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My Stupid Big Toe


Original Post
Jeffrey K · · Seattle, WA · Joined Apr 2018 · Points: 0

I'm having an issue with the big toe on my left foot and looking for some advice. I figure if I go to the doctor they'll tell me something super useful like "don't wear climbing shoes" which clearly isn't an option.

The issue is; after any extended climbing, even taking shoes off frequently, my left big toe gets very sore to the point of being my limiting factor for how much climbing I can do in a day. For the next few days it will be sore and constantly want to loudly crack, which is kind of a mixture of pain and relief. Otherwise the toe has fine flexibility and doesn't hurt more when I move or weight it; just a constant throbbing at all times.

I've primarily worn TC Pros and Anasazi Pinks, sized for comfort, which seem like they should be good options for not killing my toe.

I can push through the discomfort but I don't want to make it worse. Anyone have thoughts on this? The best my research has gotten me is icing and cold water, which I'll try.

grog m · · Saltlakecity · Joined Aug 2012 · Points: 70

Tight shoes + tight ski boots + always wearing shoes and chacos fucked my big toe main joint up. Podiatrist was worthless. IMHO, my issue comes from never letting my foot muscles get a proper work out. Feet have really complex interactions and modern shoes do not allow those to happen. I have been going barefoot more often and have been surprised with the results. This theory is based on the book "Born to Run". 

Also, I found that TC Pros F##KED my toe up. I had to go to bigger shoes, and simpler shoes.
0.75-1 size crack F##Ks my toe up. 

Nick Votto · · CO, CT, IT · Joined Jul 2008 · Points: 320

Grog's got the right idea.  Walk around barefoot as much as possible this Summer or consider getting Vibram Five Fingers, they will work muscles that your toes/ feet don't use in shoes.  

Malcolm Daly · · Boulder, CO · Joined Jan 2001 · Points: 380

We’re here in Boulder where everybody climbs and we actually have a climbing podiatrist in town. She’s probably worth to talk to;

Yvonne Weber
Boulder Valley Foot and Ankle
www.boulderfootandankle.com

Yvonne doesn’t climb much any more but when we met she was pretty solid on 5.12.

Giver her a call.
Mal

David Carrera · · Unknown Hometown · Joined Oct 2005 · Points: 15

I get pain at the base of the big toe on the top. Cracking it also helps.
For a semi-permanent cure I roll out the arch and bottom of the foot with a lacrosse ball, and sometimes another hard rubber ball that is smaller. This hurts like hell. If I hit it 10-13 times a day, the big toe pain is generally gone the next day. If you have trigger points in the arch, you'll know it when you smash them, otherwise you'll think the problem is the toe etc. You can also search the calf. Rub arnica gel on if there is trauma from the mashing.
   A podiatrist or sports guy will give you orthotics. I threw mine out after many years. I went barefoot too. If you do, and you are currently in any built up shoe, transition slow, or you can end up with many trigger points.

Jeffrey K · · Seattle, WA · Joined Apr 2018 · Points: 0

Thanks all!

I had major surgery on my left foot many years back and the arch is pretty collapsed now so that might relate to the toe issue. I'll try these ideas out!

slim · · Unknown Hometown · Joined Dec 2004 · Points: 1,107

which part of your mig toe exactly?  the toenail, big joint, joint nearest tip of toe, tip of toe?

Jeffrey K · · Seattle, WA · Joined Apr 2018 · Points: 0
slim wrote: which part of your mig toe exactly?  the toenail, big joint, joint nearest tip of toe, tip of toe?

The joint in the middle of my big toe.

Daniel Joder · · Barcelona, ES · Joined Nov 2015 · Points: 0

Probably not relevant, but I'll throw it out there anyway to make sure you have looked at other possibilities: have you ever had issues with gout? I don't drink, smoke, or eat much red meat, and I'm not overweight at all and I have gout. My one and only gout attack six years ago was misdiagnosed as a possible bone infection--until an unnecessary surgery revealed the tofi, tofu, or whatever they are in my toe joints. 400mg of Allopurinol a day and I've been doing fine since.

Andrew Rational · · Unknown Hometown · Joined Aug 2018 · Points: 10
Daniel Joder wrote: Probably not relevant, but I'll throw it out there anyway to make sure you have looked at other possibilities: have you ever had issues with gout? I don't drink, smoke, or eat much red meat, and I'm not overweight at all and I have gout. My one and only gout attack six years ago was misdiagnosed as a possible bone infection--until an unnecessary surgery revealed the tofi, tofu, or whatever they are in my toe joints. 400mg of Allopurinol a day and I've been doing fine since.

I was going to suggest this as well. A test is simple and cheap.

And, yes, current research suggests that gout has a large genetic component that lifestyle changes might be able to counteract, but some folks just need one of several choices of medications.
highaltitudeflatulentexpulsion · · Colorado · Joined Oct 2012 · Points: 35

I have been battling with a similar problem for about 10 years.

I’ve had 3 shots of cortisone in that time and it has helped. Another thing that helps is grabbing the top of my toe and pulling out, this opens the joint and sometimes gets it back into place with a wince inducing crack.

I cannot climb 2 days in a row even once. week is sometimes pushing it. New this year, awful pain in ski boots. Walking is not a problem ever.

I’m actually taking a break from climbing now. Not over the toe but i had some other goals for the year. It’s improved so much that i wonder if it would permanently improve? Probably not.

So I occasionally work with several foot docs. Enough that I’ve managed a drive by consult. It sounds like the “fix” is to open the toe and clean out the arthritis, not unlike a knee scope but it’s so small that a scope can’t be used. Hardware in the form of stability screws, partial joint replacement, and even total joint replacement is possible. I have only seen that on joints totally wrecked by gout.

slim · · Unknown Hometown · Joined Dec 2004 · Points: 1,107

is yours the little middle joint or the first, big joint (sesamoid area) HAFE? i am not too familiar with the middle joint having problems, aside from the typical rawness that comes with thight, knuckled up shoes.

