I don't know whether old injuries, bad genes, ambient radiation, invisible trolls, 40+ years in ski boots, or a failed astrological chart are to blame, but I have really, really bad arthritis in the main joint of both big toes,
The only reason I'm sharing all this personal information is that I finally reached the point where my left toe(s) demanded serious intervention and I thought it might be interesting for some folks to follow along with my experience. The problems I'm having are somewhat common, particularly with skiers, so it's kind of therapy and tracking for me and perhaps will help some other people learn what to expect if they find themselves in a similar situation in the future. We're all getting older and my problems are ones that accumulate with age.
The point of this thread is to share my symptoms, diagnosis, treatment, and results so anyone else dealing with this will have a point of reference of at least one person's experiences. There's quite a lot of information, so I'm going to add posts to this thread over the next few days.
As background, here are the stats:
I'm now 62.5 years old, 6'1", weigh 195#. I live in Jackson Hole and am very active physically. I love to ski and typically do alpine and backcountry skiing for a total of around 130 days a year or more. I also participate in hiking, biking, extreme flyfishing (that just means I tend to not believe in trails very much), watersports, and a lot of other stuff where feet are relatively important.
What I have is osteoarthritis in the main joint of both big toes. It's important to establish something right off the bat...
What I have is NOT bunions. It doesn't have the same causes as bunions and is not treated the same way as bunions. It sometimes LOOKS like bunions, but it's not.
The technical term for what I have is hallux rigidus. Here's a really good explanation from Wikipedia:
|Classification and external resources|
Hallux not labeled but visible at upper left.
- Pain and stiffness in the joint at the base of the big toe during use (walking, standing, bending, etc.)
- Difficulty with certain activities (running, squatting)
- Swelling and inflammation around the joint
Although the condition is a degenerative condition, it can occur in patients who are relatively young particularly active sports people who have at some time suffered trauma to the joint (turf toe). A notable example is NBA star Shaquille O'Neal who returned to basketball after surgery.
Non-surgical treatment Early treatment for mild cases of Hallux rigidus may include prescription foot orthotics, shoe modifications (to take the pressure of the toe and/or facilitate walking), medications (anti-inflammatory drugs), injection therapy (corticosteroids to reduce inflammation and pain) and/or physical therapy.
Surgical treatment In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of Hallux rigidus. The type of surgery is based on the stage of hallux rigidus. Stage 1 hallux rigidus involves some loss of range of motion of the big toe joint or first MTP joint and is often treated conservatively with prescription foot orthotics. Stage 2 hallux rigidus involves greater loss of range of motion and cartilage and may be treated via cheilectomy in which the metatarsal head is reshaped and bone spurs reduced. Stage 3 hallux rigidus often involves significant cartilage loss and may be treated by an osteotomy in which cartilage on the first metatarsal head is repositioned, possibly coupled with a hemi-implant in which the base of the proximal phalanx (base of the big toe) is resurfaced. Stage 4 hallux rigidus, also known as end stage hallux rigidus involves severe loss of range of motion of the big toe joint and cartilage loss. Stage 4 hallux rigidus may be treated via fusion of the joint (arthrodesis) or implant arthroplasty in which both sides of the joint are resurfaced or a hinged implant is used. Fusion of the joint is often viewed as more definitive but may lead to significant alteration of gait causing postural symptomatology. The implants termed "two part unconstrained" implants in which a "ball" type device is placed on the first metatarsal head and "socket" portion on the base of the big toe do not have a good long term track record. The hinged implants have been in existence since the 1970s, have been continually improved and have the best record of improving long term function.
It first appeared in my right foot over 20 years ago, about a year after I did a minor fracture to that toe by whacking in on the door to the bathroom in the middle of the night.
Got to go right now. More to come in the next couple days.