How to manage Bone spurs/arthritis in feet?

I have had pain, swelling and inflammation related to frequency of climbing. I went to see a podiatrist yesterday, had x-rays and was diagnosed with mild-medium osteoarthritis and bone spurs. It is in my left big toe metatarsal-phalangeal joint.

My typical patterns is after weeks to months of not climbing, I get on it and climb every other day or a 2 on 1 off etc. Over the course of 1-2 weeks climbing it flares up and becomes unbearable enough I can't continue climbing. I just aborted a trip to the Creek after 2 days climbing to come home and get this Dr's appt.

I have started taking herbal/supplemental antiinfammatories, but I think at this point is too soon to tell if they do anything.

The podiatrist offered little. I think he did not mention any corrective surgery because it's not that bad yet. He specifically asked how well I can walk, and I think correlated this to possible need for more drastic treatment. He did not want to prescribe oral anti-inflammatories, but did offer the possibility of cortisone injections. He was also a bit evasive about long term cortisone treatment and effectiveness. I am considering getting a shot, but concerned about further joint damage if I push the climbing while on the cortisone.

My left foot is bigger than my right, and though I get a little inflammation in the right side, it has never had the kind of trouble as the left. I attribute this to tighter Left shoe fit and stress caused over almost 40 years of climbing.

So my questions:

-Has anyone had particular luck with herbal/supplemental anti-inflammatory treatments, and if so, what?
-Has anyone gone the route of cortisone injections and what are you experiences?
-Aside from just shoe size, what kinds of shoes tend to cause less aggravation of this kind of arthritis? Stiff vs soft, snug vs looser width-wise without being too short? Etc? Any specific models and fitting strategies?
-Any recommendations how to deal with potentially needing different sizes for R and L feet?
-Note: Due to this arthritis, my toes do not tolerate downturns whatsoever. Need flat lasts period.

is it essentially pain in the big ball joint of your big toe?  if so, i had/have similar issues in both feet.  it got to the point last year where climbing was pretty painful if i had to get on my toes whatsoever.  i went to an awesome foot PT in seattle (neal goldberg, footworks - an absolute f_ing foot ninja).  he gave me a few exercises to use, changed the orthotics that my podiatrist gave me to a different insole, and had me start using these little rubber things between my toes when i climb - https://www.amazon.com/Protectors-Treatment-Separators-Straightener-Alignment/dp/B00SG0FG2S.  i really think these little things are key - when i forget to use them i definitely notice it.

it took a month or two, but the difference is insane.  the last few weeks i have climbed on some slabby ultra thin holds without pain (although my mind is still like holy crap i hope my toes don't buckle..).

another thing that a friend of mine recommended is yoga toes.  i wear these when i am hanging out, driving long distances, etc.

what is interesting is that my joint still hurts sometimes when i start walking (when i get up in the morning, etc) - but it subsides after i am warmed up.  i also have to be careful because that area is a little sensitive if i am toe hooking an arete, etc.  for me, those are small prices to pay compared to the upside so far.

Thanks Slim, yes that joint. However based on your linked bunion device and "yoga toes", I think it's a different problem. I don't have a bunion or hallux valgus. The bone spurs and most stabbing pain are on the top/dorsal aspect while the rest of the joint gets very achy. The yoga toes look kinda like torture for what I have!

Based on the footwork comment, any such practitioners in the Golden/Boulder CO area?

i am not really familiar with any foot PT folks in golden.  the only foot folks i am familiar with are the weber twins up in boulder.

it's interesting, i didn't really think that i had bunions either.  my xrays showed arthritis and bone spurs developing on the top of the joint.  the podiatrist (and me as well) thought that i would need a super stiff carbon fiber insert or something for my shoes that would keep my big toe from bending.  neal is definitely more of a 'keep it mobile' kind of guy.  so, he suggested a less torsionally stiff insole and the exercises.

the main exercise is where you keep your foot flat on the floor while sitting in a chair.  try to lift your big toe for 5 seconds while keeping the whole foot flat. then lower it.  then try to lift the other 4 toes for 5 seconds while keeping the rest of the foot flat.  i still try to do this several times a day.

i also do some other random foot/ankle motion stuff and do some toe stretch and foot stretch stuff.  the foot stretching can be unpleasant because the arch of my foot cramps up super easily.  after doing it for a few minutes it works itself out though.

good luck!  foot issues totally suck!

