The Blog of Jon Guerrera

Thoughts about health, goals, and anything else I'm nerding out to.

Living With Hallux Limitus/Rigidus in Your 20s and 30s

The following post is the story of how hallux limitus, the loss of motion in the big toe joint, has impacted my life. As it worsens, it's referred to as hallux rigidus, an arthritis of the big toe.

I had trouble finding encouraging stories about this condition, especially amongst young people (after all, how many young people combat arthritis?) – this post is my contribution.

How it all started

Shortly after graduating college, I noticed something odd.

My boat shoes, which I had owned for years, were causing me foot pain. I knew I had flat feet, so I concluded that it was due to the poor support, and from then on opted for more comfortable footwear. The pain subsided, problem solved.

Two years later, my more-comfortable footwear also grew too uncomfortable to wear during a typical day. That didn't seem right. So during my yearly checkup one month later, I mentioned the bit of stiffness and pain, particularly around my big toe area.

"Oh, this is probably a bunion", my doctor concluded after a quick glance. She assured me that it wasn't anything to be overly concerned about, and that I should look into orthotics.

The next week, I went out and bought orthotics. They helped for a few months, but slowly the pain creeped back.

I found a podiatrist who was known for his conservative treatment options, and he told me that I had a mild case of hallux limitus. I had no idea what that was, but he seemed very casual about the whole thing, and recommended icing my feet and doing a few joint mobilization exercises. He also recommended a better brand of orthotic to use, and modified my current shoes to take a bit of pressure off of my big toe through something called a dancer's pad.

I bought the better orthotics. I did the mobilization exercises once per day. I iced my foot when it was feeling stiff and inflamed. I didn't seem to notice any improvement from the mobilization exercises, but as long as the pain wasn't getting worse, I figured, I was satisfied.

For many months, things more or less stayed the same. Some days were worse than others, but on the whole, my life wasn't impacted in any significant way. However, in August of 2015, the pain started increasing again. I started walking on the edges of my feet to avoid the pain of bending my big toe on each step. Alternating waves of inflammation would hit my big toes with little predictability.

What the hell was happening? Given that I wasn't a runner, nor involved in any aggressive sport, I thought that the inflammation episodes might be triggered by stress or something in my diet, so I focused on stress management and healthy eating, hoping that the inflammation and pain would calm down. I also continued doing the joint mobilization exercises.

Unfortunately, that didn't work.

A few weeks later, seeing me in obvious pain, my girlfriend insisted that I go see another podiatrist to figure this all out.

By the time I had x-rays done by the new podiatrist, my left foot had gotten significantly worse – I was starting to limp slightly due to the pain in my big toe. Both feet were diagnosed with hallux limitus, and I had lost almost 10 degrees of motion in my big toes since first visiting a podiatrist. The first thing the doctor told me:

"Yep, you have hallux limitus in both feet. Unfortunately, there is no cure, but we can try and prevent it from getting worse."

Oy. If my first podiatrist had stated it that way, no way in hell would I have taken it so lightly for the last two years.

This is the moment where I began taking my foot issues very seriously. Below you'll find a summary of the treatments I've tried, with one goal in mind: stabilize this problem to the point where I can walk normally without pain or discomfort – without requiring surgery.

Treatments

Here are the treatments I've attempted, or am currently attempting, listed in order of most conservative to most aggressive.

Orthotics

The first place I started was with over-the-counter orthotics. My first big mistake was settling for orthotics that I felt were "good enough" – I should have pushed for custom orthotics 2-3 years before I finally got them. If over-the-counter orthotics like Superfeet aren't cutting to for you, go see a podiatrist ASAP to discuss custom orthotics. In my case, doing this earlier might have kept the injury in a much more manageable state than it is now.

Usefulness: 5/5

Joint mobilization exercises

I've been doing these joint mobilization techniques once or twice a daily for about a year now (though some days I forget), and, while they don't seem to be actively improving my situation, they may be preventing it from getting worse at an accelerated rate. Here's the guide I follow:

Usefulness: 3/5

Dancer's pads

Dancer's pads are designed to offload weight from the big toe joint. For many, this can provide lasting relief. They were mildly helpful during days of heavy walking before my custom orthotics arrived. Unfortunately, I didn't find them helpful as a long term solution.

Nevertheless, I see the value, and would recommend working with a podiatrist to explore this option if you're looking for something to pair with a good orthotic. (I used these dancer's pads.) You may have better luck than I did.

Usefulness: 3/5

Icing / Foot soaks

With any sort of chronic condition, pain management is important, and I'd much rather ice my foot than take a NSAID, which can be hard on your stomach.

When it comes to short term relief, icing and foot soaks help. However, icing your foot regularly can become annoying, especially if you have to hold the ice pack in place for 10-20 minutes.

So I bought these awesome sock ice packs from Amazon to make it easier to ice. It's very helpful on days where my feet aren't happy.

I also have poor circulation in my feet, which makes them feel extra stiff on days when I haven't exercised – not good for people with already-compromised mobility.

So I bought a foot soak bucket from Amazon, and try to do epsom salt foot soaks at least once or twice a week.

Usefulness: 4/5

Physical therapy

After realizing that my left foot may never be at 100% again, I decided to start physical therapy to resolve any glaring issues that may make the problem worse if left untreated.

Since starting physical therapy, I've identified muscle imbalances in my core that were putting undue stress on my knees (which are also at risk when your stride is off due to toe pain). I learned how to work out knots in my feet (I didn't even realize I had them in the first place).

Since this is still in progress, I'll report back as to how it went.

Update 4/10/16: Building out my core strength (particularly in my hips) and working through the muscle tension and knots in my foot around the big toe has been substantially helpful in keeping my stride normal and has almost completely eliminated knee pain as I've continued to do this each morning. Very glad I did the physical therapy.

Usefulness: 5/5

Cortisone injection

This was the most aggressive step I took. Why did I take it? Even after one month of wearing custom orthotics, my left foot was in pain while walking. So my podiatrist felt that cortisone in that foot was the best option to take.

The injection worked very well for cooling the inflammation down in that foot, and three weeks later, my toe is in significantly better shape. According to my podiatrist, this cooling of inflammation is important to let the joint normalize its motion with the help of the orthotic.

Ideally, these positive effects will last for months, and I'd simply need to do a yearly cortisone injection to allow me to go about my life. But there's a chance that the effects of the cortisone will be short lived, in which case I'll have to reevaluate.

For now though, I found the cortisone immensely useful for giving me the ability to walk pain-free. Just be sure to pair it with an orthotic that offers a long-term solution to poor foot mechanics, otherwise you're just masking symptoms.

Update 4/10/16: It's been a little over two months since I've received the cortisone injection. Some of the inflammation has returned, but it's not nearly as bad as it was before the injection. If the inflammation levels off here, I'd be OK with that. I wouldn't be 100% pain free, but I'd be able to continue living my life with minimal interruption (though, I'm still not comfortable going on runs). I'll provide another update in a few months.

Usefulness: 5/5

Conclusion

Hallux limitus/rigidus is not fun, and if you're not careful, it will erode away at your ability to walk, run, and be active.

In the event that things get worse, I've accepted that I may need to pursue surgical solutions, but not before evaluating the success rate and risks of the procedures. If you have been through this surgery, I'd love to hear your thoughts in the comments section below!

This post is a work in progress as I manage the condition. I'm hoping it will help others manage it too.

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