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Old 01-27-2010, 03:24 PM   #1
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Do I really have Big Toe arthritis even though my X-ray is normal? Please any input?

This is my first post and I found this place thanks to Google. I really could do with some advice. Thanks for your valuable time and patience.

I am 36 years old in good overall health, 63kgs/138lbs weight approx. 172cms/5' 8" tall. Eat a very healthy diet and a vegetarian for last 8-9 years. I do moderate level of regular training in the gym. My left toe joint area (1st metatarsophalangeal ) started hurting for no apparent reason 10 months ago. It's not extreme pain but it is constant and always there 24/7 fo rlast 10 months.

If 10 is maximum pain possible then mine is between 4 and 6. Similar pain but on a lower level say between 3 and 6 started few months later on my right toe joint too. So the pain has been there constantly for last 10 months. If I walk a lot then pain may increase slightly sometimes and other times not increase. Pain does not increase or decrease at night or in the morning or with increase or decrease of temperature.

I will tell you my story and see what you guys think. I am at my wits end. Please bear with me.....

April 2009- I went to my family doctor who sent me to get my left toe x-rayed. Doc at the X-ray place sent the following comment with the X-ray to my family doctor-
Quote:
"Inconspicuous bony structures without osteolysis or sclerotic changes. No degeneration in the Big metatarsophalangeal joints. Appears normal to the sesamoid. Normal position. No soft tissue swelling"

Family Doc said everything is ok and it must have been a strain. Will clear up in a month or so. I enquired if it could be early signs of crystal formation due to Gout as my father has Gout and on my mum's side my granddad had Gout too.
Doc said that it does not look like Gout as Gout is lot more painful with redness and clear swelling. He said that I had around 10% swelling only. Also I can rub my toe without pain something which is impossible for Gout attack patients.

June 2009-
The pain never cleared up. Did not increase nor did it decrease but was always there constantly and driving me nuts. I went back to the family doc and he had no answers any more. He thought maybe there could be Gout related crystal formation causing this pain. So he referred me to Hospital rheumatology department. Appointment date came for August as my case was not emergency.

July 2009- Tired of waiting for my appointment date I privately made appointment with MrRheumatologist A. He said that I don't have Gout. He remarked that my feet are wide in the front and maybe slightly flat. He said that he could not do anything more for me and I could come back few months later if it does not go away. He said that he is sure that I don't have Gout.

August 2009- My appointment date with Rheumatology department at the hospital finally came. MrRheumatologist B checked me and said that I definitely don't have Gout. As Gout attacks don't last this long unless it is chronic Gout which I definitely don't have. As you can't jump from no Gout straight to chronic Gout. He said my above normal blood uric acid readings are nothing to be worried about. They would be relevant if this had been a Gout attack which it isn't. He also remarked that my feet were wide and the gap between the toe and the next finger was large and maybe causing stress on the toe joint. He looked at my X-ray and said everything looks normal with the bones. He called his superior MrRheumatologist C for second opinion and he agreed with his diagnosis that my arches/bridges were flatter than normal. While looking at the X-Ray MrRheumatologist B pointed to a area on the X-ray and remarked "Could this be slight sclerosis?". MrRheumatologist C said "no that is nothing". Anyway they sent me to get shoe inserts made and said the pain will go away in 3 months.

Early Jan 2010- I wore shoe inserts for 4 months and the pain did not increase nor decrease. As always constant and always there. I went back to MrRheumatologistB at the hospital and he was surprised that the pain never went away. He had no further theories and was very curious about the cause co called his superior. A different superior from my last visit, MrRheumatologist D came into the room. They again reiterated that it is not Gout. They refereed me to "Technical ortopedist" at another hospital as they were at a loss to explain why I still had pain.

This week 2010- Went to see Mr Orthopedist E with his superior Orthopedist F present. They said not Gout related. Their diagnosis is that I have early stage of arthritis of the toe. They said that I should wear stiff soled shoes with rocker effect.
I explained to them that when I wear my canvas super flexible shoes my pain is significantly less. If I wear my Adidas stiffer soled shoes then the pain is clearly more after taking just few steps and it also forces me to walk using the outside of the foot to avoid pain (I had both shoes with me). Orthopedist E found that confusing as stiffer soled shoes normally help in this case and flexible soul is bad for the joint.

His superior Orthopedist F after playing with the Adidas shoe explained that the Addias hurt more because they are not stiff enough ie. they still bend and hence put greater force on the joint. Stiff but still bendable = more force on the joint. I need shoes that don't bend at all according to the Doc. They made me try some stiff shoes and I must say that the pain did not come straight away like with my Adidas shoes. Although I don't know how it will work after few hours of use.

