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HALLUX LIMITUS AND PF

Posted by NIELS L on 4/16/01 at hrmin (044732)

DEAR DOCTOR Z - AND ANYONE ELSE WHO MIGHT HELP ME.....

1. ABOUT MYSELF:

I AM A 34 YEAR OLD MALE WHO HAS SUFFERED FROM PF SINCE JAN 2000.PREVIOUSLY I HAD PF FROM APR TO JULY 1999, WHERE IT SUDDENLY DISAPPEARED BY 'ITSELF', BUT THIS TIME I CANT GET RID OF IT.

I AM NOT OVERWEIGHT AND I HAVE A DESK JOB (LAWYER). I HAVE TAKEN AMITRIPTYLIN FROM 1996 TO MARCH 2000 DUE TO ARTHRISIS I MY UPPER BACK(ANY CONNECTION TO AMITRIPTYLIN ?)

MY HEEL PAIN BEGAN AFTER A 6 MONTHS PERIOD OF WEEKLY HARD HOUSE AND GARDEN WORK (BECAUSE I BOUGHT AN OLD HOUSE THAT NEEDED A LOT OF FIXING, PAINT, GARDEN WORK ETC.)

I HAVE BEEN EXAMINED BY MANY DOCTORS, MOST OF THEM TERRIBLY IGNORANT, AND ARROGANT AS WELL. X-RAYS OF MY HEELS WERE TAKEN IN JULY 1999 AND IN JULY 2000. A VERY LITTLY SPUR WAS DETECTED ON THE RIGHT HEEL.

I HAVE BEEN TOLD I HAVE A HIGH ARCH.

2. MY SYMPTHOMS:

IT IS OFTEN DIFFICULT TO POINT OUT EXACTELY WHERE THE PAIN IS. OFTEN I CAN
NOT FIND ANY PARTICULARLY SORE SPOTS WHEN PRESSING WITH MY FINGERS.

THE PAIN IS MOSTLY AT AND NEAR BY THE 'HEEL SPUR PLACE', BUT IT ALSO MOVES AROUND, ESPECIALLY TO THE PLANTAR AND PLACES BEHIND MY TOES.

NORMALLY MY HEELPAIN IS NOT WORST IN THE MORNING.

I HAVE PF IN BOTH FEET, BUT IT IS MUCH WORSE IN MY RIGHT FOOT.

I AM UNABLE TO STAND OR WALK WITHOUT PAIN. OFTEN THERE IS ALSO PAIN WHEN SITTING OR LYING IN BED, ARISING FROM THE PART OF MY FOOT THAT TOUCHES THE SURFACE.

3. HALLUX LIMITUS:

I ALSO HAVE HALLUX LIMITUS. ONE DOCTOR (OF THE MANY I HAVE BEEN EXAMINED BY) TOLD ME IN AUGUST 2000 THAT I HAVE HALLUX LIMITUS IN MY BOTH BIG TOES. HE SAID THAT THE TOES COULD ONLY BENT UPWARDS APP 25-30 DEGREES. NO X-RAY WAS TAKEN.

FURTHER THE DOCTOR TOLD ME THAT MY HALLUX LIMITUS PROBABLY IS BOTH THE CAUSE MY PF AND FURTHER MAKES IT EVEN MORE DIFFICULT TO GET RID OF MY PF.

THE HALLUX LIMITUS HAS STARTED TO GIVE ME PAIN IN THE BIG TOE JOINTS, BUT THIS IS -AT THE MOMENT (?)- NOT AS HURTING AS MY PF.

4. PREVIOUS ACTIONS:

A.ACCUPUNCTURE.HELPED MAYBE.CONSIDERING TO REASSUME.

B.MASSAGE OF THE CALF MUSCLES.HELPS -BUT NOT AT ALL CURES-TEMPORARILY (1 OR 2 DAYS)

C.STRECHING BY STANDING ON STAIRCASES OR BOOKS.MADE IT WORSE, I BELIEVE.

