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frozen toe joint

by C Stroud
(Pipe Creek, TX USA)

After a bunionectomy surgery, the joint of the big toe became frozen. The toe moves up normally, but doesn't move down at all. This is causing all kinds of trouble with my running. I have pain in the opposite knee and hip. The foot with the frozen joint is overpronating without the support of the joint doing what it should. the other foot is normal, high-arched and is best in a neutral shoe. Can the "knuckle" under this joint be unfrozen somehow?


ANSWER

Hi,

You do not mention how long ago you had your bunion surgery but if it was not too long ago, like a few months, your problem may be nothing more than excessive scar tissue which is limiting the ability of the joint joint to go through its full range of motion. This is known as adhesions.
In these cases the area of the foot is anesthestized either locally in the office or sometimes in the hospital and the toe is forced through its range of motion in order to break up the adhesions and increase the range of motion.
Another possibility is the alignment of the joint as a result of the surgery itself.
Again, I do not know what kind of procedure you had done, but if included a procedure where part of the metatarsal bone, or even the base of the great toe was broken and re-set then there is the possibility that the alignment is not perfect and this could be affecting the ability of the great toe to bend in a certain direction.
This problem will not be as easy to fix. Again, if the surgery was reasonably recent, physical therapy may be of benefit, but you will not know unless you actually go through the therapy.
Another way perhaps to address the deformity and consequential problem is through the use of a custom orthotic.
Two points to consider here. One is that you state the surgical foot is pronated. The problem with excessive pronation is that is creates a mis-alignment of the great toe joint (similar to unbalanced tires on a car), so like tires wearing out too quickly, the big toe joint also wears out quicker.
With the use of an orthotic to control pronation you should get better joint alignment and perhaps slightly more range and therefore less pain.
In many instances depending on how the toe bone lines up with the first metatarsal, additions can be added to the orthotic to make for a better alignment.
What this is going to require is a visit to your surgeon, particularly if you had surgery by a podiatrist, who should understand the biomechanics of the foot, and let he or she know about your problem. Your surgeon should be able to come up with a course of treatment that should improve your situation.

Marc Mitnick DPM
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May 27, 2015
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Update
by: Pam

After seeing 2 more podiatrists(both recommended fusion) I saw an orthopedic foot specialist. After an MRI and a CT scan she told me that it is not my large toe joint that is the problem but the joint closer to the toe nail. I also have continuing numbness on the top of the big toe from the 2 incisions for the bunionectomy and RSD manifesting in discoloration of my foot....maybe from a nicked nerve?? The ortho thinks that the bone lost it's alignment and essentially collapsed thereby causing the tendon in the toe to tighten up and immobilize the lower joint. She will not do a fusion surgery because there is too much going on in my foot as it is. I did see a PT for 8 sessions but saw no real improvement so I opted not to continue. I will now see a podorthist(?)to get fitted for a plate to go in my shoes. While I'm relieved that I won't have to go thru another surgery now I really have a hard time believing I will ever walk normally again. In hindsight I never should have had the bunionectomy. I am in way more pain and discomfort than I ever experienced with the bunion. UGH!!!

RESPONSE

The orthopedist's diagnosis is a little puzzling to me as it is fairly simple to identify which joint actually hurts, but then again since I have not examined you, nor seen any films or scans I am not in a position to make a diagnosis.
I will say this, if you actually have RSD, then that needs to be remedied ASAP since it can worsen and become very debilitating.
Your best bet is a neurologist or pain management anesthesiologist, but one who actively treats RSD.
Good luck.
Marc Mitnick DPM

Apr 04, 2015
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Frozen toe joint
by: Pam

I had an Austin Chevron bunionectomy in Dec 2014. It is now 3 1/2 months later. I went back to work after 6 weeks of laying around with my foot elevated and doing everything my podiatrist said to do. He seemed to think I was healing just fine. My job requires that I walk a lot so I worked only half time for the first 2 weeks. After a full day of walking around my ankle was swollen to twice normal. My doc told me that stretching exercises were not necessary and that just walking and taking care not to overdo would be best. I got acupuncture on my foot a few times and it helped with the inflammation a lot. There really was no pain, my ankle and foot were just extremely stiff. I was feeling positive that all was well until about a month ago. Then my heel and arch really started to ache. I mentioned it to the doc and he seemed unconcerned. I should add here that my doc has a huge ego and didn't seem to want to hear about my issues....he seemed more concerned with how great my foot looked rather how it functioned. Anyway, at the 3 month point, my doc finally took an xray and the results showed that the joint on my big toe had essentially fused itself together!! WHAT???? I can't believe this could happen. All doc had to say was that it happens for no reason that they know of. My options are to see a physical therapist and/or to have the joint replaced. I am deeply distressed by all this. I was an avid hiker and now it seems I will never be able to hike again. I can't even go up and down stairs without pain. My job is in jeopardy. And the pain seems to be getting worse every day. I will try physical therapy but I must say I am losing hope. I cannot fathom another major foot surgery but I suppose I need to wrap my brain around that possibility. The mental aspects are bad enough without even thinking about the financial side of another 2-3 months without income. Can anyone explain how this could happen? Was I unknowingly not bending that toe joint when I walked...I thought I was. And to anyone reading this whose doc says no PT....insist on it!! It seems that if I had gone to PT from the start I would not be in this position.


Hi Pam,

Because an Austin osteotomy essentially shortens the first metatarsal, in theory at least, there should be less chance of the great toe joint fusing with this procedure, but nonetheless yours has fused.

At first blush one could assume that it is just because your toe has been immobilized for so long that it has stiffened up. Most foot surgeons have their patients exercise the big toe from day one in an effort to get motion in the toe.

With six weeks of no movement, I am not surprised that your toe is stiff.

One can assume you have stiffness due to adhesions which is essentially scarring.

The only other reason I can think of that would cause stiffness with this type of procedure is if there was a slight misalignment when the bone was reset after the osteotomy, this too could cause limitation of motion.

Physical therapy would be the logical first step. It will have to be aggressive in an effort to get the big toe to start moving.

If that does not work, another option would be to have the big toe joint manually manipulated up and down, under anesthesia, in an effort to break up any adhesions.

These two options would be predicated on the fact that the head of the first metatarsal lines up properly with the base of the big toe as evidenced on x-ray. If there is a mal-alignment where the head of the metatarsalimproperly articulates with the base of the big toe, then physical therapy or manual manipulation under anesthesia will probably be a waste of time.

I would also suggest you get a second opinion from another foot surgeon in your area. Doctors with big egos have a tendency to not take responsibility for their problems and end up blaming every one else but themselves, for the problems they have created.

I do not know how old you are, but be very careful about further surgery, as in most instances your options are either a joint implant or a permanent fusion of the big toe joint.

Marc Mitnick DPM

Aug 19, 2014
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Frozen Toe Joint
by: Charlene

I also have a frozen toe joint from bunion surgery 30 years ago. It also left the toe not quite aligned. The pain I had from the bunion is gone but I notice I stumble and trip on things a lot. As I'm getting older, I have actually stumbled and torn ligaments in my foot, sprained an ankle and now have a badly broken big toe on my other foot from tripping and falling. I don't pick my feet up enough when I walk and I realize that but can't seem to help myself. Is there any therapy or exercises I can do to help me with this problem. I'm afraid I'll keep doing more damage to my body! Thanks for you help.


More than likely after 30 years there is limited chance to increase the range of motion. However, from a conservative standpoint, you could consider physical therapy to see if some motion can be brought back to the joint.

Marc Mitnick DPM

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