Case Study: Toe Pain

Patient: 45 year old male construction worker

Complaint: Right first toe pain, especially with running.

The patient presents with a chronic, intermittent complain of right first toe pain. He reports that the toe does not hurt if he avoids running, but that when he does go for a run the toe pain comes on in the first few minutes of the run and will last for several days afterward. The pain is local, and he denies and sharp, shooting or electrical pain.

Upon examination, observation reveals the right first toe's metatarsal to be hypertrophic, with excessive bone formation at the proximal end. This causes a bump on the dorsal surface of the patient's foot. Palpation of the joints and muscles reveal a hypertonic adductor pollicus and decreased joint motion at the metatarso-cuneiform joint.

Discussion: This patient is suffering from a very common condition: Osteoarthritis. Through no real fault of the patient, his joint has begun to degrade with the forces of time and stress. This causes his toe's joints to not move as well, which in turn causes muscles to become tense and painful. When he runs, he aggravates the condition by putting further stress on an already-stressed joint.

Treatment: We will focus on pain control. The current deformation of bone from the arthritis is nearly impossible to reverse, but we can slow any further progression of the disease. We will massage the adductor pollicus muscle to help it relax and then adjust the toes, foot, knee and hip as needed to make sure the entire limb is moving as best it can. Then, we will make sure the patient's sure are providing the proper foot support. In this case, the patient's high arches need to be considered and orthotics are recommended.

Osteoarthritis

This week's post is from our practice newsletter. Osteoartritis is something that affects all of us and I think it's important to stay informed.

Osteoarthritis and You

Did you know that 90% of all adults age 50 and older have some degree of osteoarthritis (OA)? That’s practically everybody! OA is arthritis that results from gravitational forces pulling on the body. Without intervention, OA can result in significant joint degeneration and will eventually result in joint fusion. Since we cannot avoid gravity, how are we supposed to prevent this from happening?

Then answer is movement. Studies show that when a joint is kept immobile, the process of OA accelerates dramatically. When movement is restored, the degeneration slows again. On a large scale, the best thing we can do is KEEP MOVING: take a walk, swim, stretch, roll your shoulders, make circles with your wrists and ankles. On the small scale, you need an expert. Chiropractors are trained to find joints that are not moving enough and help them move better. Every time you get adjusted it is one more step in the fight against OA.

If you want to learn more about OA or other types of arthritis, stop by the office to pick up a free brochure on your topic of interest. These are provided by the Arthritis Foundation to help our patients learn about the dangers of arthritis and how to prevent it from happening to them.

The Arthritis Foundation is also a great resource for information on local aquatic exercise programs. A lot of arthritis sufferers feel the worst when they are cold, making exercise such as swimming difficult. Because swimming is a low-gravity activity, it is the perfect exercise for people with arthritis. To solve the obvious problem, the Arthritis Foundation has begun aquatic exercise programs where the pools are HEATED. Not hot tub temperatures, just pleasantly warm. There are three heated pools in San Francisco, alone, and many others across the Bay Area. You can contact us at the office or the Arthritis Foundation to find a heated pool near you.