Vulcan Toes - predislocation syndrome

[Angela]

Anybody out there ever have to deal with predislocation syndrome? From all that jumping around out there on the sand courts, I've developed this condition where my second toes drift over and climb up a little bit over the big toe. It's like my feet are constantly giving me the Vulcan greeting. Except it hurts.

A podiatrist fit me for orthotics but they're helping only somewhat. He told me surgery would be the only other alternative. I'd rather not have surgery, especially since I'd have to do both feet, one at a time, so recovery would be lengthy and sedentary - yuck! My chiropractor wasn't much help. There is no PATHS module for it yet . I've looked it up on the Internet, and there's not much more information than I've already got. I've heard rolfing might help, but that it would be extremely painful.

I used to have toes so strong I could open a beer bottle with them, and I'm nostalgic for those days. Any ideas for me on alternative treatment so my toes can live long and prosper?

(I know, I know, stop drinking beer.)

[Shamou]

Originally Posted by Angela

I've heard rolfing might help, but that it would be extremely painful.

I am not an expert in rolfing but supposedly it seeks to free deep seated emotion buried in the soft tissues of your body... so I fail to see where that could help you with your toes...

I am in accord with your podriatist... surgery is probably your only solution... sorry about that...

.

[Megan]

Hi, Angela--so sorry about your foot problems. Another chiropractor (who also plays sand volleyball) said this:

Regarding your friend's injury, I can tell you toes are commonly hurt on the volleyball court. In the sand, it's usually a hyperplantarflexion injury of the great (and sometimes lesser) toes, caused by 'rolling' over the toe while pushing off with the foot. This is informally known as 'sand toe', which is the opposite of the 'turf toe' that football players get (a hyperdorsiflexion injury).

As far as the second or third toes overlapping, I would first want to know if the great toe is aligned properly. Specifically, does the great toe angle outward (toward the other toes)? If so, this is called hallux valgus (which can lead to bunion formation), and would be a great toe problem -- not a lesser toe problem. This is also commonly caused by wearing narrow-toed shoes.

If the great toe is normally aligned, then it may be a problem with the lesser toes -- either a ligamentous, tendinous or dislocation injury of the involved toes. All of these are easy to discern during examination, but it's hard for me to tell which she has based on what she's written.

A temporary solution may be to buddy-tape the involved toes (tape them each to adjacent toes) while playing. This will help stabilize them during movement, and may be part of her ultimate treatment plan.

Hope this helps, and tell your friend I'd be glad to talk more with her, either by phone or email.

Regarding buddy-taping the toes, you've probably read this Podiatrist's site:

Letter from patient: My latest trick I stumbled across through a recommendation by a salesman at a surgical supply house where I was trying to track down some foot pads or insoles, has been wrapping Elastikon tape around the metatarsal region a few times (snug, but not too tight).

Podiatrist's answer: The original problem is a weight bearing one, that is, the second metatarsal is bearing more weight than it was designed for. Redistributing this weight is the long term goal. (...)

Another method of getting weight and pressure off of the 2nd metatarsal is to change exercise habits. Repetitive stress activities involving the forefoot make matters worse. (...)

I have not tried the Elastikon trick but I will. (...)
Metatarsalgia

PS: Remember, sand volleyball is a metaphor for life--how you solved this problem can be a chapter in YOUR BOOK!

Best wishes,

Megan

[Angela]

Originally Posted by Megan

PS: Remember, sand volleyball is a metaphor for life--how you solved this problem can be a chapter in YOUR BOOK!

Oh, YEAH!!!! you are so correct to point that out to me. I need to get my footing in life, but I don't want to toe the line. Still, I have a lot of sole.

My dear, where have you been!?! I have missed our scintillating discussions, and have thought of you whenever I see a coyote.

Sand Toe. At least now I have a name for it. It sounds kind of glamorous. I will try the taping thing (I had not seen your second reference -- I'll investigate and make sure to do it right.)

Thank you very much. My toes feel so much better, knowing there's someone out there concerned about them. Please thank your cool chiropractor volleyball pal thank you for me.

Lots of love,
Angela

[Megan]

You may have a point there, for true!

