Hallux Limitus and bone spurs

Discussion in 'Ask the Docs' started by wrast, Aug 21, 2014.

  1. wrast Barefooters
    1. Colorado

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    I've had pain in my big toe joint for about a year now and finally went to see a podiatrist. She says I have bone spurs (top of big toe joint and heel) and Hallux Limitus. She wants to put me into stiff shoes and custom orthotics (along with some calf and hamstring stretching). For the next week I have tape on my feet that is supposed to help ease the tension in the joint. Isn't this exactly the opposite of what I want to do?

    What I really want to do is find a BF-friendly podiatrist near me, but the closest one is about 1.5 hrs away. I'd much prefer to stay on the non-orthotics path if at all possible!

    Any other advice anyone has would be welcome. Thanks!
  2. Backfixer Barefooters

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    Probably a better choice is to see a sports chiropractor who does Active Release Treatment or a myofascial therapist who does fascial release. From what you describe, the stiff toe is likely due to shortening of the extensor hallicus longus shortening, causing the spurring from the tension it creates on the toe. The flexor hallicus is also likely involved and my guess is that there are some other gait issues that you may not be seeing by just looking at the toe. I am personally not a fan of the calf and hamstring stretching idea since the literature has little support for stretching having a long term benefit. Myofascial release on the other hand makes a world of difference if done properly fast, which is why I made the chiropractor recommendation first.

    Chiropractors will also do manipulation on your extremity joints as well as your pelvis which is going to be helpful as well. I hope that helps

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  3. Longboard Chapter Presidents
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    I suffer from bilateral Hallux Limitus. Radiographs clearly show a total loss of cartilage at the first metatarso-phalangial joints, and even vision WAY below 20-20 can easily see the bone spurring (dorsal bunion) on the top of those joints.
    Orthotics, surgery, and post-surgical orthotics were recommended long ago, but instead I opted for an always barefoot lifestyle. It may come as a surprise to some of the newer members here, but I took up running AFTER this diagnosis! Sure, I still have pain, but I am fully functional since I shed the shoes. I can't even THINK about a fast paced walk (too much action at those toe joints), but normal walking and moderately paced distance running......not a problem.
    Everyone's different of course, but the prescription that worked best for me was a 24/7 barefoot life.....and taking up running!

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  4. Longboard Chapter Presidents
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    OK I just realized that this is the "Ask The Doc's" forum so I guess I wasn't supposed to post the above here, but I also wanted to give a +1 to KenBob's post regarding your issue in the Chapters forum, but unfortunately I got this:
    (You have insufficient privileges to reply here.)


    So hey, I just remembered............... I AM a doc, so I'll even post my +1 to KenBob right here as well!

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  5. wrast Barefooters
    1. Colorado

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    Aug 19, 2014
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    @Backfixer: It hadn't occurred to me to try ART, and I have the inventor of ART practically in my backyard! I think I will see about setting up an appointment ASAP.

    @Longboard: I appreciate hearing that you are doing well barefoot following your diagnosis. That gives me a lot of hope!
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  6. Sid Barefooters

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    My understanding is that non-docs should wait until after a Doc has answered, then non-docs can chime in.
    http://www.thebarefootrunners.org/index.php?posts/124446

    Keep in mind that Longboard's doctorate is in dentistry, so while he is a doctor and very knowledgeable about various health topics, he may not have necessarily made a profession of treating patients with foot and gait disorders.

    That being said, Longboard's posts are usually very worthwhile reading! :D
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  7. Sid Barefooters

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    Although I am not a foot expert, I have a personal experience to share. I have bunions. After four years of doing a lot of stretching, manipulation, and strengthening, my right foot is doing really well. My left foot is much better, although my best guess is that it will be another year, before it will be fully functional.

    One thing that I'm not entirely certain of, is if bone spurs can resolve after several years. As I understand, bone remodels. I have no radiographic evidence, but it feels that the spurs in my right big toe have improved. The spurs on my left big toe still problematic, but it feels like they are improving slowly.

