08 Sep 2018

My bunion, my teacher.

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After decades of poor footwear, and 16 years in figure skates, my left big toe joint has a new name: hallux rigidus. It is nearly immobile, a classic bunion. Because it has lost its flexibility, it can’t take its share of my body weight during walking. As a consequence, the toe next to it has more work to do than it is meant to have.

My big toe joint looks less distorted and smaller compared with some women I have seen. This doesn’t matter.  Apparently the severity of impairment is judged by function, not by its appearance. My poor hallux is paralyzed in horror after also dealing with arthritis and trauma from a stumble in April 2018 that left bone fragments floating in the joint.  The discomfort was aggravated when I started yoga teacher training in April, suddenly spending many more hours a week barefoot.

I saw three doctors. The first, a local and popular woman my age, gave me metatarsal pads that I could put in my shoes myself., adhering them to the insole. This is a good idea, but  it is difficult to do, as every shoe is different and even a hair’s width of difference in placement can cause pain. Repositioning the pads can be done only twice, as their glue backing stops working.

The Rothman Institute took X-rays and gave me more information about inserts, suggesting a synthetic cartilage implant to be placed between the bones of the joint. This is a new technique, started in Canada and is called, Cartiva. The Rothman doctor thought by the time I needed surgery, that Cartiva would have enough of a track record to consider using. In the meantime, he suggested another kind of shoe insert, called a Morton’s extension.

After seeing the first two doctors, and being told that surgery someday is inevitable, I got an exciting idea, to have surgery now, when my healing abilities and resilience are at their peak. I am not getting any younger. I asked my stepmother and some other friends, and they agreed with me. So I went back to the local doctor; she said, “Sure, we can do surgery” , said that my idea made sense, and recommended her favorite foot surgeon, saying “You’ll love him.”

I went to see the surgeon as soon as I could. After telling him my story and idea, and showing him the X-rays, he said that I had not used a single word that would indicate that I was ready for surgery. He also found the real source of the pain. This was in the second, neighboring toe’s tendon. It had fluid around it and was inflamed. He said he could take care of that, with a steroid injection. He said this injection would feel like a sting, less painful than a Novocain dental injection; he assured me that my music camp vacation starting the following day would not be affected. He said, “no problem” when I told him that that I would be walking at least 3 miles a day over hilly countryside, carrying my guitar over my shoulder. He made this injection sound easy and trivial. I was tempted by the promise of instant pain relief.

Then my intuition spoke to me, and I said “no thank you”  to the injection.  My tendon is doing what it is supposed to do, swell up and get mad at being abused. I want to support it, not suppress its reaction.

It took three doctor visits to get enough information to make a decision; the last doctor was the only one who listened to me. The first two doctors had focused on the obvious, the enlarged hallux, and its reduced mobility, and started describing the surgery they would recommend.  I told them that the big toe joint didn’t hurt, that it was the toe next to it that hurt, but they didn’t seem to hear me.

I am glad that I refused the steroid injection. The saleswoman in the shoe store I went to after seeing the surgeon, told me that she’d had several of those injections and that they are a big deal and painful. She was laid up for a few weeks after one of them.  My vacation could have been ruined if I had had the injection. My intuition was validated. I am grateful that I listened to it.

I have purchased a pair of Stegmann brand clogs. And a Morton’s extension. And got rid of some shoes that my toe joint doesn’t like. Birkenstocks are good because they offer metatarsal support. I have also learned about other things that have helped my foot to be comfortable almost all the time.

First, it helped to loose a few pounds so the foot has less weight to carry.

Secondly, changing shoes at least once a day helps as foot gets variety in how it carries my weight.

Thirdly, as being barefoot makes my foot unhappy, I am going barefoot only for yoga and showers. I am wearing shoes all the rest of the time. I put on my doctor recommended Oofos brand flip flops even at night, when I get up to go to the toilet.

Avoiding inflammatory foods helps,  as tendon is already inflamed.

Using a rubbery soft  toe spreader has been very nice. My feet enjoy that. My yoga teacher told me about them. I use them every night in bed, while my husband and I watch a show.

All these things have made my foot comfortable; I can continue the hikes I love around my beautiful neighborhood.

My hope is that all these will enable me and my precious foot to live a happy and long life together. So far, so good.




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