I kind of go in gusts on forums, but I spotted this thread & thought I'd drop in and say hi to my bud.

You think of me when you see...coyotes? Not...um...cougars? Wait, wait, I know, when you see coyotes you think of cougars? But, OTOH...how often do you see coyotes, now that I think of it...oh well....

Now about 'sand toe,' I'm not 100% sure that's the same thing as predislocation syndrome. It doesn't say anything about overlapping toes. That may just be another ill that volleyballers are prone to--not sure really.

Anyway, if you've read that article, you see that predislocation syndrome is not something you want to mess with.

OK, since you're asking for advice, and I just read a chapter in a book about chronic inflammation, here's what I would do: I would try to reduce the inflammation response any way I could systemically, and perhaps locally, and I would give the foot time to heal.

I know it's summer and volley ball season, but you don't want your foot to degenerate, because after all, someday you'll be MY AGE!

IOW, take the long view of what's going on here. (Does sand volleyball teach us to take the long view? Maybe it does now....)

My neat volleyball-playing chiropractor is also my son. He recently got punked on ESPN (he's the first 'victim'):

http://www.espnaustin.com/PodCast/05...%20Tickets.mp3


I recently outlined a chapter on chronic inflammation for my own purposes, so I'll post what I learned on the next frame.

Rest assured, there are people in this world who care about your toes!

LOL (laugh-out-loud and lots-of-love!)

Megan

cont.

[Megan]

Inflammation:

There are two kinds of inflammation:

• acute
• chronic

The three functions of Acute Inflammation:

• Healing and repair process
• Prevent the spread of damaged cells
• Rid the body of damaged and dead cells

Acute Inflammation is like a toggle switch:

• Turned on by inflammatory chemicals
• Turned off by anti-inflammatory chemicals

Causes of Acute Inflammation:

• Trauma, such as a fall
• Microtrauma, often from repetitive motion activities such as typing
• Intense physical activity, such as anaerobic exercise
• Chemical stresses, such as food allergens, birth control & hormone replacement
• Infections

Chronic Inflammation happens when:

• Insufficient anti-inflammatory chemicals
• Too much inflammatory stress (which impairs production of anti-inflammatory chemicals)
• Nutritional imbalances, especially dietary fats
• Increased body fat, especially around waist

Results of Chronic Inflammation:

• tendinitis
• faciitis
• arthritis
• cancer
• heart disease
• Alzheimer's
• etc.

Diet and Inflammation:

• Balance dietary fats: avoid trans fats; eat omega-3
  
• Eat foods that combat inflammation: lots of veggies, especially onion & garlic, citrus peel, ginger, turmeric & raw sesame seed oil
  
• Get all nutrients necessary for maintaining balanced fats: B6, E, C, niacin, magnesium and zinc
  
• Limit refined carbs & moderate carb intake.
  
• Limit alcohol intake (but red wine is good)

This information is taken from The No-Nonsense Guide to Diet, Exercise and Disease Prevention by Dr. Phillip Maffetone (recommended by my son), chapter 32, "Chronic Inflammation: The Hidden Epidemic."

Dr. Maffetone also says:

Allowing the tendon to heal is the key remedy. As with most conditions, the course is very individual. In many people, the muscles associated with the injured tendon may not be functioning correctly. Getting help from the right health-care professional to restore proper muscle function can be an important part of any therapy.

Prevention of these common tendon problems is the best approach. (...)

Avoid overtraining or other overuse. In addition, be sure your body has adequate levels of EPA from omega-3 fats.

--No Nonsense Guide, p 258

So, perhaps myotherapy? Also, I would throw some EFT at the issue too--hey, it took me from a 10 to a 2 on my cougar phobia, and it fixed a long-standing shoulder problem for me, literally instantly!

So in a nutshell what I'm saying here is that if you keep jumping around on an injured foot, you'll keep creating inflammatory chemicals, which might eventually create chronic conditions which might be prevented now. Just my guess.

I'm working on an injured toe condition called hallux limitus, which I wish I'd started on years ago, when the injury was fresh. Neglected things have a way of hardening over time.

