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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