exercises after toe fusion surgeryexercises after toe fusion surgery

Keep in mind that your feet have more nerve-endings per square inch than any other body part. You can make the SLR more challenging by adding a 2- to 3-pound ankle weight. Ive trekked a few more times in Summit County, Colorado. Brenda, Do you have experience dealing with foot surgery? I want to start swimming but I am nervous about moving my foot around too much when swimming. You should also be able to start driving a manual car, if advised by your consultant, but also check with your car insurance company. It means that, in some ways, healing is going on! Everyone heals at their own rate so its not possible for another to provide any estimations for a recovery process. Susan, I m a very active type A personality so I cant wait to get back on my feet! Patience is the key. Thanks for sharing your story,its really very helpful. The invasive procedure is extremely helpful in correcting toe malformation and reducing pain in the metatarsophalangeal joint. After 2 weeks, the surgeon will review the wound and will remove stitches. I have googled womens slippers bunionectomy post-recovery in various formats and it just gives me shoes, which is becoming very annoying. Im pleased with my recovery process. She also stated that a few months after her big-toe fusion, the ankle began to hurt. The exact time differs from one case to another. The gold standard treatment for end-stage arthritis is a surgical procedure that locks the great toe joint up and is called a "fusion" or "arthrodesis". Each doctor determines his or her post-op protocols based on multiple factors. If so, do you have anything to share? Toe socks and metatarsal pads are other helpful natural footgear in rehabilitating the foot after surgery. As you stretch out your feet and point your toes, draw circles or trace the letters of the alphabet. In a normal shoe after three weeks, you can also put on weight. In the spine, theres a name for this problem: adjacent segment disease, or ASD (2). 1st MTP Joint Fusion: If the big toe knuckle joint has a lot of arthritis or a very large deformity, fusion surgery will be recommended. Do you have any tips that youd like to share with my readers? Physical therapy is prescribed by the surgeon and/or specialist who recommended surgery, and typically includes a combination of the following: The shoe saleslady directed me to similarly constructed shoes. Thanks for taking time to comment. Hence, dont immediately buy in when a fusion is recommended, and get lots of opinions. Help? Next, try to lift your toes off the ground once you've lifted them, set them back down onto the ground. However, there are some precautions that you MUST observe including: Without curling your toes, draw your arch upwards by sliding your toes closer to your heel. I am an active person and my inability to workout has been killing me. Week 0-2 Expect a week-long bed rest. However, follow your doctor's instructions so your foot heals properly. Say Your ABCs *DISCLAIMER: Like all medical procedures, Regenexx Procedures have a success and failure rate. FIRST AND SECOND WEEKS AFTER SURGERY: Rest, elevation. $B-Iejq( 7(:\&' *((PtH~9. Try scrunching up the towel with your toes and pulling it underneath your foot, but make sure your heel stays connected to the ground. However, when you fuse the big toe, that energy has to go someplace. In most cases, you will be able to leave hospital on the same day as your surgery, but some patients spend a night in hospital. While sitting, point your big toe towards the ground while pointing the rest of your toes up. While the surgeon offered to retrieve it, Ive chosen to wait and see if it heals on its own. I fractured three toes. The procedure requires a minor incision to be made on top of the big toe and the removal of damaged bone prior to the fusion of the joint with a tiny plate and screw. After you return home from the hospital, you will still need to stay off of your feet as much as possible. This technique helps to activate the intrinsic muscles in the foot that help to stabilize your arch while you stand and walk. Your article is great and it helps me see an end to this at some point. I viewed the recovery process as a marathon where I had to pace myself rather than a sprint that would be completed quickly. These include: Triple fusion - The fusion of the subtalar, calcaneocuboid, and talonavicular joints. However, the correction process shouldnt end up there. #2: Toe Scrunches Sit in a chair with your affected foot flat on a towel or blanket on the floor. therapy and exercise are critical to the success of a lumbar fusion. Remember the swelling is likely to persist (albeit slowly improving) until 4-6 months after surgery. The result is a recovery process that is much . Everyones recovery process is different. My foot still swells and causes pain intermittently. I had bunion correctional surgery and a tendon reattached + my navicular removed. As soon as my foot started to throb intensely, I knew that I had surpassed my limit. Hold this position for 1 to 2 seconds before lowering back down again. My wife and I need a new doctor. Lift your leg straight up until it is about 12 inches off the floor. There are many different exercises that can positively impact the imbalance in muscles, ligaments, and tendons, eventually correcting hammertoe without surgery. Little efforts make the big differences. Failure to do so may put your recovery from surgery at risk. Exercises such as swimming with a pull-buoy between your legs (so as to avoid kicking with your legs) and basic water aerobic exercises can often be quite beneficial. In the early stages, medical professionals recommend that you keep your foot elevated. Hold this position for 3 to 5 seconds before releasing it. Its important that you approach the recovery phase with an upbeat attitude. Each person has his or her own recovery story. Surgery might be your only solution for severe pain and discomfort caused by hallux rigidus, but there are some expenses to take into account if, If you suffer from arthritis, stem cell injections can be used as a form of treatment in addition to the common orthopedic care. With the support of the walker, try toe raises, heel raises, and hip rotations. After checking with your doctor to ensure it is appropriate after your particular surgery, try these home exercises to aid in your rehabilitation after a foot procedure. Tarsometatarsal fusion - Fusion of a joint in the mid-foot. Praying that this is just the dark before the dawn. Fusion surgery means removing the joint so that it does not move anymore and is one solid piece of bone. No exercises are necessary. Do you have any questions or concerns regarding the big toe fusion surgery that I didnt answer? Why? This website uses Google Analytics to collect anonymous information such as the number of visitors to the site, and the most popular pages. Anyone contemplating a surgical procedure that isnt in an emergency situation, should also take the time to consult with more than one doctor. To avoid this, try to rest as much as possible, with your leg raised above your heart. After careful consideration of surgical and non-invasive options, I consented to ganglion metatarsal bone cyst foot surgery. June 2016 in Health + Injury. Although most hammer toe surgeries end up successful, patients need time to heal and regain motion and strength in the operated toe -and some toe exercises can help with it. I slowed my pace when I approached the uneven rocky surfaces and the wooden footbridges that crossed small creeks. Other exercises like walking uphill and climbing up the steps is a great way to increase the flexibility in the big-toe joint. On the Altra website, I read about the Zero Drop Platform and wide toe box. That might be hard after surgery, but Ill be sure to tell my brother that because he may need foot work done soon. <> Good luck! My dad might have to get foot surgery. Ive always tried to incorporate water aerobics using Hydro Fit products, walking in the pool, and swimming with Aqua Sphere training flippers as part of my rehab process. You can do it through the website, or you can give us a call Monday through Friday and schedule a free consultation. Although this exercise is used mostly with an unoperated hammertoe, it can be helpful after the surgery, as well. Everyone has a unique pain tolerance level. I was frustrated. In this surgery, the bony bump is removed and the two bones of the big toe are fused together - Refer to Figure 3. The steps would focus on strengthening and supporting the lower body, especially when standing. Big toe fusion is generally a 45-60 minute procedure. She also recounted how a big toe fusion recovery that she endured was awful in that it took a full year before she felt somewhat normal. You should, however, try to wriggle your toes during these first two weeks this exercise will aid your recovery without causing damage. Do this daily in 3 to 5 minute increments. You may need big toe joint fusion surgery if you are suffering from big toe arthritiswith symptoms of stiffness, swelling and inflammation. Standing both heel raises x 20: Stand close to a wall for balance, raise heels to the limit of toe pain and hold for 3 seconds 7. This exercise uses a towel to strengthen the muscles on the inside and outside of the foot, which are influential in maintaining your balance. Good luck finding a physician who can address your issues. Since then the nerve pain has gotten worse and its worse at night so I be been getting zero sleep which turns me into a grouchy monster the next morning. Tailors Bunion Surgery: A Comprehensive Overview, From Diagnosis To Recovery: Navigating Your Journey With Posterior Tibial Tendonitis, Understanding The Benefits Of Sports Medicine For Foot And Ankle Injuries. Dont get hung up on any minor setbacks. This means that