I see Dr. Maffetone also wrote a book on feet:

Amazon.com: Fix Your Feet: Build the Best Foundation for Healthy, Pain-Free Knees, Hips, and Spine: Books: Phil Maffetone

Best wishes, dear heart!

Megan

[Kaspian]

Another quick thought - see a reflexologist.

[Megan]

These supplements are widely used to rebuild damaged joints in osteoarthritis, and common sense tells me they might be helpful in your case and mine, although I've found nothing to suggest that so far.

In any case, they are sold over-the-counter, and might be worth a try to strengthen and rebuild the damaged connective tissue. I'm strongly considering trying them. Several books on arthritis in Barnes & Noble discussed important things to look for in buying this supplement, unfortunately I didn't have a pen with me today.

The podiatrist I linked earlier said:

Metatarsalgia of the 2nd metatarsal bone and predislocation syndrome in general are terrible problems. There are no easy solutions if a cortisone injection or two do not help you. And obviously a cortisone injection by and of itself in the absence of changing something, is not likely to work.

Metatarsalgia

Mayo clinic says:

Complications

Left untreated, metatarsalgia may lead to:

• Injury to ligaments in the foot
• Pain in other parts of the same or opposite foot
• Toe problems
• Chronic stiffness
• Loss of range of motion

In some cases, metatarsalgia may contribute to a condition known as avascular necrosis — the death of bone tissue due to a lack of blood supply. Without treatment, the affected bone may collapse.

Treatment

Conservative measures usually relieve the pain of metatarsalgia.

Rest. Protect your foot from further injury by not stressing it. You may need to avoid your favorite sport for a while, but you can stay fit with low-impact exercises, such as swimming and cycling. Continue with stretching and lower body strength training as your pain permits.

Ice the affected area. Apply ice packs to the affected area for 15 to 20 minutes at a time, several times a day. To protect your skin, wrap the ice packs in a thin towel.

Take an over-the-counter pain reliever. Try ibuprofen (Advil, Motrin, others), naproxen (Aleve) or aspirin to reduce pain and inflammation.

Wear proper shoes. Your doctor may recommend a shoe that's especially suited for your foot type, your stride and your particular sport.
Try shock-absorbing insoles. These off-the-shelf shoe inserts — often made of cork, plastic, rubber or a gel-like substance — fit inside your shoes to help cushion shock.

Use metatarsal pads. These off-the-shelf pads are placed in your shoes just ahead of the metatarsal bone to help deflect stress away from the painful area.

Consider arch supports. If insoles don't help, your doctor may recommend arch supports to minimize stress on the metatarsal bones and improve foot function. Off-the-shelf arch supports come in various sizes and can be fitted immediately. More durable arch supports can be custom-made from a plaster cast of your foot.

Rigid arch supports are made of a firm material such as plastic or carbon fiber. They're designed to control motion in two major foot joints below your ankles. Semirigid arch supports are made of softer materials such as leather and cork reinforced by silicone. Arch supports designed to treat metatarsalgia may include metatarsal pads, too.

Metatarsalgia - MayoClinic.com

Loss of range of motion in your foot has many spin-offs in other parts of your body, so doing what it takes to preserve foot function is well worth the effort, it seems to me.

I currently have little more than 0 degrees of dorsiflexion in my right big toe--supposed to have about 60 degrees. Doesn't seem like a big deal, but walking is my favorite exercise, and I don't have normal "push off strength" any more. Anything that affects your gait affects your whole musculoskeletal system.

You did me a big favor by bringing up your foot issues, Angela, because it started me looking into and taking seriously my own. That "nagging little thing" I have actually has a name and should have been looked after long ago! Yikes! Thanks!

Megan

[Angela]

Ack!! It's dire!

By the way, I tried glucosamine supps and immediately broke out into a rash that went away when I retired them. I've never heard of the other one.

I'm beginning to think my life should be spent in bed eating bonbons and being catered to by a team of handsome and willing youths.
Probably be cheaper than the prescribed treatment!

Good luck with your peds, Megan.

[Megan]

...good luck with that.

As for the bon bons...Sonic keeps advertising root beer floats and I'm fighting back urges.

