Advanced Arthritis
 

That's what my Doc says I have in my big toe. I Injured it years ago and now its to the point I cant even put on certain shoes. Got an appt with a Foot & Ankle Specialist in a few weeks. So what are they going to do to take care of the pain? It is nasty looking, Joint looks like a golf ball...

you sure it isn't gout? i ask because they are similar and gout is excruciatingly painful...does it come and go?

Not gout, I know people with gout and that is very painful too: The X-rays showed something, He just said it does not look good. I think "Ragged" was the word he used..

well if you have Pelican Ins.
T may talk to you..
paging Dr. T...

Rika

Best part of Pelican Ins is you can put all the costs on your bill.

So there is a Doctor in the house somewhere? Maybe we can get a Nurse to do a preliminary examination?

Yeah, yeah

Few things you can do for degenerative arthritis, in I am assuming the 1st metatarsophalangeal joint

Steroid injection can give transitory relief, not permanent, though I have one or two people who come in once a year for that and stay pretty happy. Sometimes orthotics can help, but they are better for prevention than treatment, most of the time.

Basically, you are talking about surgery. Choice of procedure is dictated by age of pt, degree of damage to the joint. You try to figure out why it is like that, trauma, biomechanical problems, like the 1st metatarsal being too long, or flat foot leading to jamming at the joint, that sort of thing. Surgery breaks down into joint salvage and joint destructive procedures.

Salvage is just like it sounds, you correct whatever mechanical problem is causing trouble, osteotomy to realign or shorten the bone, remove bone around joint, when the joint is not working right, you get spurring around it, further limiting motion. Resurface the joint, typically by trying to replace lost articular cartilage with fibrocartilage. You drill through the head of the bone where the cartilage is worn away, get the joint moving soon as possible and scar tissue covers the area where the cartilage was gone, replacing the hyaline cartilage with fibrocartilage.

You can get a fusion of the joint, which eliminates painful motion by eliminating motion. You fuse the big toe cocked up a bit, so you can still walk, but top of toe tends to rub on shoe. This is the direction orthopedic surgeons tend to go. You can have an arthroplasty or joint implant done. Arthroplasty is remodeling the joint, but in this usage you are talking about removing the joint, and either putting an implant in there or just removing one or both sides of the joint. Implant for this area can be a one piece, hinged silicone device, or a two piece, similar to the total knees. You can get shortening of digit, or stiffness with either way of doing this.

You are looking at a few months of grief if you get surgery, assuming no infections or complications, which can make it a whole other ball game.

Checked out their website, don't know any of them personally. Those guys all did good residencies and are board certified in surgery. The difference between the American Board of Podiatric Surgery certifying you in foot surgery(like me) and rearfoot and reconstructive surgery(like a couple of the younger dudes in that group) is what cases you submit and what is on the tests, written and oral. They are seperate certifications, pretty sure you have to be certified in foot surgery to get the rearfoot one, but I could be wrong.

That was sort of verbose, sorry

Dr is in
upside to surgery....you can wear those roachkillers boots.

Rika

Damn, you're old, Craig. :)

I think that's more than I needed to know, but appreciate it, I hate to go in blind, I have simple goals, just get it not to be so painful and still be able to hit the gas and brake peddle, never dance and don't care what it looks like. Jim, its not age, all my other joints are just fine, I dropped a big piece of steel on my toe about 13 years ago when I was younger, although now that you mention it my right wrist has been giving me some trouble lately!:eek:

perhaps, but no time soon, you will have enough swelling to keep you from wearing tight shoes for a while. A while is anyhere from a month to a year.

You can get a lot of relief from removing the bone spurs around the joint. That is what that big knot on top of your foot is

That's not what I hear. :p