Thanks slim.

do you know how to pop your big toe joint back out ?  i've found that joint can kind of collapse on itself.  do you do gentle massage, squezing the toe between your palms.?  epsom salt warm footbath?  do you do any specific foot PT daily or at least every other day? especially during those off months.  

this one mentioned above is a good start "the main exercise is where you keep your foot flat on the floor while sitting in a chair.  try to lift your big toe for 5 seconds while keeping the whole foot flat. then lower it.  then try to lift the other 4 toes for 5 seconds while keeping the rest of the foot flat.  i still try to do this several times a day. "
but i would add.. do it standing up, and after you do the toe raises, relax toes, and slow and controlled as possible just rock forward onto the ball.. lifting up the heel and engaging the toes as gently as possible, stopping the rockup before it gets too painful and come back down slow and controlled... then repeat all!

ever tried something like this? https://www.amazon.com/PediFix-Hammer-Crest-Cushion-Medium/dp/B000O0AJZM?th=1\
https://www.amazon.com/Hammer-Toe-Pads-Envelop-Straightener/dp/B00SX9T4QG/    support under the toe

or have you ever tried wrapping your toe with https://www.rocktape.com ? (it's a completely different beast than normal climbers tape. more like an adhesive ace bandage) helps prevent irritation on the top of the toe.

there's climbing shoe companies out there that offer split size shoes... Butora comes to mind..

Cortisone is something you only want to try a few times at most... steroids are not a good long term solution

I've got arthritic feet.. i've found these shoes https://www.saucony.com/en/jazz-original/11842M.html?dwvar_11842M_color=2044-2#cgid=originals-mens-shop-all&start=1  (the sole on these is super grippy)
plus these inserts https://secure.yoursole.com/us/mens/footbeds/performance-thick 
have saved my life.

shoes that are too tight will aggravate the joints and circulation.. but shoes that are too loose in the toebox will make the toes work harder and also aggravate..
got to find that goldilocks pair..

J Squared wrote: do you know how to pop your big toe joint back out ?  i've found that joint can kind of collapse on itself.  do you do gentle massage, squezing the toe between your palms.?  epsom salt warm footbath?  do you do any specific foot PT daily or at least every other day? especially during those off months.  

ever tried something like this? https://www.amazon.com/PediFix-Hammer-Crest-Cushion-Medium/dp/B000O0AJZM?th=1\
https://www.amazon.com/Hammer-Toe-Pads-Envelop-Straightener/dp/B00SX9T4QG/    support under the toe

or have you ever tried wrapping your toe with https://www.rocktape.com ? (it's a completely different beast than normal climbers tape. more like an adhesive ace bandage) helps prevent irritation on the top of the toe.

there's climbing shoe companies out there that offer split size shoes... Butora comes to mind..

Cortisone is something you only want to try a few times at most... steroids are not a good long term solution

I've got arthritic feet.. i've found these shoes https://www.saucony.com/en/jazz-original/11842M.html?dwvar_11842M_color=2044-2#cgid=originals-mens-shop-all&start=1  (the sole on these is super grippy)
plus these inserts https://secure.yoursole.com/us/mens/footbeds/performance-thick 
have saved my life.

shoes that are too tight will aggravate the joints and circulation.. but shoes that are too loose in the toebox will make the toes work harder and also aggravate..
got to find that goldilocks pair..

Thanks J squared. Saucony Jazz? Wow, I think I had a pair of them around 1980!

I don't know what you are referring to in terms of popping the toe back out. It doesn't get popped in. 

I have tried hot water and hot/cold soaks. Just seems to promote more inflammation.

I am not sure how taping would help. I don't have irritation on top of the toe. It is compression of the metatarsal-phalageal joint that causes the problem, and now most other flexion/extension movements exacerbate it.

I have not tried any such cushions. Do you use these in the climbing shoe?

Thanks for the Butora tip!