D.CURLING A TOWEL WITH MY TOES.ONLY A FEW TIMES, AS I FELT PAIN GOT WORSE

E.VIOXX.MAYBE HELPED FOR 1-2 WEEKS, THEN APPERENTLY NO EFFECT

F. Ibuprofen Cream. ?

G. TAPENING.NO EFFECT OR VERY LITTLE.DONT LIKE IT

H.HEEL LIFTS. NO EFFECT, I THINK

I.CUSTOM ORTHOTICS. FULL LENGTH AND HARD WITH SOFT PAD IN HEEL.FELT GOOD AT FIRST, BUT AFTER 1 MONTH MY CONDITION GOT AS BAD AS EVER AND THE PAIN MOVED TO MY PLANTARS. WHEN I STOPPED USING THEM, THE PIAN WAS REDUCED AND THE PAIN MOVED BACK TO THE HEEL (PRIMARILY)

J.ICE. NO EFFECT

K.SOFT, FLAT FULL LENGHT SOLES IN MY SHOES.MAY BE BETTER THAN NOTHING

L.SWIMMING. GIVES GOOD RELIEF

M:REST. I FEEL THAT REST HAS DONE ME NO GOOD AT ALL. I BELIEVE I HAVE RESTED VERY MUCH: FOR MORE THAN 9 MONTHS WITHOUT IMPROVEMENT. I HAVE EVEN RECENTLY BEEN IN BED FOR 10 DAYS (DUE TO SURGERY IN EAR FOR OTOSCLEROSIS), ALSO WITHOUT ANY IMPROVEMENT.

N.SHOTS. A SERIES OF 3 SHOTS.ONLY LITTLE IMPROVEMENT AND ONLY FOR A FEW WEEKS.

SUMMING UP: MASSAGE AND SVIMMING IS OK, BUT FAR FROM ANY CURE. I HAVE ORDERED -BUT NOT YET RECEIVED- THE FOOT TRAINER.

5. MY NEXT ACTION:

THE STRAW I AM CLUTCHING AT RIGHT NOW -APART FROM YOUR REPLY TO THIS MAIL- IS THE FOOT TRAINER, MAYBE COMBINED WITH GENTLE STRECHING OF THE CALF MUSCLES AND GENTLE MASSAGE OF MY PLANTARS.

6. QUESTIONS:

A.IN MY SITUATION, WHAT SHOULD I DO TO GET CURED FROM MY PF ? ANY SPECIAL ADVISE DUE TO MY HALLUX LIMITUS ? WHAT IS YOUR COMMENT TO 'MY NEXT ACTION' ?

B.I HAVE THIS THESIS: MY HALLUX LIMITUS HAS NOT ONLY TRIGGERED MY PF. IT ALSO CONTINUES (FOR EVEREY STEP I TAKE) TO CAUSE EXTRA STRESS AND INFLAMATION ON MY PLANTARS. THEREFORE CURE OF MY PF IS ONLY POSSIBLE (OR LIKELY) IF MY HALLUX RIGIDUS IS 'ELIMINATED' (BY WAY OF CORRECTLY PERFORMED SURGERY I SUPPOSE).

IS MY THESIS CORRECT ? DO YOU KNOW OF ANY CASES WHERE SURGERY OF HALLUX LIMITUS HAS HAD POSITIVE EFFECT ON PF ? NEGATIVE EFFECT ?

C.I AM SERIOUSLS CONSIDERING ESWT. HOWEVER, THAT PROVIDES I CAN FIND ANY PLACE I DENMARK (A COUNTRY NORTH OF GERMANY WHERE I LIVE) WHERE ESWT IS PERFORMED. IS ESWT LIKELY TO HELP IN MY SITUATION ?

''''''''''''''''

THANK YOU FOR HELPING SO MANY PF SUFFERES.

NIELS L

Re: HALLUX LIMITUS AND PF

Dr. Zuckerman on 4/16/01 at 17:07 (044755)

Hi,

The high arched foot is a tough one. Is there what we call crepitation in the big toe joints. This is where there is grinding when you move the big toe joint up and down.

Two things can contribute to this pf pain.

1. Short heel cord
2 . The hallux limitus in the big toe joint.

Now what to do with this.

Orthosis with heel lifts and special modificaton to reduce the stress and pulling at the big toe joint. This can be done with either a morton's extension and or just a cut out in the extention of the orthosis to allow the big toe joint a reduction in weight bearing.

Now if this doesn't help: ESWT if the pf is at the insertion of the heel bone. Surgery on the big toe joint if there is grinding in the joint. If the big toe joint is elevated there are procedures to move the entire joint into the correct position this will reduce the pull of the pf .

I hope this helps somewhat. Can you tell us more about the orthosis, that did work for one month.