every time you visit this website you will need to enable or disable cookies again. . Its as if my foot wants to walk like it still has the post op shoe on! However, both must be gradual and consider the fusion surgery. These were the only shoes that I was able to wear before the surgery. It is usually a day-case procedure. These are indications that you need to slow down your pace. It is not possible to predict how long it will be before you are pain-free. Orthopaedic Specialists offers consultations and treatment in prestigious locations in the Harley Street Medical area and across London. I like how you said that its good to stay positive. However, if your job involves heavy manual labour, you should not return to work for up to three months, depending on your recovery. The swelling will disperse over the . If surgery was on your left foot, you can usually start driving if you drive an automatic car at this point, if advised by your consultant. For it, you need to place a towel under the operated foot and make yourself comfortable on a chair. You can look to other peoples experiences as a guide, but its unwise to believe that youll follow the same path. Hi Sandra, Hallux rigidus is a degenerative type of arthritis that affects the large joint at the base of the big toe (sometimes called the great toe). Anyway, if you have any additional suggestions , Id love to hear from you. It appears that you are very proactive and will speak up or seek medical attention if something doesnt seem quite right. Gradually, increase the amount of time you spend upright. I ordered the HOKA ONE ONE recovery sandal. Repeat until you get to the end of the towel, then start over. While surgery is not always the appropriate response, it can be an effective way to eliminate or minimize pain. Following a well-structured conditioning program will also help you return to sports and other recreational activities. Additionally, the doctor can help you understand what to expect when . Sandra is the author ofMAY THIS BE THE BEST YEAR OF YOUR LIFE. My doctor did the foot surgery anyway but I do feel like I was thrown from a tall building instead of having had surgery. If your rehab takes longer than anticipated, dont get unglued. You should be able to fit two fingers under your arm when standing with crutches. The road to a recovery after a foot surgery can be a tricky one. After reading a preponderance of medical studies that tie physical activity levels to longevity, Im trudging on. Yes, its great to know that the average recovery time should be X number of weeks. Given those profit margins, there is an entire army of orthopedic sales reps who sell this hardwareto surgeons and hospitals. Patient Testimonial: I cant recommend Onur Berber highly enough. You may be a good candidate for bunionectomy, After surgery, most people can resume their activities in six to 12 weeks. Went to see surgeon this week for check up after 6 weeks and told him the syptoms and he has assured me that the pain in the ball of my foot is still swollen tissue as a big deep neuroma had been removed, and the pain in my toe is part of the nerve pain which will settle down in time,( It is like when you lose a limb, and can still feel your . When you reach the end of the towel, reverse the exercise and move the towel outwards again. When three sets of 10 repetitions are easy, attempt the exercise using only your recovering leg. Yes, the initial few weeks were painful and challenging. moove_gdpr_popup You can set your browser to block or alert you about these cookies, but some parts of the site may not work then. 147 0 obj <> endobj 168 0 obj <>/Filter/FlateDecode/ID[<58C81D8E26B0384FAEE6C40116D36DEC>]/Index[147 64]/Info 146 0 R/Length 107/Prev 518608/Root 148 0 R/Size 211/Type/XRef/W[1 3 1]>>stream Since I rarely experience post-op bruising, I was surprised. However, with the proper care, rest, and toe exercises, healing will occur much faster. I purchased a second pair to wear when I go swimming. Adjacent segment disease. Hi Kathleen, As I mentioned in one of my posts, the HOKA rocker sandals were a wonderful addition to my shoe wardrobe. Repeat the process ten times, and then start with the exercise again, but this time move in the other direction. Without allowing your heel to leave the floor, use your foot to slide the towel in an inward direction. Increasing the movement will help you obtain a more normal walking pattern and can also help improve your balance as you begin to move around again. After a couple of weeks, I flew to Chicago. However, you should also check with your car insurance provider. Foot pain in rheumatoid arthritis prevalence, risk factors and management: an epidemiological study. Part 1 Setting Yourself Up for Recovery 1 Stock up on food and other supplies. yo have been quite helpful Thanks, Rebecca, She also writes for Fareportals online sitesOne Travel Going Places and CheapOAir Miles Away. Sandy. Follow your doctor's