Not all the sites make it sound so dire. In any case, those are worst-case scenarios, which are unlikely for you.

I see you healing that foot, going back to hopping around in the sand, tapping out the chapter on the wisdom gained from your 'sand toe' ordeal in your spare time, making a million on the book and then being catered to by willing youths.

How's that for a plan?

Me, I have a lot of faith in EFT, prayer & meditation even though my particular malady can eventuate in gangrene, etc., like yours. Who knew!

But I just keep visualizing the joint regenerating. Seems like the way to go.

Hey, I just started reading a book called The Presence Process. This guy healed an excruciating neurological malady with this process he hammered out over time. He went through a lot of despair and confusion (and peyote), but finally succeeded.

Amazon.com: The Presence Process: A Healing Journey into Present Moment Awareness: Books: Michael Brown

Well...keep the faith, baby.

Megan

[Angela]

Ai chihuahua. I'm sorry I asked.

I'll take a look at that book -- you always point me towards good ones. It's funny, I've always loved feet, and now I'm faced with this challenge. Have you read the book, "The Time Traveler's Wife"? Great love story, and feet are a central motif.

By the way, I said "coyotes" in a previous post because that's the closest thing we've got -- no cougars here. At dinner that night with Danger Man, there was some talk of cats and canines and I realized I had the wrong species family entirely. Wild-ass predators both, though. Danger Man, too. He's more related to the lizard family. You should see him eat broccoli. Looks just like a dinosaur. Except much cuter.

[Megan]

...like Job in the Bible...with friends like me, who needs enemies?

Still...it's good to know what you're dealing with, and then stop focusing on that aspect and focus on what you want. That way you're in touch with the reality of the situation. Still working on that, but what else can you do?

I think the people who get those terrible complications are mostly the seriously malnourished, neglected, down-and-out sort of people, you know? A reasonable well-nourished, healthy person isn't going to go totally down the tubes, I doubt, but still, losing range of motion, etc., is something to take seriously. It creeps up on you.

The Time Traveler's Wife sounds good, I shall have to read it.

And see, you've already read a love story with feet as the central motif. How many people can honestly say that?! You've got foot karma, I just know it! This is going to be big, Angela, BIG I tell ya! This is bigger than the both of us, bigger even than our feet!

Danger Man sounds really interesting and sexy. And he eats his broccoli. Hang on to 'im.

PS: Do you have Morton's toe too--second toe longer than first toe? That predisposes to foot problems, you know.

[Angela]

Originally Posted by Megan

PS: Do you have Morton's toe too--second toe longer than first toe? That predisposes to foot problems, you know.

Yes, I do. It's supposed to be a sign of a superior intellect.

[Shamou]

Originally Posted by Angela

Yes, I do. It's supposed to be a sign of a superior intellect.

A bit like big noses for guys...???

.

[Megan]

Next time you are in an art museum, notice the paintings and statues...Morton's toes (aka "Greek toes") all over the place, even on the Statue of Liberty. [Big noses too!]

Besides being known unofficially as a Greek or Roman
toe, this is a common forefoot disorder where the second
toe is longer than the Big Toe (the Hallux) known,
officially, as Morton's Toe, and unofficially as Classic
Greek Foot, hyperpronation of the foot, or pes valgus.
Morton's Foot was first described in the 1930's by
podiatrist Dudley J. Morton. It is a normal variation in
the structure of the human foot that is present in
roughly 20% of the population.

Actually, it is not that the second toe is longer than the
Big Toe as much as the second bone, the second metatarsal
(or a short first metatarsal) is the distinctive feature.
You can't tell by simply looking at the length of
your toes.

Morton's Foot creates an instability in the ankle that
causes ankle weakness and frequent ankle sprains. The
feet compensate by turning the toes outward, which
turns the ankles inward and flattens the arch. Physical
stress from this abnormal posture promotes the development
of myofascial trigger points (tiny contraction
knots) in the muscles of the lower leg and foot.

The sandal of the Statue of Liberty is 25’
long. Using US Women’s Shoes Sizes -
based on the standard formula - her
sandal size is 879.

http://www.endex.com/gf/buildings/li...oes.041231.pdf

Endless fretting about long second toes, etc., here:
More Toe Sizes Poll comments


Are we having a scintillating conversation yet?