    So, I can imagine that ART could be very helpful, and possibly quite faster than my personal experience. Good luck!
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  8. Longboard Chapter Presidents
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    Bone definitely remodels, and us dentists watch it happen all the time. It's the basis for orthodontia, and is a major reason that following tooth extraction jawbones become smooth. As long as I don't wear shoes my spurs are only a problem to the eyes, but yeah I still hold hope that they will disappear over time.

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  9. Longboard Chapter Presidents
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    True, but now that I've been fixing teeth and gums for 40 years and have begun to taper a bit, I find that between the running club I've been hanging out with this Summer as well as the Monday night Detroit Slow Roll (as featured in the current ipad ad) which had over 4,000 riders at this week's event I'm actually spending more time explaining barefoot stuff than I am trying to be a Floss Boss!
    I just heard about a suburban Detroit Run for Brews weekly club (a meetup.com event) so I'm planning on that too. I guess soon my patients will wonder why I'm practicing out of the scope of my license by analyzing their gait as they walk from the reception to treatment areas and recommending barefoot activity with more enthusiasm than improved oral hygiene........

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  10. Barefoot TJ Administrator
    1. Nomad
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    Floss Boss! Seriously! Ha!

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  11. Sid Barefooters

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  12. Longboard Chapter Presidents
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    That article talks about Hallux Valgus which is an entirely different bunion from Hallux Limitus.
    Since the bunion part of the latter comes secondary to the loss of cartilage and destruction of the joint I can't see how any form of massage or manipulation could help it. Typically Hallux Valgus patients with distorted Hallux angles don't report pain when barefoot, the shoe irritation being the culprit rather than the joint itself. Hallux Limitus patients with the Dorsal Bunion have joint pain from the pathology of the joint itself. But of course it could be worth a try, you never know.....everyone responds differently to a variety of treatment modalities.

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  13. Sid Barefooters

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    Yes, once Hallux Limitus progresses to Hallux Rigidus the pain inside the joint is gone. But the OP is at Limitus stage, so the joint is probably painful upon dorsoflexion.

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  15. Sid Barefooters

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    Reading a bit more. I wonder if I have a bit of both? My left big toe definitely has limited range of motion, compared to the right. I'm constantly and gradually trying to mobilize that toe.
  16. Longboard Chapter Presidents
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    Have you had radiographs taken?
    I was in so much pain that I went to my doc. Simple x-rays clearly showed a total loss of cartilage on the left and almost there on the right. Bone on bone, and your body tries to fix it (literally) by fusing it. The dorsal bone growth limits the movement of the the joint, but that's not where the fixation occurs, it's in the joint itself. Once fused all joint pain is gone, but there is still discomfort when footwear pushes on the bone growth at the top and somewhat on the sides, but nothing like the medial bone growth seen with Hallux Valgus. Fusion can be prevented by manipulation or barefoot activity, but I don't see how it can relieve discomfort.

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  17. Sid Barefooters

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    Would xrays change management? I'm improving with what I'm doing.
  18. Longboard Chapter Presidents
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    Probably not but you would know whether or not you are dealing with true Hallux Limitus or not. It' not reversible, but if you actually do have cartilage YOUR condition could be.

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  19. Sid Barefooters

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    LB, I appreciate the thoughtful suggestions. Been thinking more about this. My bunions had been a long time coming, angulating over time. I even saw a podiatrist some years ago for an unrelated issue, and he had commented about it. He offered no suggestions to ameliorate or reverse the process.

    A few years ago, I filled out a request to get copies of my xrays, and pay for any associated costs. He and his staff were unhelpful. The xrays were in storage, and he stated that since they were 2 years old, that they would be of no use.

    This was no run of the mill podiatrist. Assistant Director of the Podiatric Residency Program, Diplomat of the American Board of Podiatric Surgery, Fellow of the American College of Foot and Ankle Surgeons, Past Director of Podiatric Training, Board Certified in Foot and Ankle Surgery.
    His response only serves to diminish him and, sadly, given his standing, podiatry in general.

    I am familiar with HIPAA, and understand that I have the right to access my records. However, I have decided to move on. I have nothing to gain by taking action against him.

    Now, I am aware of methods to reverse bunions, and my feet are healthier than ever! :D
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