instructions for putting weight on your foot. Without curling your toes, draw your arch upwards by sliding your toes closer to your heel. If you start too early and dont do these exercises correctly, you can intensify the pain after hammertoe surgery and interfere with the natural healing process, which will prolong the recovery. The operation can be done under local or general anaesthesia (with an added injection during the operation in the foot to numb the foot for pain relief after surgery). Ive invested in a light footrest and made sure theres a good space so me to sit in every room so I dont get claustrophobic. You will continue to wear the post-op heel weight-bearing shoe as well. So thats what we did and it was determined that the cast the surgeon put on was way too tight and not able to expand with the swelling so the cut into it to reduce the pain and sent me home. I hope by now you are well on the way to a full recovery. I had no choice but to remain patient throughout this tedious process. When it gets bad, it can result in lost range of motion in the metatarsophalangeal (MTP) joint, and the medical term for this is hallux rigidus (Latin for rigid toe) (1). For some bizarre reason, one of the treatments is to fuse the MTP joint solid with one or more screws. Prior to leaving the hospital, a physiotherapist will teach you how to navigate around using a pair of crutches. If those methods don't relieve your pain, surgery may be a good option for. stream Lesser Toe Surgery 5 PIPJ Arthroplasty/ PIPJ Arthrodesis/DIPJ Arthrodesis 5 Correction MTPJ Lesser Toes/ Stainsby Procedures 5 MIDFOOT PROCEDURES 6 First Tarso-Metatarsal Arthrodesis for Severe Hallux Valgus 6 Tarso-Metatarsal Arthrodesis (1,2 & 3) 6 ORIF Metatarsal Non-union/ First Tarso-Metatarsal Arthrodesis 6 Mid-foot Arthrodesis 7 The toe is positioned according to the need to roll off the big toe and will rest off the ground when standing. It is important, however, not to overdo it, so try to avoid walking long distances. For this type of exercise, you wont need any kind of additional equipment. HOW TO DO IT: Sit in a chair with your bare feet on the floor. Sandy. Pain and swelling are common side effects and each type of operation has its own unique challenges. HOW TO DO IT: Sit in a chair with your foot resting on a towel. My surgery didnt require any type of brace so I cannot recommend anything. This is a general conditioning program that provides a wide range of exercises. We would be happy to help you in any way you need us to, so dont hesitate to get in touch. cookielawinfo-checkbox-non-necessary. Yikes! The Foot & Ankle Orthopaedic Surgeon 1.68K subscribers Subscribe 93 Share 19K views 1 year ago This video goes through the chance of. i(YR$]d-QFzvG=vwwxaw[?rPSf{BJv4LhMN}4L . It was the same one that was prescribed after my injury. Do not mistake the smaller interphalangeal joint which is . My hip started to suffer from the unevenness of my gait. While there are a few medical problems that truly need a fusion, based on my experience, this surgery should never be used as a way to commonly treat pain with surgery. Best wishes for a speedy recovery to your brother for his upcoming surgery. When it gets bad, it can result in lost range of motion in the metatarsophalangeal (MTP) joint, and the medical term for this is hallux rigidus (Latin for rigid toe) (1). 1 0 obj Keep in mind that you should not start exercising without previous medical consultation. Sandy. Procedure. I looked at the composition of the post-surgical shoe and observed that it was totally flat and extremely wide. Your toe joint will be stiff and quite sore and swollen. Bev, This stretch helps you improve the flexibility in your calf and assists with regaining a normal heel to toe walking pattern. Early on after surgery, try to do one set of pumps for each hour you are awake. You will be given a special shoe you can wear for 6 weeks. High-impact sports should still be avoided but swimming is generally fine. The pain was definitely more than I anticipated. This exercise also helps to push swelling from the foot by contracting your calf muscle. Looking for more insight? As a former teacher, I say THUMBS UP to this shoe. This is normal, and the smarting should subside within a day or two. Clin Rheumatol. In some situations, non-weight bearing activities such as swimming and riding a stationary bicycle may be better than walking. Keeping this cookie enabled helps us to improve our website. First MTP Joint Fusion For Big Toe Arthrititis | Jeddah Foot & Ankle Surgeon. Pain can be so debilitating. Orthopaedic Specialist Partnership LLP 2022 | Privacy policy | Cooking settings. Im recovering slowly from all of it because my pain is everywhere. Once you do, start returning toes to the ground, one by one, starting from the small toe. Her ankle was tender and so was her big toe, despite the fusion. 