Dr. Z

Re: HALLUX LIMITUS AND PF

niels l on 5/01/01 at hrmin (046344)

Hi dr. Z

Thanks for your response and sorry for my late reply (computer problems).

There is no grinding in the big toe joints, when i move them up and down. My toes are beginning to point more inwards. My right big toe is worse than the left -like my pf- and can only bent upwards app. 20-25 degrees. I sometimes feel pain in the big toe joints when sitting or lying in bed, usually not when walking.

I feel more and more convinced that my hallux limitus is the cause of my pf- and the reason why i cannot get rid of my pf. I believe that the right pair op orthosis is my only way out, or maybe surgery of my big toe joints.

i dont understand what 'short heel cord' means. Please explain. How is it diagnosed and what can be done about it ?

My previous orthosis that seemed to work (a little)for one month were full length, with a core of polyprophylene (hard) and a thin surface of polyeuritane. the part from heel to behind the big toe joint was hard and stiff. flexible at the toes. much arch support. No rocker bar.

The orthosis was made by putting wet plaster/gypsum on the buttom of my feet.It was removed from my feet when it had dried and then the gypsum mould was used to create the orthosis.

I felt that the orthosis gave me too much arch support and it gave me pain all over the plantar (in stead of just in the heel).

I believe that it is essential for me to get an orthosis with a rocker bar and any thing else that can help reduce the extra stress caused by my hallux limitus.

Please remember that i have used 3 different heel pads (heel lift) with out feeling any improvement. Will heel lift help reducing the stress on my plantars ?

By the way, I have started using the Foot Trainer. For 10 days.I feel it has given me some relief. I will of course continue using it and I will tell you about the results.

I hope the above gives you the information you need to advice me.

Best regards

Niels

Re: HALLUX LIMITUS AND PF

Dr. Zuckerman on 4/16/01 at 17:07 (044755)

Hi,

The high arched foot is a tough one. Is there what we call crepitation in the big toe joints. This is where there is grinding when you move the big toe joint up and down.

Two things can contribute to this pf pain.

1. Short heel cord
2 . The hallux limitus in the big toe joint.

Now what to do with this.

Orthosis with heel lifts and special modificaton to reduce the stress and pulling at the big toe joint. This can be done with either a morton's extension and or just a cut out in the extention of the orthosis to allow the big toe joint a reduction in weight bearing.

Now if this doesn't help: ESWT if the pf is at the insertion of the heel bone. Surgery on the big toe joint if there is grinding in the joint. If the big toe joint is elevated there are procedures to move the entire joint into the correct position this will reduce the pull of the pf .

I hope this helps somewhat. Can you tell us more about the orthosis, that did work for one month.

Dr. Z

Re: HALLUX LIMITUS AND PF

niels l on 5/01/01 at hrmin (046344)

Hi dr. Z

Thanks for your response and sorry for my late reply (computer problems).

There is no grinding in the big toe joints, when i move them up and down. My toes are beginning to point more inwards. My right big toe is worse than the left -like my pf- and can only bent upwards app. 20-25 degrees. I sometimes feel pain in the big toe joints when sitting or lying in bed, usually not when walking.

I feel more and more convinced that my hallux limitus is the cause of my pf- and the reason why i cannot get rid of my pf. I believe that the right pair op orthosis is my only way out, or maybe surgery of my big toe joints.

i dont understand what 'short heel cord' means. Please explain. How is it diagnosed and what can be done about it ?

My previous orthosis that seemed to work (a little)for one month were full length, with a core of polyprophylene (hard) and a thin surface of polyeuritane. the part from heel to behind the big toe joint was hard and stiff. flexible at the toes. much arch support. No rocker bar.

The orthosis was made by putting wet plaster/gypsum on the buttom of my feet.It was removed from my feet when it had dried and then the gypsum mould was used to create the orthosis.

I felt that the orthosis gave me too much arch support and it gave me pain all over the plantar (in stead of just in the heel).

I believe that it is essential for me to get an orthosis with a rocker bar and any thing else that can help reduce the extra stress caused by my hallux limitus.

Please remember that i have used 3 different heel pads (heel lift) with out feeling any improvement. Will heel lift help reducing the stress on my plantars ?

By the way, I have started using the Foot Trainer. For 10 days.I feel it has given me some relief. I will of course continue using it and I will tell you about the results.

I hope the above gives you the information you need to advice me.

Best regards

Niels