But, hey, here are ideas that might be worth trying:

How To Conquer Crossover Second Toe Syndrome

What About Conservative Treatment Options?

Treatment of the crossover second toe is somewhat grade-dependent, although there is a great deal of overlap. In all cases, attempt conservative care for a period of time prior to planning any surgical correction.

Conservative care is fairly easy in grade I cases and works very well most of the time. Begin by applying simple taping over the second toe with half-inch wide paper tape, as close to the MPJ as possible. Once the toe is in the ideal position, pull the tape onto the plantar arch region. In order to avoid strangulating the toe, do not cross the tape too close to the toe on the plantar surface.

An alternative treatment, but one which does not seem to work as well, is using a prefabricated device with an elastic strap and a plantar flat surface to hold the toe in the ideal position. You would combine this with stiff shoes and an orthotic device in cases of poor metatarsal length and/or laxity of the first ray. You may further customize the orthotic with a metatarsal pad or an accommodation plantar to the second metatarsal head, if you deem it necessary.

If treatment is not successful, consider a five-day course of oral steroid therapy which you may combine with physical therapy in order to resolve the inflammation and possible partial tear of the second MPJ plantar plate.

When patients are not improving with stiff shoes, a below the knee walker or surgical shoe is an excellent option. Resolution of symptoms is supported with orthotic use and shoe changes.

How To Conquer Crossover Second Toe Syndrome

Conquer! Conquer is a good word!

[Megan]

Can't hurt....

Jello Anyone?

As strange as it might seem, the main ingredient (gelatin) in good old Jello might be just what the doctor ordered for painful joints.

Gelatin has been marketed world wide for many years as a food and as a supplement. Gelatin is made from animal collagen.

In all animals--including man--collagen is an essential structural protein that forms an important part of bones, tendons, and connective tissues. It is a tough insoluble protein that is essential for keeping the many cells and tissues of the body together.

Gelatin contains an exceptionally high content of two amino acids which play an important part in collagen formation, namely proline and glycine.

In fact, it takes 43 grams of dried egg whites or 35 grams of dried non fat milk or 89 grams of lean beef to equal the amount of proline in just 10 grams of hydrolyzed gelatin.

Though the body can form these two amino acids on its own, it has been suggested that under certain conditions the rate of synthesis may be insufficient to provide essential body requirements and degradation can exceed synthetic processes (i.e. there is a steady loss of body collagen).

The intake of hydrolyzed gelatin appears to be an alternative route to getting chondrocytes (cartilage producing cells) and osteoblasts (bone forming cells) of the body sufficient amounts of these important amino acids for making structural proteins.

Although chondrocytes are critical for collagen formation, their number is limited and their ability to form this much needed protein is influenced by heredity, age, physical activity (too little or too much), injury, and availability of nutrients.

Although bone metabolism is quite complex and not fully understood, there is a growing number of studies showing the intake of just ten grams per day of hydrolyzed gelatin is effective in greatly reducing pain, improving mobility and overall bone/cartilage health. Several randomized, double-blinded, crossover trials have shown improvements in symptoms related to joint pain (Adem et. al. Therapiewoche, 1991).

The people at Knox (the Jello people) have made a product specifically for bone health and joints called NutraJoint. It contains hydrolyzed gelatin, calcium , and vitamin C. Calcium is of obvious importance to bone health and vitamin C is an essential and limiting nutrient for connective tissue formation.

NutraJoint is cheap, has no side effects, and tastes good. I recommend one packet mixed with OJ with breakfast for people suffering from joint pain.

Joint Pain, Joint Health - Joint Supplement for Join Health and Pain

OTOH:

Does it work?

The NutraJoint web site refers to several laboratory studies, some animal research, and a few small human clinical trials from Europe to support the product claims. But this evidence seems to be about as soft as, well, Jell-O. There is apparently no hard scientific evidence, from replicated, double blind human studies, showing that NutraJoint works.

Undoubtably, some people who take the supplement may feel better. However, this could be due to the placebo effect -- if you believe something works, it sometimes does.