Jeffrey K · · Seattle, WA · Joined Apr 2018 · Points: 0
slim wrote: is yours the little middle joint or the first, big joint (sesamoid area) HAFE? i am not too familiar with the middle joint having problems, aside from the typical rawness that comes with thight, knuckled up shoes.

It's the smaller middle joint, the interphalangeal. It feels like it's from directly in the middle of the joint, so smack dab in the middle of my big toe.

highaltitudeflatulentexpulsion · · Colorado · Joined Oct 2012 · Points: 35

Slim, it’s the distal IP joint. So just like the OP, right in the middle of the toe. If it were more proximal, the next joint up would be the crease between the toe and ball of the foot. That would hurt walking unlike this.

I’ve got another kid coming soon. We’ll see how it looks insurance wise but I might hit the family deductible this year. If I do, I’m definitely getting it operated on.

highaltitudeflatulentexpulsion · · Colorado · Joined Oct 2012 · Points: 35

Just an update to the thread. I've been almost exclusively on a bicycle this spring. I had one big day sport climbing in March that nearly killed me.

Last week I went to the YMCA climbing wall and after an hour or so my toe was so sore that I could barely walk to the parking lot. After a few days it got better. On Sunday of this week, I went to another climbing wall, got in a dozen routes on the autobelay. Today is Tuesday and I'm still so sore from it that I scream in pain if you look too hard at my toe. For those of you that know me, this is a laughably low volume and certainly isn't a case of building up to it. Right now, I'm at an all time low level of climbing. The psyche is still there but I physically cannot put in hardly any volume. I've all but quit climbing. I ride my bike a lot and I look at pics of me crushing hard routes.

I went ahead and made an appointment with the foot doc. To get ahead of the doc, I had my regular doc do a blood test for gout. It's literally the first thing any doc should ask when looking at a man with a jacked up toe.

It's going to be an interesting conversation. This isn't Boulder, the docs here don't climb 5.12. The problem will basically be non existent if I quit climbing. So it'll be somewhat of an uphill conversation. I'll update this thread once I know more.

JCM · · Seattle, WA · Joined Jun 2008 · Points: 95
highaltitudeflatulentexpulsion wrote:It's going to be an interesting conversation. This isn't Boulder, the docs here don't climb 5.12. The problem will basically be non existent if I quit climbing. So it'll be somewhat of an uphill conversation.

This basically describes every time I’ve been to a regular ortho for a climbing-related issue. It is also why I laugh whenever people say “go see a doctor” when someone has a finger injury.

Ted Lanzano · · Boulder, CO · Joined Dec 2002 · Points: 255

You might have sesamoiditis.  The sesamoids are the two little free floating bones on the ball of your foot.  They can affect the joint from the big toe to the ball of your foot.  I’m dealing with this right now.  

Jessa Lee · · Northern California · Joined Aug 2017 · Points: 0

Sounds like the same problem. For less than $100 I saw a podiatrist who did an xray on the spot: thinning of the cartilage. Said there is currently 2 options: 1. Fuse the toe aka lose all mobility. Uhhhh no brainer, not an option at all. 2. Cortisone shot. Had a terrible reaction to the cortisone shot so no help at all. So far all of my research points to kinda f*cked. There's no known way to rebuild cartilage. There are cartilage replacement surgeries usually done in the knee but even trying to see a specialist who will do this is big $$$. Hopefully this isn't what you've got! But may as well get that xray.

highaltitudeflatulentexpulsion · · Colorado · Joined Oct 2012 · Points: 35
Jessa Lee wrote: Sounds like the same problem. For less than $100 I saw a podiatrist who did an xray on the spot: thinning of the cartilage. Said there is currently 2 options: 1. Fuse the toe aka lose all mobility. Uhhhh no brainer, not an option at all. 2. Cortisone shot. Had a terrible reaction to the cortisone shot so no help at all. So far all of my research points to kinda f*cked. There's no known way to rebuild cartilage. There are cartilage replacement surgeries usually done in the knee but even trying to see a specialist who will do this is big $$$. Hopefully this isn't what you've got! But may as well get that xray.

Jessa, you can get a total or partial toe joint replacement. They aren't too much different than the ones in a knee, just smaller. I've seen the ones that Stryker makes but I'm sure other brands exist as well. There is also a semi-flexible piece of silicone they can replace the joint with, it doesn't articulate but gives a fairly natural flex. I don't know what the 40+ year outlook on any of these would be.

I'd be skeptical of a fusion, I can't think of a 2-3mm screw of any material (titanium or cobalt most likely) that would hold up to the pressures of edging. Even if the screw held, would the bone?. I think that would be begging for revision surgery.

My appointment is July 1st. 
Jessa Lee · · Northern California · Joined Aug 2017 · Points: 0
highaltitudeflatulentexpulsion wrote:

Jessa, you can get a total or partial toe joint replacement. They aren't too much different than the ones in a knee, just smaller. I've seen the ones that Stryker makes but I'm sure other brands exist as well. There is also a semi-flexible piece of silicone they can replace the joint with, it doesn't articulate but gives a fairly natural flex. I don't know what the 40+ year outlook on any of these would be.

I'd be skeptical of a fusion, I can't think of a 2-3mm screw of any material (titanium or cobalt most likely) that would hold up to the pressures of edging. Even if the screw held, would the bone?. I think that would be begging for revision surgery.

My appointment is July 1st.

WHOA!!! I'd definitely like to hear how that goes! I will not even consider fusing my toe. I don't have any insurance so any form of surgery is currently off the table. I hope you have better luck

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