For some reason I am only half convinced with all the consultations I have had. My toes have full movement range and if X-rays are supposedly normal then is it really big toe arthritis? Applying reasonable force against the toe upwards or downwards with my hand re-creates the sharp joint pain. Other times it is like a burning sensation in the general joint area 24/7.

When the pain first started it was pin point accurate pain on the top of my big toe joint. Now it's the whole general joint area and feels like burning sensation deep inside.

My Converse canvas shoes are flat at the bottom and super flexible in all directions and cause the least amount of pain to me. I can walk properly in them apart from the burning sensation that is there 24/7 irrespective of what I wear or not wear (resting or walking)

My Adidias shoes are stiffer soled but not completely 100% stiff. I get extra pain within few steps of wearing them. I don't and can't wear them any more but before this pain thing started they were perfectly comfortable for me.


NOTE- My blood uric acid level is in the 450-650 µmol/L (7.5-10.8 mg/dL ) range generally. Normal should be under 420µmol/L .

Wiki- Gout can occur where serum uric acid levels are as low as 6 mg/dL (~357µmol/L), but an individual can have serum values as high as 9.6 mg/dL (~565µmol/L) and not have gout.

So based on what I have told you what is your opinion? Is it Big Toe arthritis? Should I buy very stiff soled shoes with rocker effect as recommended by the Orthopedist? Is their diagnosis wrong or right? Please any advice would be highly appreciated. I am losing my mind here. Should I ignore my blood uric acid readings as I am being told by everyone?

 
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Old 01-27-2010, 05:26 PM   #2
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Sounds very much like you may have what is called here in the US turf toe, runner's toe, tennis toe. Continual jamming of the joint or a one time injury can compress the joint and cause pain. The treatment for the injury is to pull the toe gently out straight and hold and repeat many times. In fact, here there is a machine that will do that - the pro football teams, etc use them.

Long term damage results in arthritis due to the joint compression destroying the cartilege. Bone spurs and chips can also occur causing more pain. Over time, if not addressed, bone bumps can build up on the top of the joint from the bare bone rubbing together.

There are various ways of handling these issues. Anti-inflammatories can help with the pain. There are various products to help stabilize the joint. A simple cheilectomy will clean out the chips and spurs and may be all that's needed. If the bump has appeared on top the toe joint, an osteotomy may also be needed.

It is certainly possible that at some point continued damage to the joint will require a fusion.

I've had the cheilectomy done with osteotomy and it was a life saver! I'm a long time jogger and a vain female who likes to wear high heels - not good for your toes!
I know you are not in the US but if you could find a sports med ortho who specializes in feet, he might be able to determine if this is in fact what you have and the proper course of action. Good luck and let me know if you have any questions.

 
Old 01-27-2010, 06:03 PM   #3
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Thanks for the reply. I am so desperate right now. It's really driving me insane. Every second of the day I get reminded of it.

Titchou as things stand.

- My toe bone joint spacing is even and normal. So cartilage has not worn out in anyway so far.
- No wear and tear visible on X-ray
- No spurring.
- No external bump visible.
- When this pain started 10 months ago (for no explainable reason) I had slight general swelling on the toe. No visible swelling since then.
- I feel burning sensation constantly and sometimes electricity type of tingling sensation. As I type this it's driving me crazy. I feel like putting an axe to my toe
- I have full motion on both my toes
- Extreme dorsiflexion of the left toe causes pain. Extreme dorsiflexion of the right toe does not cause similar pain. Although the burning sensation and electricity thing happens on both toes.

I am getting so worn out because of seeing doctors. If I add them all I have seen

1 x Family doctor
4 x Rheumatologists
2 x Osteologists

I will give sport med orth doc a try.

Should I buy stiff soled shoes with rocker sole or continue wearing my flexible Converse Canvas shoes? I guess buying the stiff soled shoes will protect the joint irrespective of what I have.

Google-
Quote:
Quote:
Wear stiff soled shoes which tend to be curved towards the toes (rocker sole) rather like army / walking boots. This reduces stress to the joint
shoes that are primarily inflexible in the forefoot.
Quote:
Quote:
Using a stiff-soled shoe can help decrease the dorsiflexion force. Shoe modifications can include an extended steel shank or a rocker bottom sole. Currently available athletic shoes termed “All Terrain,” “Off Trail Jogger,” “Trail,” and “Hiking” often have the characteristics of both a stiff and rocker sole, and can be used for many sports or conditioning activities. However, one should be cautious about using an excessively stiff-soled shoe since it may promote conditions such as Achilles tendinitis and shin splints.