5. List of Specific Home Exercises to Do After a Broken Fibula, Knee Surgery, Sports Traumatology, and Arthroscopy: Rehabilitation and Surgical Treatment of Peroneal Tendon Tears and Ruptures, Manual Therapy: Effect of Plantar Intrinsic Muscle Training on Medial Longitudinal Arch Morphology and Dynamic Function. This means your foot will be numb during surgery and a few hours post-procedure ensuring minimal pain is felt. I love your knee injury rehab tips. The goal of the operation is to have patients weight bearing through their big toe again. You can use ice cubes behind your knee to prevent swelling. While each of the exercises listed above can be beneficial, it is extremely important to check with your doctor prior to beginning the regimen to ensure it is appropriate in your particular situation. drGo#c;2Lb 7KShvHZArHV1+'!(\\o}sBAc&B[M*O[=?zKg~C3Y(~tH^K0vf#!rhpqMG\BRP?@Ubc; OC Successful rehabbing requires being motivated to reach definable milestones. She also taught college-level courses. After surgery, you may need to wear a special type of shoe or boot for 3 to 6 weeks. Tandem Walk Tandem walking is a great balance exercise that also helps you regain a normal gait pattern after a surgery. RULE 2: Keep your training pain level at a 4/10 or lower. As the weeks go on, standing exercises will help fire the muscles in the lower back and legs. Focus on the benefits of your surgery rather than the frustrations that normally encompass a surgical procedure. As this becomes easier, progress the exercise by looking straight ahead. Reply Janna Banana over a year ago From my experience, I would rather look forward to the end of a recovery than cope with endless days of pain with little hope of improvement. International Medical Centre PO Box 2172 Jeddah 21451. After disc protrusion surgery, there are some exercises you will want to avoid. HOW TO DO IT: Sit on your bed with your ankle hanging off the edge. Yes, I agree that its always best to focus on positive aspects of a situation. Wrap a towel around your foot and pull up towards you until a moderate stretch is felt in your calf. Patience is another important ingredient to the overall success of your rehab process. Because her toe joint fusion recovery was a long-drawn-out process that forced energy from her toe to her ankle. The only exception is when the toe is not yet completely fused. My tip would be to buy(we got off internet for NZ$200) a wheelchair. Hence, given the business plan, its not surprising that fusion surgery has become so popular. Thank you for sharing and allowing others to as well. Nevertheless, toe exercise can be beneficial in this case as well and help you prevent hammertoe reappearance. In order to achieve the best results after the correction, make sure you practice the following hammer toe exercises. Pull the toes towards your body with the help of the towel and keep that position for up to thirty seconds. 2 0 obj Let me explain. Whenever possible, I arranged for wheelchairs and reserved a handicap room. For more details about recovering from big toe joint fusion surgery, read our downloadable patient information leaflet. Used to treat hind foot pain and/or deformity. . Over the past 10 years of practicing I have been looking for procedures to maintain pain-free motion, reduce downtime from . Symptoms of osteoarthritis of the big toe include tenderness, achiness and pain at the joint, and occasionally, a burning sensation. After toe fusion. Sandra Bornstein is a freelance travel and lifestyle writer. I was extremely tired and simply didnt seem quite right. Put the foot on the opposite tight, place your finger between the toes, and squeeze them together. Selected clinics are also available in Ascot and Brighton. In addition, any significant increases in swelling or pain should be reported to your physician as they may be a sign of something more significant like an infection or a blood clot. For the first couple of weeks, my foot was wrapped in an oversized soft cast. Given that there is no way to undo the big toe fusion surgery, outside of treating her ankle to keep it hanging in there, there was no solution to that issue. Simply walking in the pool can be the first step. Copyright Regenexx 2023. Important note The operation in general will involve 1-2 incisions around each toe that requires straightening. Each body part has a different number of nerve endings. Thank you. Thanks for sharing your story! Main Risks of Big Toe Fusion Surgery: Swelling - Initially the foot will be very swollen and needs elevating. Youve got great tips for foot surgery recovery. <>/Metadata 64 0 R/ViewerPreferences 65 0 R>> Predictably the pain was unbearable by Saturday night and of course the doctor couldnt be reached. Read books binge Netflix. x[ms6|31B t:n'NOv&Z$2R\] $%Ru:S@~3#pv<>"`>3IVG_d#|&X" --2.3aGSz204aHd+KONox3|swI8avw3>OMW/]SO{B8)4xBC&1US9>Er{VNT:^DWmpMQya5/kxtCkeuI:}"l)C3}Dj]ohk.a0rN& Tips for Handling Multiple Doctors Opinions. Thanks again and best wishes with your continued recovery. I made