My Big Toe Joint Hurts! The Arthritis You Never Knew!

Have you ever suspected you have arthritis in your big toe joint? It is one of those conditions that slowly creeps up on you. You may be going about your business only to notice that your big toe joint hurts! You may end up limping around for an hour or even a few days and then it disappears only to reappear when you least expect it! What’s up with this? Well, it may be plain ol’arthitis!

Arthritis in the big toe (aka: hallux) joint is known as “Hallux Limitus” or Hallux Rigidus” depending on whether it the motion in your toe is limited or not moving at all (rigid). Basically, how much arthritis you have puts you in either one of those categories. So here it how it works. Over the years, all of your joints wear down to some extent. We start to lose the cartilage, (this is the stuff covering the bones at the joint so the joint can glide smoothly). Once we have worn down enough cartilage, the bones at the joint start making bone on bone contact instead of cartilage on cartilage contact, and this causes pain. This bone on bone rubbing is not as smooth either and it limits the amount of movement at the joint. This is arthritis. As the amount of arthritis in the joint increases, the amount of pain in that joint increases as well!

How does it all start? I tell my patient that simply stubbing your toe, which most of us have done at some point or other, can accelerate the wearing down process. Many times, arthritis in the big toe joint shows up in people with other foot conditions, such as bunions, or flat feet or high arched feet simply because of how our bones line up in the feet. If they are not perfectly aligned, that joint will wear down quicker because it was not meant to work in that position.

What can be done about the pain? Once you have been diagnosed, your podiatrist will be able to tell you just how severe the arthritis in your big toe joint is and treatment will be based on that. Treatment could include anti-inflammatories, custom inserts, physical therapy, shoe alterations, padding, cortisone injections, and in the worst of cases, surgery. That being said, the sooner you see us about your big toe pain, the quicker we can slow down the damage being done to that joint and keep you moving!

My toes are starting to curl!!

I first noticed it when I wore a pair of heels the other night(that were maybe a little to pointy). I figured that the 2-3 hours that I wore them wouldn't kill me, but my goodness... By the end of night I had severe pain in my feet, right on the top of my toes.

Today I was looking at my toes and I noticed a small area of redness on the top of my toe right where it is starting to curl. It is sort of hard and painful to the touch, and truthfully a little ugly.. I think it is a corn.

If you are suffering from anything similar to this you may have hammertoes. Hammertoes are a contracture of a joint in the toes, that usually start off flexible and may progress to a more rigid deformity. The more rigid they become the more they will interfere with your ambulation and may lead to corns, or even worse an open sore.

What causes Hammertoes? Hammertoes are a mechanical imbalance of the tendons in the toes. The tendons on top of the foot gain control over other tendons and start to contract and curl your toes. Why does it happen?

1.Can be caused by biomechanics (your foot structure and the way you walk)
2.The wrong shoes (high heels, pointy shoes)
3.Neuromuscular condition
4.Broken toe or trauma to the toe (jamming)

Treatments for Hammertoes:

Treatments usually include accomodative padding, different shoe gear, trimming of corns, anti-inflammatories, injection therapy and surgery. Orthotic devices may also help control abnormal biomechanics.

If you are suffering from any of these symptoms talk to your podiatrist. There are many advances in the treatment of these silly toes!

Toenail Disorders Due to Chemotherapy:

I am training to walk the Susan G Komen Breast Cancer Walk Dallas of 2009. During my training I have met a lot of great women. Some are walking as survivors, and others are walking because someone close to them is suffering from the disease, or have lost someone they love.

As you can probably imagine there is a lot of talking during these long training walks. I happen to be a podiatrist, so I commonly have people asking me questions about their feet, proper shoe gear, how to prevent injuries, and most commonly their toenails! Most will say they have either lost toenails or they have turned colors due to the chemotherapy.

Alot of the survivors agree that when undergoing chemo, most of the time they are not warned on what to expect their toenails to begin to look like. No one tells them that their toenails will most likely fall off, turn colors, get thick, have skin attached to them and possibly smell.

When undergoing Chemotherapy the drugs that are commonly used; (Adriamycin, Taxol, 5-Fluorouracil) cause damage and attack the tissue that keeps the toenail in place. This is called onycholysis. It is common for the nail to loose its attachment to the entire nail bed or sometimes only half of the nail bed. Either way when a nail looses its attachment it allows dermatophytes( the bugs that cause fungus) to get under the toenail, also known as onychomycosis.