 
Old 01-28-2010, 05:07 AM   #4
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Some people on this board have had success with an X-1 brace (carbon fiber plate for turf toe) and Brooks Beast runners. I don't know if these are available in your country but you could do a search and see what you can find...perhaps they are called something different there.

 
Old 01-28-2010, 09:19 AM   #5
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

My only advise to you at this point is to make sure that the Ortho Surgeon you see is a specialist in feet! Good luck.

 
Old 01-28-2010, 09:32 AM   #6
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Quote:
Originally Posted by my sore feet View Post
My only advise to you at this point is to make sure that the Ortho Surgeon you see is a specialist in feet! Good luck.


Thanks. Why do you say surgeon? Are there ortho surgeons and then ortho non surgeons? Or you think I will end up going under the knife eventually?

Last edited by Axemytoe; 01-28-2010 at 09:32 AM.

 
Old 01-28-2010, 09:41 AM   #7
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

titchou is right,
I have to say it's probably not so much the brooks beast shoes as it is the carbon steel inserts that have saved me from getting a cheilectomy/or fusion. The shoes are good, but steel inserts keep my big toe from moving, and I would not be able to walk without pain without them. Wish I would have caught my left toe in time a little earlier before I got the bump. The rubbing on the shoe is really the only thing that hurts. Can't run anymore. Have started taking large doses of calcium also. Just trying to delay the inevitable as long as possible

 
Old 01-28-2010, 10:49 AM   #8
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Quote:
Originally Posted by Axemytoe View Post
Thanks. Why do you say surgeon? Are there ortho surgeons and then ortho non surgeons? Or you think I will end up going under the knife eventually?
They are all surgeons here so some people include that in the description and some don't...I just say ortho because everyone knows they are surgeons...and if you end up needing surgery down the road, you'll already know one.

 
Old 01-28-2010, 11:00 AM   #9
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

That X-1 thing looks interesting. I might order one for both my feet. Rheumatologist got me to wear a $300 shoes insert. Soft one with a bump on it to help my flat feet. He thought it would fix my toe pain. Did not do anything. Orthopedist said I need stiff soled shoes and no need to wear inserts. Don't know which one of them is right.

Now if I get the carbon X-1 stiff insert then

1- Do I place my current soft shoe insert on top of it? or
2- Just use the X-1 on it's own?

3- Do I buy stiff soled shoe and then put the X-1 in it to make it extra stiff or
4- Can I wear fashionable stylish soft sneakers and then insert X-1 to provide the needed stiffness?

Last edited by Axemytoe; 01-28-2010 at 11:04 AM.

 
Old 01-29-2010, 05:17 AM   #10
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

I think it goes under the inner sole but haven't used one so don't know for sure.

Are you wearing these shoes for exercise purposes or just for daily wear? If for exercise purposes, I'd go to a shop that specializes in athletic shoes and get properly fitted for a pair suited for the type of exercise you do (jogging, weight lifting, etc).

If for daily wear, I'd stick with the ones you get from the specialty shop until you see if the blade will make a difference. And just wear "dress shoes" when needed.

 
Old 01-29-2010, 06:54 PM   #11
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Quote:
Originally Posted by Titchou View Post
I think it goes under the inner sole but haven't used one so don't know for sure.
I will mail the manufacturer an e-mail with few relevant questions.

Quote:
Are you wearing these shoes for exercise purposes or just for daily wear?

If for exercise purposes, I'd go to a shop that specializes in athletic shoes and get properly fitted for a pair suited for the type of exercise you do (jogging, weight lifting, etc).

If for daily wear, I'd stick with the ones you get from the specialty shop until you see if the blade will make a difference. And just wear "dress shoes" when needed.
As things stand currently I wear only converse super flexible canvas shoes. I use them for everything from gym to daily use. In the gym for cardio part I use step machine so it does not involve lifting the feet. For weight training I use machine weights so shoe is not that important compared to if I was using free weights. I am only doing upper body exercises as I am not touching my leg area out of fear of making matters worse. I wear a $300 custom shoe insert (the foam type) that doc gave me. It makes ZERO difference to my pain. In the house I walk with no shoes on.

What I find interesting is that if I sit, sleep or stay home all day then the pain still stays constant. It does not decrease or calm down. I would have though if someone had arthritis then walking etc would cause more pain and staying stationary would cause less pain.