sure that the organizers of the trip were aware of my limitations. Perform three sets of 10 repetitions daily. Ranging from 1 to 5 pounds, they allow you to progressively increase strength and endurance in a safe manner. I suggest asking your doctor or physical therapist. Attempt three sets of 10 repetitions each day. After your big toe alignment is improved with surgery, regaining your range of motion (how much you can move a part of the body) is an important focus. When this is easy, progress the exercise by staring straight ahead or by closing your eyes. You can find out more about which cookies we are using or switch them off in settings. Take care, Sandy. This apparatus made me feel off-balanced when I hopped around on crutches. In this post, I answer most peoples questions regarding the surgery. If you need surgery, I hope you have a positive outcome. Lones Peak 3.5 trail running shoe by Altra, tips for recovering from ganglion cyst surgery, The Traveling Bornsteins Motto for 2022: Keep Moving-No Regrets, Recapping 2022 Events: 100 Things to Do in Boulder Before You Die, How Skiing and Travel Have Enriched Iras Glioblastoma Journey, Continuing to Promote 100 Things to Do in Boulder Before You Die. If youre an active person, it will be harder to deal with your lack of independence. You many need to spend one night in hospital. Yes, active people struggle when they need to be in a rehab mode and cannot do everything that they want to do. Your body is strong and wants to recover and get stronger. A big mistake I see a lot of post-fusion people make with exercises is pushing too hard or not pushing at all. . While ordering shoes online can be a disastrous experience, I decided to take a gamble. After several weeks, I was back to swimming for more than 30 minutes without stopping and doing another 30 minutes of combined aerobic activity and walking in the pool. Swimming and Water Aerobics In theory, water activities can be started relatively soon after surgery. Use life-giving positivity to put the breaks on your negative thoughts and negative life-draining negativity. Good luck! I was able to participate in a weeklong press trip which uplifted my spirits. Guide to Recovering From Your Foot Fusion Surgery Contact Us Call: 250-868-9799 by Okanagan Health Surgical Centre November 01, 2017 Are you considering a foot fusion surgery? Balance can be a challenge when your feet hurt, and the goal now is to re-balance your body after foot surgery, and exercise, (the right exercises) can help you achieve this goal. The surgery, involving an incision on the upper part of the big toe, extraction of bone spurs, and fusion of the big toe joint with low profile thin plates and screws; is performed under a general anesthetic. Over time, I put more and more weight on the surgical foot. I am overweight and have a habit of walking barefoot around the house, which I have read is not good. Yoga/Pilates Yoga is another exercise that you can jump right into after surgery. By lightly pulling on the towel, slowly bring your toes back towards you until you feel a stretch. A second opinion can help determine if your recovery after surgery was normal or if you need to be concerned, particularly if you're experiencing post-surgery symptoms. To my surprise, I walked up a steep portion of the Oregon Trail. HOW TO DO IT: Stand in a long hall way or an open room. 4 0 obj This website uses cookies so that we can provide you with the best user experience possible. Fusion surgery (Arthrodesis) of joints within the foot. I was instructed on how to use crutches so that I could be partially weight-bearing. A medical expert should determine the ideal time, to begin with the exercises and provide you with valuable advice on how to do them properly. You don't have to spend hours exercising your feet! The foot pain will intensify and the toes may swell. My daily walking was kept to a minimum. FeqTd.EL{q"hpzQ|X-|, OvJsXB%+C `K~0 @vlgNfXozEr:rG}Wv&B,L, {l-R#){q>%XqL_%N&O+T>72R@_!} Call our friendly team today on 020 3195 2442 Online payment Refer a patient Contact Information A-Z of all conditions and treatments Health Professionals How Long Will It Take For My Heel Pain To Go Away? It is possible to return to low-impact sports in six weeks. Most people are not able to resume all their usual activities for at least 6 months, and it may be 1 year or more before . Perform three sets of 10 repetitions daily. Higher impact sports can be done around ten to twelve weeks after your operation. I was thrilled that I could do this at less than 6-weeks post-op. If youre not sure how quickly you should be increasing your activity level, call someone on your medical team. Please see our privacy policy for more information relating to GDPR. Continue taking your pain killers regularly. Big toe fusion surgery is often recommended for patients suffering from big toearthritis and severe bunions.
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