Man, sorry to hear. I have a friend with arthritis in her toes. She just avoids slab climbing and that seems to help extend the periods she can climb. I'll ask her if she has any other advice.

heh, i found the saucony jazz for sale in a Marshals just a month ago..

well the rocktape isn't only for the top of the toe.. it can give some support to the whole joint.. while not being as bulky as the undertoe cushion.  I would go with the felt cushion for climbing shoes instead of the gel one..

but I dunno... climbing is basically the hardest thing you can ask your toes to do..  like when footchips get to a certain smallness I just don't stand on them if I can't smear over them..  slabs with good hands are sometimes ok... slabs with bad hands are just not worth it ;p

I have end stage OA in almost all of the joints in my right foot. My big toe is so bad, I can't bend it all. For long approaches, I wear prescription orthotics with a morton's wedge/reverse morton's extension. Be sure to go to a GOOD podiatrist and don't even bother with the off the shelf stuff like superfeet. The morton's wedge limits the ROM of your big toe so it's not constantly flexing and putting more pressure on the arthritic joint. You can't put them in climbing shoes (or I've never tried) but wearing them in your approach shoes takes a lot of the pain away so that once I put my climbing shoes on, my big toe isn't already screaming. I also wear relatively stiff shoes (miura vs, TC pro) that help keep the toe from flexing when I'm actually climbing.

unfortunately, there's not much you can do about slab...it just sucks to not be able to bend your toe, or for it to be painful when you encounter a slab move in the middle of a route. I go through all sorts of contortions and gymnastics to try to only slab climb with my left foot. I manage to get around, but it's really annoying...like playing twister with the rock.

I have found that Move Free Ultra (got it at costco) combined with glucosamine+chondroitin does wonders for my OA. however, it really only works for true arthritis and doesn't do anything for other non-arthritic soft tissue injuries. I started taking those two supplements last fall and within 2 weeks had significant pain relief in my arthritic ankle and foot, but it did nothing for my knee pain (torn MCL and meniscus) or my tennis elbow. A lot of people start taking glucosamine and chondroitin who don't feel any benefit because they don't actually have arthritis.

I have considered surgery, but have been dissuaded so far because between the supplements, lots of aleve, and prescription orthotics, I seem to be able to get around OK. Also, my foot and ankle specialist keeps telling me that my foot and ankle are so f'ed up that my toe is the least of my worries, which is sort of true, but your toes are really important for climbing. it's been about 10 years since I developed OA in my foot/ankle/toes and I still haven't progressed to where I feel like I can't manage through non-surgical interventions. Good luck! 

slim wrote: is it essentially pain in the big ball joint of your big toe?  if so, i had/have similar issues in both feet.  it got to the point last year where climbing was pretty painful if i had to get on my toes whatsoever.  i went to an awesome foot PT in seattle (neal goldberg, footworks - an absolute f_ing foot ninja).  he gave me a few exercises to use, changed the orthotics that my podiatrist gave me to a different insole, and had me start using these little rubber things between my toes when i climb - https://www.amazon.com/Protectors-Treatment-Separators-Straightener-Alignment/dp/B00SG0FG2S.  i really think these little things are key - when i forget to use them i definitely notice it.

it took a month or two, but the difference is insane.  the last few weeks i have climbed on some slabby ultra thin holds without pain (although my mind is still like holy crap i hope my toes don't buckle..).

another thing that a friend of mine recommended is yoga toes.  i wear these when i am hanging out, driving long distances, etc.

what is interesting is that my joint still hurts sometimes when i start walking (when i get up in the morning, etc) - but it subsides after i am warmed up.  i also have to be careful because that area is a little sensitive if i am toe hooking an arete, etc.  for me, those are small prices to pay compared to the upside so far.

Hey Slim,

I followed links and found references to what I have:  Hallux limitus with arthritis. Some of the recommendations are exactly what you posted here. some here: https://www.youtube.com/user/correcttoes/videos 

I am going to try toe seperators and start some stretching recommended by this guy.

Also found info about carbon fiber turf toe plates designed to limit dorsiflexion, might be able to apply this in the climbing shoe when appropriate to the footwork on particular routes.