Tips to Keeping your Toenails Looking There Very Best:

1. Clip toenails straight across and keep them short, this prevents splitting and breakage of the toenail.

2. Keep toenails clean and moisturized. If getting a pedicure make sure all instruments have been sterilized.

3.Cut away any loose cuticles, do not pick or pull at them. This can cause bleeding which can easily lead to an infection.

4. Try to avoid injuries to your toes and toenails, they will bruise easily. Wear wider shoes that have plenty of room in the toe box. Wider shoes will also allow for more circulation to the toes and toenails.

If your nails become infected, inflamed or painful you may need to see a doctor. There are some over the counter treatments that may be fine for your type of infection or you may need a doctor to prescribe a medication to help combat the problem. There are some very advanced treatments that are now available including topical treatments, oral pills and laser treatments.

“Mom, My Heels Hurt!”

It is that time of year again. Returning to school and those extra curricular activities. Kids are excited about sports and band practice, but this sudden increase in activity can cause them to have heel pain. Pediatric heel pain is nothing to ignore. It is not your typical adult heel pain caused by plantar fasciitis and will not go away with advil alone. It can be excruciating for some children to the point they cannot walk. So what is it really and why does it happen?

Calcaneal apophysitis is the medical term for inflammation of the growth plate in the heel caused by the pull of the plantar fascia below it and the Achilles tendon above it. As we grow, the bones in the legs get longer, but the muscles and tendons have to stretch to grow with them. If these structures are tight and have not reached the same length as the bones, then they pull much harder on the growth plates. This causes significant pain that usually occurs after activity and improves with rest. Other symptoms including swelling of the heels, pain with pressure and increased warmth.

Treating pediatric heel pain early is important. In our office, youf child will be fully evaluated including xrays to make sure that the growth plate is normal and the pain is not caused from other reasons like a stress fracture. Rest, ice and stretching are key factors in treating heel pain in children. Appropriate shoe gear, orthotics and physical therapy will also improve their pain and reduce recurrence. In severe cases, complete immobilization may be necessary.

If your child is complaining of heel pain, don’t ignore it. This pain can prevent them from participating in the activities they enjoy. At Foot and Ankle Associates of North Texas, we are here to get your children back in the game.

Why are my feet hurting now?

“I have never had a problem with my feet before. Why are they hurting now?” I have heard on so many occasions patients ask this question. I must admit, this is really a very good question! Why do your feet hurt now?

The easiest way I can get across to explain this phenomenon is that, unlike our teeth, which we make sure to brush several times a day, we completely and utterly seem to abuse our feet taking them completely for granted! We expect them to go on and on like the Energizer Bunny and never give out. Sure, we may moisturize them and pedicure them and soak them thinking this is how we are to care for them (and some of us do not even do that!). This does make them look on the outside and to a certain extent feel good. We also spend our years walking on them barefoot, without as much as a slipper for cushioning. We women strap strappy sandals and heels that force our feet to walk in no way God intended. Even if you don’t wear heels or strappy sandals, we too often put them into shoes with confined spaces and so very much UNlike the actual shape of our feet. This brand of torture does a whole lot of damage to the insides of our feet and ankles.

Now think about this. In our life time, we have walked around the earth several times!! That is a lot of mileage! Add the above mentioned abuse to our feet and Voila! Foot pain! I tell people we do more to take care of the tires on our cars than our own “tires”! No wonder at some point in our lives, we will all experience some form of foot pain! And when we do, oh, we will long for the days when we were able to walk without limping!

A reminder to all: Do not take your feet (or your podiatrist) for granted!! We will do all we can to get you dancing again. We only ask that you take our advice to help you take better care of those feet! You have so many more miles to go!!

Am I Ready for Surgery Yet?

Am I ready for surgery yet? Seems like such an easy question to answer huh? Actually, unless it is something obvious like getting your foot stuck in a lawn mower or shattering your ankle putting up Christmas lights, this question is a little more challenging.

Some important questions to ask yourself:
Do I have pain nearly on a daily basis? Having pain more often than not is a red flag. If your answer is yes, that doesn’t necessarily mean you need surgery, but it does mean you may have let your condition drag out longer in hopes that it would get better on its own.
Is it difficult to find shoes that are comfortable? This is a “biggie” if the only shoes you can wear is a sandal and fall is quickly approaching!
Am I unable to perform my day to day activities because of the pain? A good example of this, and one I hear often, is not being able to exercise because of the pain. The lack of exercising causes weight gain and your foot or ankle pain gets worse because of it!
Have you ever seen anyone about your pain? It is surprising to me how many people I see on their first visit wondering when they can be scheduled for surgery without their ever having seen a podiatrist! Have you seen a podiatrist yet to even be evaluated? If you think you are ready, that is a most important step (no pun intended!). There are a number of conditions that we can treat conservatively. We will be able to tell you how serious your condition is and whether or not you can hold off from doing anything as drastic as surgery.
Is my pain severe enough that I am willing to risk the potential post-operative complications to have a chance of relief? This may be the hardest question to answer. There is no guarantee when it comes to surgery. You have to be willing to accept the risks involved. After you have run the gamut of conservative treatment options with your podiatrist and understand not only what your surgery would entail, but also what complications could occur post operatively, hopefully, this question will be easier to answer.

