Big toe pain and stiffness: Will physical therapy help? – Answers to questions about hallux rigidus (2)


I was recently received the following comment from a reader:

I am only 2.5 years out from cheilectomies of both big toes. I thought I was looking at years of relief. But I never experienced what I would call a full-fleged recovery. Then about 2 months ago I began to feel the same pain I had before surgery, mainly underneath the toe, every step. Now x-rays show no joint space. “You don’t have the bone spurs, but you still have arthritis,” the (new) podiatrist said. Getting past my profound disappointment, I’m about to begin PT to mobilize the joints. Is this wishful thinking about PT, at this point? I also have a 2nd toe that had Freiberg 20 yrs ago and has been like walking on a marble for years. I’m 66, lots of walking to do yet in life, I hope. Custom orthotics never helped prevent the progression of my problem. I also appreciate your comments about stiff soled shoes.

First off, thank you for stating that at 66 years old there is lots of walking to do. Unfortunately I encounter plenty of people who think it’s time to pack it in and put their feet up at this stage of life. Cheilectomies often provide patients with hope, and their is this thought that “okay the surgery is done, I should be okay now”. Unfortunately Wolff’s Law is not typically taken into account when dealing with bone spurs. Wolff’s Law states that the body will respond to the stresses that are placed on it. When bone has stress placed on it, the body’s response is usually to produce more bone in that area. So people undergo these surgeries and are basically told that they will be “fine” after they let the bone heal.

However, why did your big toe develop bone spurs? Was it footwear, prior activity selection, genetic expression, etc. There are usually reasons why bone spurs occur. The problem with cheilectomies, is that they do not remove the cause of the spurs, only the spurs themselves. The spurs are a symptom, like a headache, and the surgery is a way of achieving some relief, like Tylenol, but this does not get rid of the reason for the headache like dehydration, stress, or getting punched in the face. If you only remove the symptom and not the cause, you can safely predict that the symptom will return.

So, can physical therapy help for your big toe pain and stiffness after a cheilectomy? Can physical therapy help for arthritis pain in the big toe? Yes. Even if you mobilize the big toe, will the pain go away? No.

A full evaluation should be able to tell you what some of the contributing factors are to your big toe pain. You have to remember, that there are plenty of people who have plenty of arthritis in their joints and never feel any pain. So why does yours hurt? Yes, you had a surgery there, but it is possible the same stressor that formed the bone spurs in the first place continues to place enough stress on your big toe to make the sensation register in your brain as pain (basically, your brain is telling you to stop doing something or change the way you are doing something).

It sounds like your feet have been through quite a bit over the years, and it’s possible your gait pattern is one that includes increased pressure on your first metatarsal during toe-off.  As stated above, physical therapy can likely help your toes become more mobile, but not necessarily less painful. Pain reduction often needs to include changing the stressors on the tissue and then increasing your body’s ability to withstand gradually increased demands. As always, when changing mobility of joints, neuromuscular re-education must be utilized to increase motor control of the joint and associated limb.

I hope I have been able to answer your questions. But if you have any more, please always feel free to leave your questions in the comments section, or email me at mikescott.dpt@gmail.com.

Always evolve,

Mike

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