I understand that for more pronounced stages of arthritis the pain might be constant even when resting but my X-rays are supposedly normal (no clear wear and tear) so why is my pain constant and always present even when I don't walk for few days (apart from bit of walking in the house)?

Today I went to shoe shops to buy stiff hiking type of boots. Most were not stiff and the ones that were stiff were heavy, ugly and like $300-400.

I will give the Carbon X1 Blade thing a try first as it's a better option for stiffness. I am not tied to one shoe. I can use them with as many shoes as I want.

Thanks for listening as I feel so alone.

Last edited by moderator2; 01-29-2010 at 07:24 PM. Reason: please do not post websites except as described in the Posting Policy

 
Old 01-29-2010, 09:47 PM   #12
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

You should definitely get a proper pair of shoes for exercising. The stair machine needs you to have your foot properly supported. I would be willing to bet that use of this machine is part of your issue. Talk to someone at a good athletic shoe store for more information and assistance.

And it really does sound like you've got the start of arthritis...even the one x ray said "inconspicuous bony structures" which leads me to believe something - however small - is there and possibly causing the issue.

If you can, try taking an anti-inflammatory such as Aleve or Meloxicam (don't know what they'd be called there) and see if that helps. If it does, then it is most likely at least the beginning of arthritis.

 
Old 01-30-2010, 04:24 AM   #13
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Ok on Monday I will get some proper athletic shoes for the gym. Although they will be flexible so not good for the toe according to the doc? Once X1 Blade arrives then won't it negate all benefits of an athletic shoe anyway? Btw even if I don't go gym the pain stays constant. For example I haven't been to gym for last 3 weeks and the pain actually seems greater in last couple of days.

"inconspicuous bony structures" was translation using Google translate. I will check with a native speaker if the original non English text means "Not readily noticeable bony structures ie small structures visible" or "nothing is visible on my bones ie. no structures visible". I don't know why I assumed it meant no structures visible. Could be because all docs said X-rays look normal.
If the Google translation is accurate then I agree I am screwed as it must be arthritis then :-) :-(

I bought Ibuprofen NSAID(400mg tablets) yesterday to see what happens. I took one 6 hours ago and it made ZERO impact. Although online I read that you have to take it for couple of weeks for it to work on arthritis cases. I will continue taking it for few more days to see what happens.

Thanks again for listening.

Last edited by Axemytoe; 01-30-2010 at 04:26 AM.

 
Old 01-30-2010, 06:43 AM   #14
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Standard ibuprofen is not an arthritis drug - but they do make a formula for arthritis and I would try to find that. Aleve is naproxen sodium and is very good for arthritis. I did not realize that your diagnosis was a translation from some other language. It very well may be that a communications issue is causing some difficulty.

 
Old 01-30-2010, 09:12 AM   #15
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Re: Do I really have Big Toe arthritis even though my X-ray is normal? Please any inp

Quote:
Originally Posted by Titchou View Post
Standard ibuprofen is not an arthritis drug - but they do make a formula for arthritis and I would try to find that. Aleve is naproxen sodium and is very good for arthritis.
Ok will buy it on Monday and see if that eases the pain.


Quote:
I did not realize that your diagnosis was a translation from some other language. It very well may be that a communications issue is causing some difficulty.
Here when your family Doc sends you for an X-ray then the X-ray place hands you the X-ray but privately the X-ray place sends mini report of their take on the X-ray directly to the family doc.

So I took a copy of that mini report from my family Doc. The family Doc said that my X-ray was completely normal. The same X-ray was viewed later at different stages by three different Rheumatologists and they all said that my X-ray/joints were normal. So all my conversations were in English Just the actual X-ray report from X-ray place meant for my family Doc was not in English.

Anyway a native speaker just confirmed that the Google translation was accurate. So if there are "Inconspicuous bony structures".....
Quote:
"Inconspicuous bony structures without osteolysis or sclerotic changes. No degeneration in the Big metatarsophalangeal joints. Appears normal to the sesamoid. Normal position. No soft tissue swelling"
........then the osteologist's diagnosis that I have Gout must be the most accurate one. It baffles me why 3 Rhumatologists said that my joints were normal when they also read the copy of the X-ray report.

More worryingly if I have this much trouble when apparently my joint gaps are even without noticeable wear of my cartilage then I shudder to think how painful this is going to get in the future. I am only in my 30s and like being active

P.S- Sorry for being bit of a drama queen but I genuinely thought I was indestructible and this problem would go away forever :-)

Last edited by Axemytoe; 01-30-2010 at 09:15 AM.

 
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