Will an op on my big toe fix my arthritis?

I AM very active for my age, 66, and enjoy golf, cycling and walking. I have arthritis in my big toe, with limited movement in my joint and often severe pain. I have used painkillers, anti-inflammatory drugs, special shoes and orthotics.

Three years ago, I had a cheilectomy, which helped. However the pain returned. A surgeon has recommended joint fusion. Should I have it? Glynis Lawrence, Verwood, Dorset.

WEAR and tear arthritis of the big toe joint as severe as yours is known as hallux rigidus. And your story is a perfect example of how this troublesome and disabling condition often progresses.

It occurs when the protective cartilage in the joint gets worn away with use. This causes inflammation and, in an attempt to repair the damage, the body responds by forming new bone — in the form of lumps, called osteophytes — which cause the joint to swell and become deformed.

These two features — the osteophytes and loss of cartilage — often show up on an X-ray.

Not everyone with this condition will be in much pain. However, many do find themselves with the same sort of problems as you have experienced, with the pain especially noticeable while walking or being active.

The bony spurs can also cause considerable discomfort when they press against shoes. Other symptoms include redness, swelling and warmth around the toe joint — all signs of inflammation.

As IN your case, treatment begins with orthotics — shaped pads placed in the shoes to help spread and cushion the load and thereby reduce pain when walking — along with suitable footwear that allows adequate room for the swollen joint.

From my experience, painkillers such as paracetamol or ibuprofen, or even stronger anti-inflammatories such as naproxen, are of little value for anything other than short-term use.

As the joint has been worn away, this is now a mechanical problem, which requires a mechanical solution. The cheilectomy procedure that you had is a minor operation carried out under local anaesthetic. It involves removing the osteophytes, then flushing out the joint to get rid of the debris from the fragmented and worn cartilage.

When this is carried out in the early stages of arthritis, before the joint has been totally worn away, it can be effective at relieving pain. Indeed, this was your experience, but in your case the cartilage eventually began to erode again.

This is why your orthopaedic consultant is now recommending arthrodesis, or fusion of the joint. This involves fixing the bones of the joint — with screws or wires, for example — so that they no longer rub against each other.

This provides long-term pain relief, including when walking.

While this means that the toe with be permanently rigid and will no longer bend at the joint, it is nevertheless an excellent procedure that is recommended in most cases of advanced hallux rigidus, as it is reliable and long-lasting.

It is the gold standard, and I cannot think of a better solution.

In your longer letter, you say that a replacement toe joint has also been mentioned to you in the past. But this has not yet been established as the treatment of choice. It is effective in some patients, but is a more complicated operation and there is little evidence about how long the implants will last.

My advice is that you should go ahead with the treatment you have been offered. Once healed, you will be pain free and mobile and able to carry on doing your normal activities — sporting or otherwise. MY WIFE and I are in our 80s and are fortunate to be still engaging in an active sex life. However, recently, my semen has changed colour. I have been to see our doctor, who first gave me some antibiotics which cleared it for a while. However, he has now taken the attitude that we should not be active at our ages and that there is not anything he is prepared to prescribe.

Name and address withheld. MANy readers will no doubt be heartened to read your letter.

you are indeed fortunate to have such a close relationship at your age, and I take issue with your GP being critical of the fact you are sexually active in your ninth decade.

The change in colour is probably due to the presence of blood. The technical term for this is haematospermia.

In all likelihood your symptom was caused by a minor degree of infection in the seminal vesicles, the tube-like structures which store the seminal fluid secreted by the prostate.

A sensible next step would be to test a sample, as that will help doctors identify the bacteria causing the infection and the correct antibiotic to treat it, which would typically be prescribed for a course of 14 days.

BUT this would require the agreement of your GP and his acknowledgement that there could be some infection or disease underlying your symptom.

I should also mention that the seminal vesicles are anatomically close to the prostate and prostate cancer can potentially invade these structures.

This is much less likely than infection, but nevertheless it’s a diagnosis to be excluded by testing.

My suggestion therefore is that you should consult your GP again and seek referral to a urologist.

WRITE TO DR SCURR

TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.