A 53-year-old woman contacted me after developing pain along with a big "bump" on top of the foot, just at the base of the first metatarsal. After taking X-rays, her podiatrist diagnosed her with hallux limitus.
The podiatrist advised taking 500 mg ibuprofen twice a day for 10 days to see if that would reduce the inflammation. He noted that the patient could continue that regimen for an additional 10 days before returning to get a cortisone injection. The DPM also suggested she use warm, moist heat for 20 minutes several times a day. She took ibuprofen for 15 days but does not want a cortisone injection.
The patient then started using my "top ten" list for hallux limitus treatment. This included contrast bathing at least once daily; applying diclofenac sodium (Voltaren, GlaxoSmithKline) twice a day; using Spica tape; wearing dancer's pads (which she discontinued after experiencing discomfort in the ankle and limping); wearing only comfortable, flat, soft shoes; and gentle joint mobilization every day. Generally, she estimates her pain level is 0–2 on the Visual Analogue Scale (VAS). Doing a lot of walking will cause some pain but an ice bath right after walking brings relief.
After six weeks, the patient notes that while she has less pain, there is still “a big old bump” on top of the foot and she has limited range of motion. The patient had one lingering question: What is the timeframe for reducing the inflammation that causes hallux limitus?
If the patient has a 0–2 pain level on the VAS, she can gradually increase activities but should try to avoid excessive toe bend for the next six months. A patient like this may have entered a new phase of the hallux limitus and I would advise her that the joint will be somewhat more restricted. I would also advise getting some ¼-inch adhesive felt to place a small pad behind the bump. I would advise the patient to re-lace the shoes so there is minimal pressure on the bump. One can cut the felt thinly in half and make better dancer's padding.
I would do a cortisone shot if the magnetic resonance image (MRI) shows no bone edema. Edema in these cases is rare so cortisone use is also rare. The cortisone effect is temporary if there is joint damage. If the joint got all jammed up and there is no damage, the cortisone may help address the aforementioned inflammation in the joint.
Based on the MRI, which is usually the first of a few over the next year, we can really appreciate if there is healing. With no MRI, we can still go by benchmarks. Each month, this patient should be able to do more. If not, one needs to reassess the joint.
Editor’s note: This blog originally appeared at http://www.drblakeshealingsole.com/2017/08/big-toe-joint-pain-email-advice.html . It is reprinted with permission from the author.