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May 2022 - MSK referral to podiatry surgeon

In May 2022 I saw a specialist who confirmed my diagnosis of arthritis of the big toe, hallux rigidus (stage 2). X-rays showed I had diminished joint space and osteophytes peri-articular, with a range of movement 20 degrees dorsiflexion (normally 50 degrees for a walking gait - 65 running) and 10 degrees plantar (sole) flexion.

Usually for people in my age group (over 50's) the recommended course of treatment is destructive surgery, whereby the toe is fused rigid with plate and screws to stop it bending and creating more arthritis. The primary objective is pain elimination. 

A quick word on pain:- since the accident with the axle grinder two and half years earlier, I have experienced pain or discomfort in the foot at the big toe around 90% of the time (and that includes while in bed or at rest). The pain can be classified as between 0-10 on a scale (0 - no pain/ 10 - excruciating) in the following:

1. At rest/asleep - 5 - often I would be woken up by it in the middle of the night, and it was worsened with a duvet or blanket resting on it, and if I lay on my front it would throb in contact with the mattress below. Doesn't give a lot of sleeping options, except sideways. 

2. When starting to walk - 9 - in the first kilometre or so, searing red-hot pain would greet me on each 'bend' of the toe. I adopted orthotics to try to stiffen the underneath of the foot and take some of the pressure out of the 'bend' as you (normally) roll of the end of the big toe propelling you forward.

3. In activities such as yoga (I'd given up all other sport on account of the toe/knee problems), downward dog, lunges and any activity requiring flexion of the toe in an 'upward' direction was impossible and if attempted then an immediate 10 was scored - even my beloved 'child's pose' was restricted at it was just too painful to have an pressure on the front of my toe against the floor (the osteophytes or bone spurs that develop on top in response to the arthritis makes the joint very tender). 

4. Running - forget it, not possible.

5. Swimming - 0, ah, bliss!

So, back to the story. The specialist talked me though the options for surgical interventions:

1. Destructive - fixing the toe with plate and screws to achieve pain-free solution. Down-side is the toe never has flexion again.

2. Preserving - a procedure called a cheilectomy which cleans the joint up, removing any bone spurs that have grown that restrict flexion and thus achieving some more movement.

3. Joint replacement - complete replacement to achieve pain-free solution, but not greater levels of activity.

Because I'm over 50, the first procedure is generally recommended, but because my main goal is to be able to recover the ability to walk greater distances pain free (I'm an avid walker - have been all my life - for mental and physical well-being. If I can't walk, I'd die, as months of disabling toe and then knee issues confirmed) the second option was put on the table.

The specialist said at my age, I could hope to achieve flexion enough for return to normal milage again for maybe a decade before I'll need to get the joint fused forever. So, that takes me up to 64. Hell, yeah, that's worth it. (It turned out that I was to have a cheilectomy and Moberg osteotomy - extension osteotomy, dorsal closing wedge osteotomy - with a screw to help the bone fuse back.)

'If it doesn't work out, you can always come back and we'll fuse it now. What's there to lose?'

Indeed.

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