Unfortunately, we abuse our feet to no end. When they start to hurt, we should not ignore them hoping it will all go away. That is like hoping that cavity in your tooth will magically heal itself! The real message here is getting to your podiatrist before things get this bad.

Be assured that if surgery becomes our only answer, our goals for surgery are the same. We want to eliminate pain. We want to restore function. Simply stated, we want to make your feet happy again!

When is a Bunion Not a Bunion?

It happened again today in my office. A woman came in asking for bunion surgery. She had put up with the pain in her big toe for years and finally had had enough. Many years ago her family physician told her to wait until she couldn’t stand the pain in her foot before discussing surgery with a podiatrist. Like many physicians, she assumed any pain in the great toe accompanied by a bump was a “bunion” or Hallux Abducto Valgus. Unfortunately in this case, she was wrong. The patient actually has Hallux Limitis also known as osteoarthritis of the great toe joint. If she had sought treatment many years ago, her joint may have been salvaged. Now her joint was so destroyed that she needed a joint replacement or fusion. Not what she wanted to hear! In her mind, she came in the office asking for a simple bunionectomy and left needing a joint replacement. She regretted not seeking the advice of a podiatrist earlier.

So what’s the difference between Hallux valgus and Hallux limitis?

Hallux valgus is a crooked big toe joint. Over a period of years, the great toe becomes much friendlier with the second toe and drifts toward and eventually under or over the second toe. At the same time, the first metatarsal (long bone connected to the great toe) drifts towards the center of your body making the distinctive bump. This starts out as a minor annoyance, but then quickly becomes a shoe problem with rubbing on the bump. Most people seek the attention of a podiatrist when the bump is rubbing in their shoe and becomes painful. If the deformity is allowed to progress, the great toe joint can actually start to dislocate and you will start to experience joint pain and degeneration.

Hallux limitis is wear and tear arthritis or osteoarthritis of the great toe joint. Many people are predisposed to have this problem by the underlying biomechanical function of their joint. It becomes much worse after an injury or repetitive trauma from things like high heeled shoes, ballet or some sports. The symptoms are different than Hallux valgus. Hallux limitis usually starts with a feeling of stiffness of the joint. It can be accompanied by swelling and redness. This usually progresses to a decrease in range of motion, a distinctive crunching feeling when moving the joint and then a bump that forms usually more toward the top of the joint, not the side like Hallux valgus.

Hallux valgus and Hallux limitis can occur together in a more complex foot deformity. Usually the bunion deformity has progressed and then is injured by repetitive trauma or a distinctive injury. This starts the progression of the arthritis change. Bottom line: don’t ignore pain in your great toe joint. Treatment of Hallux limitis early can save you from needed a fusion or joint replacement!

Why is treatment of Hallux limitis so important in the early stages?
Once you have destroyed the cartilage in your joint, there is nothing a physician or surgeon can do to make more cartilage. Research is underway trying to replace or regrow cartilage, but we are many years from a solution. Hallux limitis in the early stages can be controlled with a functional shoe orthotic to control the biomechanics. A clean up procedure known as a cheilectomy can help remove all the debris from the joint and get rid of much of the crunching. This will slow down the progression. Some patients can really benefit from a surgical procedure to realign and shorten the metatarsal to give the joint better biomechanics and more joint space. Unaddressed Hallux limitis leads to complete joint destruction and the need for a fusion or joint replacement.

The flip side to this story is that patients with Hallux valgus or your tradition bunion can often delay treatment until they start to have pain. Bunions in the early stages are a cosmetic concern, but the joint is usually not damaged until the later stages. It is important to address Hallux valgus when it starts to hurt so the joint is not permanently injured, but a bump, in the absence, of pain can wait.

The take home message is to have your great toe pain examined by a podiatrist. A full examination including functional biomechanics and x-rays can determine whether your pain is from Hallux valgus, Hallux limitis or a combination. Only then can you make an informed decision on treatments for your foot deformity and pain. Waiting until you can’t stand it anymore is a recipe for unhappy outcomes! If you have great toe pain with or without a bump, don’t delay. See your podiatrist today!