Also, joint discomfort, and many forms of arthritis, often tend to flair-up and then subside. So, taking NutraJoint, or some other concoction, when pain is about to subside, could lead you to attribute the relief to the product rather than to the natural pain cycle. In short, based upon current published research, NutraJoint will probably do little, if anything, to improve your flexibility or the health of your joints.

Bottom Line:

Although there is little evidence to backup NutraJoint marketing claims, the supplement will do your body no harm. But it can stress the pocket book. NutraJoint is not cheap, about $13 to $16 per month if taken as recommended.

If you decide to buy this product, talk to your doctor first. Don’t, of course, replace any of your current medications with NutraJoint. If a medication you are currently taking is not working or is causing side effects, ask your doctor to suggest some options.

Knox NutraJoint -- A Questionable Value

See also:

Food Features: Why Broth is Beautiful "Essential" Roles for Proline, Glycine and Gelatin

I think it's worth a try, even if the studies are not yet replicated. But that's just me--sure cheaper than surgery....

[Megan]

Can't hurt either....

Flax oil for everything!

Many bodybuilders and other athletes are starting to see the many benefits of flax oil for all sorts of uses. One obvious use of flax oil is a reduction in pain due to any type of inflammatory condition, including joint troubles.

To understand why this is so, the reader must now endure a crash course in the topic of essential fatty acids....

(...)

Remember the "-itis" part of the word relating to joint problems? How do you think non-steroidal anti- inflammatories work? They reduce inflammation, but they also come with potential side effects and health problems. So how does flax oil do this wonderful thing?

(...)

A high intake of Omega 3 oils reduces inflammation (and pain) by this mechanism. (...)

People who add in 1-3 tablespoons a day of flax oil to a protein drink, or over a salad, often notice a reduction in pain in their joints, not to mention all the other great things EFAS can do for the hard training bodybuilder.

Flax oil can be found in any large health food store under such brands as Flora, Omega, Barleans, and several other names (Even better than flax perhaps, Udo's Choice oil is a great blend of different oils. More info can be found at Udo's site connected to the links section of this web page).

Joint Pain & Joint Supplements - Flax Seed Oil and Joint Pain Supplements

[LouiseH]

I also have a Left second toe drifting over my Great Toe. It hurts a great deal walking and aches when I am sitting or sometimes sleeping. I am 56, but this all started when I had L ball of my foot pain and went to a podiatrist. She gave me 2 steriod and pain killer injections in between my L toes. She installed Metatarsal bars on my L foot. And she took Xrays the first day (June 07) She also told me to wrap my 2 middle toes with stretchy tape, not too tight. I follwed her regimen, finding the tying my toes together to be extremely painful. (My toes have a good bit of painful arthritis.) So I eventually stopped. The Metabar made me walk peg-leg. I went back and said -what next? She gave me a coupon for a wide toe shoe (New Balance) that I could wear in business work. By the time I started wearing the shoes, my toe had drifted over the Great Toe. I went back, very frustrated, and asked the explanation. My Xrays had not shown any toe-drifiting in June. This was just July! I demanded my medical records and Xrays. She tried to explain, but it did not sound plausible. (Since I am an attorney, they always treat me defensively.)
I took my records AND original Xrays (which the disorganized podiatrist office had given me by mistake (smoking gun-I think) and my painful toes to another podiatrist, about whom I had heard good things. He diagnosed predislocation syndrome, and showed me on my Xrays (both feet) that my bone is longer on both second toes that on the other toes. He said, in so many words, that the shot, the metabar or the wrapping could have speeded up the process but that it would have happened eventually. I replied that my R 2 middle toes are spreading even wider apart, but they don't hurt.
He said there is a body of work by a Dr. Gerald Yu, deceased who in about 1990 researched hammertoe and discovered that there were other causes that needed to be addressed.
He eventually gave me a pad to put under the orthotic on L foot, but it has made no difference. Now I am facing surgergy. Has anyone experieced the surgery, often called hammertoe surgery?
I used to walk a mile a day, do treadmill, gym and water aerobics. Now I can only do the latter.