor had a CT and determined a cyst was forming and that there was cartilage damage. Conservative treatment was to wear a boot for 6 weeks to let the tissues calm down and heal.

Over the course of the 6 weeks I moved the toe frequently and began to try strengthening the toe and it began to heal a little but the whole foot and leg became significantly weak from non-use. So now I have had the boot off for 3 weeks and I am continuously trying to strengthen the toe joint and walk around barefoot which is most comfortable. I try to stretch it often as well.

All in all, it seems to be improving but I don't know what to do next. I can walk pretty normally now but still ice the toe when it gets sore. I feel like if I can bring the strength up in the toe then the toe will continue to improve.

Let me know what you think if you can. My purpose in sending you my experience was to just let you know how the type of you treatment described has worked for me.

Zack
____________________________
Gary responds:
You are doing things right Zack.

As an onservation, I am constantly disappointed that so much resource goes into diagnosis and treatment by expensive specialists and high-tech services; while there is near total neglect of after care. It is regaining that last 10% of function that is so challenging and often so vital for a full recovery following injury or illness.

walk barefoot, in ankle deep water, walk on sand and grass. Do the exercise in my foot pronation video. Get some fins and flutter kick length after lenght of a swimming pool.

You might want to fit a pair of Formthotics Shock Stop inner soles from my web store to protect your feet from excessive stress when resuming running.

Please let us know how you get on.

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Hallux Rigidus: How can massage therapy prevent the bones rubbing together?

Hello Gary,

My wife is 55 years old. She has seen 3 Podiatists. They all said she has Hallux Rigidus. She is scheduled for surgery. I found your web site and now have reservations.

She used to be an avid walker but the pain is too bad and she stopped a few months ago.
Not until then did she see the first doctor about the problem.

She has lost significant cartilage and there are bone spurs. Besides loss of mobility, the pain is mainly from bone rubbing against bone. From what I understand, part of the procedure will be to shave bone to eliminate the grinding/rubbing.

** I read all of your articles and watched video. Here is what I didn't find the answer to and don't understand: How can the message therapy eliminate the bones rubbing together. Even if mobility is restored, won't she still be left with the bone grinding/rubbing ?

Thank you for your time and assistance.

Steve
USA
_______________________________
Gary responds:
If there is some movement then she does not have "hallux rigidus". There are still likely to be some cartilage left, although it may be thin and missing in places and there may be bone spurring at the joint margins.

Conservative procedures should be thoroughly exhausted, being given time to work, before going down the one-way street of surgery.

Movement stirs the synovial fluid that lubricates and nourishes the joint tissues, stimulating cellular activity, including cartilage regrowth. Lack of movement, such as occurs with thight shoes, toe splinting and most orthotics reduces joint nutrition and may accelerate the slide towards surgical fusing of the joint.

The technique I use involves pulling the joint surfaces apart and then smoothly moving the joints back and forth, gliding and twisting. It is possible that the procedure smooths off some of those bony joint margin spurs as well.

It is most important to support this procedure with good joint nutrition, as well as to address any other factors that may be adding to the problem - one of the most common being the toxic effects of many pharmaceuticals, such as anti depressants, cholesterol lowering drugs and bone-sparing drugs.

It continues to really bother me why medical experts continue to refuse to even consider this simple and cheap procedure when it so clearly works for the majority of sore toe sufferers. You will not find it in the medical text books.

Incidentally, I use this procedure on my fingers all the time because of the stress and strain they are under - what with the combination of hours of massaging clients daily and then slamming about on a mountain bike for recreation!

It works.

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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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Advice about self manipulating a sore big toe

For a few months I have noticed an intermitent sharp pain in my big toe. A podiatrist diagnosed hallux rigidus and pointed out the bump on the top of my foot below the big toe. He suggests X-rays and perhaps surgery. I have started using yogatoes every night and this eliminated the pain immediately, but not the bump. I tried emulating the massage you were doing as I watched your video. It seemed pretty straight forward, but you recommend getting treatment from a professional, and desisting from self treatment. What type of professional should I seek help from. Are you thinking of a chiropractor, or physical therapist or some other type of practioner? Thanks for posting the interesting video.

Mary

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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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