And I am searching for used shoes same models as what I have 1/2 size larger for the left foot. 

After finding this info I think the podiatrist I saw was a hack.

I had a bone spur last year in my heel. It was super painful, but I treated it by wearing a toe separator between my big toe and 2nd toe on that foot, staying off of it as much as possible for 1 week, and wearing birkenstocks for the week after (decreases constriction of toes in toe box and increases blood flow to affected site). It worked for me, but I'm not a doctor, so take what I say as no more than an opinion. 

Jake W wrote: I had a bone spur last year in my heel. It was super painful, but I treated it by wearing a toe separator between my big toe and 2nd toe on that foot, staying off of it as much as possible for 1 week, and wearing birkenstocks for the week after (decreases constriction of toes in toe box and increases blood flow to affected site). It worked for me, but I'm not a doctor, so take what I say as no more than an opinion. 

Toe separator for HEEL bone spur?

While I hesitate to offer any advice: I was struggling with some issues in my arms and finally ponied up to visit Dr. Lisa Erickson, who has a practice in Boulder and has treated a lot of professional climbers. I diagnosed the problem with her and did probably 4 follow-up visits that involved: creating a recovery plan; lots of massage; and some acupuncture work. It was worth every penny. I was - to my shock - able to start climbing again while I worked through the recovery program and am now almost entirely pain-free. If you're in the area, it may be well worth a visit just to explore you potential options for recovery. I did this before even thinking about follow-up visits and, in itself, it was really valuable. She's known for her extensive work with climbers and her book gives good insight to how she thinks about climbing injuries (although it's not intended to be a recipe for recovery from any specific injury or issue). She's also good about working with you up front to figure out insurance, co-pays, etc. I paid for a few visits out of pocket and it was still worth it.

On a final note, I would be highly skeptical of herbal anti-inflammatories. I'm skeptical of homeopathic "remedies" in general, but a variety of new research has begun to question to what degree even tested NSAIDs such as Advil reduce swelling and to what degree reducing swelling is even desirable to promote healing. (You can search around for academic articles but here's one overview article from the popular press). Anyways, that's just my two cents as somebody who tried to deal with things on my own for a long time. Wishing you a speedy recovery.

mountainhick, i think i basically have early stages of the hallux limitus or hallux rigidus.  i had originally tried using stiffer shoes and was thinking about trying the carbon fiber inserts, but luckily with the exercises, stretching, and separators i have been able to switch back to my usual shoes (katana velcros for mostly granite crack/face climbing these days).  hopefully it works out for you as well.

jake W - i also am in a continuous battle with bone spurs on the backs of my heels (near the base of my achilles).  i had surgery on the left one almost 20 years ago and it is doing ok.  last fall, for some weird reason my normally comfortable climbing shoes aggravated the living shit out of my right heel spur.  uggggh, i was so desperate i bought a pair of crocs (vomit...) and wore those to work for quite a while and it helped quite a bit.

damned feet....

Can't speak to the feet, but I have early onset/mild osteoarthritis in my DIP joints. I got a cortisone injection a couple months ago and besides numbing my fingers for a couple days it did absolutely nothing to ease the pain.

mountainhick wrote:

Toe separator for HEEL bone spur?

As my orthopedic surgeon put it, the heel bone spur is caused by restriction to the toe from toe boxes that are too narrow, so a toe separator restores normal blood flow through the foot, alleviating the heel spur. 

are you sure you aren't describing the cause of a bunion?  that sounds completely crazy (as in crazy) for a heel spur.  my original bone spurs were from snowboarding boots that didn't have very good heel protection.  as my feet would raise up and down in the back of the boot it continually rubbed that area causing the bone to react by growing.  i had plenty of room in the forefoot area.

my last issue that caused it to flame up was some sort of tiny pebble or something in the fabric of the climbing shoe.

if you really do mean heel spur (instead of bunion) i would seriously think about a second opinion because it sounds like the OS is on drugs.

heel spurs are growths where the ligament connects to the heel bone caused by over stretching of the plantar fascia.

the ones that grow on the back of your heel are similar from stretching of the achilles.

The pain in the big toe joint could also be Gout.