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Could arthritis be TMS? (big toe joint)

Discussion in 'Support Subforum' started by avik, Sep 22, 2022.

  1. avik

    avik Well known member

    Been dealing with on and off big toe pain for 5+ years now and finally decided to go to a Podiatrist last week to get it checked out.

    I have something called "Hallux Limitus" or, limited movent in the big toe from a deteriorating joint due to arthritis. It's apparently a very common thing, it can be seen very plainly in the x-ray and it apparently cannot be fixed.

    It only gets worse with time. Yay!

    I can't help but think how reminiscent this is (for me) of my old TMS neck and should problems. BOTH of which involved the supposed deterioration of the cartilage between the discs of my spine and the rotator cuff in my shoulder. The same thing is happening to my toe.

    Is the TMS causing inflammation/arthritis? Seems very plausible to me.

    I'm happy to attribute this to TMS and quite literally just walk it off but...I am concerned that it will just deteriorate further. Doc says if I don't get aggressive with it now, the cartilage between the two joints in my foot will at some point in the next decade, cease to exist. At this point, the joints must be fused together as the pain becomes unbearable.

    So...what do ya'll think?
  2. mbo

    mbo Well known member

    IMHO arthritis is just "tear and wear", but the pain atributed to arthitiz is just TMS.
  3. Katia

    Katia New Member

    I'm so glad you asked this question. I've been diagnosed with hallux limitus, and wondered the same if it's TMS. Oddly, I have no pain. The symptoms that sent me to the dr. were intermittent redness and swelling in my big toe and top of foot.
  4. avik

    avik Well known member

    hi Katia-

    The swelling and redness could be from Uric Acid buildup/Gout.
    Have you had your uric acid levels checked?
    Have you ever had kidney stones?

    Gout can lead to hallux limitus...
  5. Katia

    Katia New Member

    Hi Avik,
    Thank you so much, this is great information. I haven't had kidney stones and haven't had uric acid tested, but I'll definitely ask for the test.
    I appreciate this information. Thank you!
  6. JanAtheCPA

    JanAtheCPA Beloved Grand Eagle

    @avik and @Katia, I believe that you're both talking about yet another inflammatory/autoimmune condition, am I right? the kinds of conditions that seem to be increasing exponentially recently?

    As I was forced to acknowledge when I was diagnosed with RA in the spring of 2020, long-term exposure to unmitigated stress will overactivate the inflammatory response and thus the immune system, leading to the development of a growing number of auto-immune conditions. In my case, I believe it was the buildup of outside societal stressors starting in about 2016, then the pandemic and a burn-out volunteer job in the spring of 2020.

    Ironically, it's not like I didn't already know this - I've been a big fan of Dr. Gabor Mate, MD and When The Body Says No since I discovered his work in 2012, not long after I discovered Dr Sarno. And even as I read his book back then, I thought about how my lifetime of anxiety had led to multiple doctors diagnosing me with stress and advising me to get it under control for my long-term health (smart docs!) But my stressed-out brain was only willing to go so far. I had great success resolving many TMS symptoms back in 2011, including disabling anxiety attacks. I got my life back, but I still slipped into super-stress mode during demanding job times (tax accountant!) and as a goodist and perfectionist I managed to increase the stress of my job in multiple ways, along with volunteering for at least three other local activities.

    Anyway, after the RA diagnosis, I consulted with David Schecter, MD (well-known TMS doc) who told me that although I was probably correct to attribute the onset of RA to stress, now that the inflammatory process was in place and affecting my joints, I had to be a good patient and take the medication and do what my rheumatologist told me. Dr. Schecter did say that he's seen remissions from RA, which I attribute to people working on the stress (aka TMS) aspect.

    I don't have answers, by any means, and I am, after all, a CPA (retired!), not a medical professional. Still, I have my theories, based on many years of doing mindbody work. Personally, I have improved my general day-to-day mindfulness and acceptance of the RA so that I can maintain quite well on a low dose of the most standard RA drug, without side effects - so I'm grateful for that. I have increased my exercise level, and significantly reduced my intake of added sugars (other than too much sugar, my diet has always been pretty healthy).

    I still believe that if I managed to engage in meaningful meditation every day, that I could achieve remission - but my brain resists.

    These are hard times, folks. Be kind to yourselves. And perhaps heed the advice of Dr. Schecter - protect your joints and get the inflammation under control, even if that requires medical intervention, then work on the stress behind the inflammation. That's my theory, thoroughly unproven.

  7. avik

    avik Well known member


    Thank you for your incredibly insightful, informative most importantly...sensical post.

    I agree that once the inflammation gets started, you try and knock it down with any and all means to allow for some space to do the mind-body work.

    But...is it possible that that in and of itself (the attention, the medication, etc), is only feeding the TMS?

    For me when I had rotator cuff issues (for example) and I was in excruciating pain...it was only when I stopped taking meds, pushed through my workouts, and stopped giving it any attention, that it completely subsided.

    Again, your approach makes so much sense but there's this "hardcore" TMSer side of me that just wants to tell my toe pain to go to hell and power through the pain.

    I can't tell you how many times and with home many tms-iterations that I have internally debated this very point.
  8. JanAtheCPA

    JanAtheCPA Beloved Grand Eagle

    There's just no simple answer to any of this. It took me a while (as a dedicated TMS advocate) to become concerned enough about the condition of my hands in April 2020 to finally see my primary doc - who became quite alarmed and immediately sent me for x-rays and blood tests. The x-rays showed no joint damage "yet" but the blood tests showed inflammation. She sent me to Rheumatology and that doc ordered 14 more tests. No wait - it was 14 different tubes, so the number of tests those covered was more than 14. Big fun. The comprehensive tests confirmed RA, as opposed to other possible AI conditions. Confirmed diagnosis, clear plan of treatment.

    I'm all about TMS, but I'll draw the line at arguing with blood tests. I had really been hoping that they wouldn't find anything wrong, and that I could work on it as TMS, but it was not to be. I conferred with Dr. Schecter to ask if I could just deal with it as TMS, and he said Nope.

    Now, in a story that appears to start out the same way, @TG957 describes in her book (highly recommended, by the way) a lengthy process through the traditional medical system to try to diagnose the swelling and redness and dysfunction in her hands, a condition that one of her aunts had also suffered from for years, so she was naturally looking for a genetic disease. She eventually obtained various diagnoses of CPRS, Reynauds, CTS, and other stuff. The thing that's important to note is that she had blood tests, and autoimmune conditions were consistently ruled out. Then she discovered Dr. Sarno and TMS, and recovered from all of her symptoms with a rigorous and committed meditation practice in addition to TMS knowledge and techniques.

    I read Tamara's book after I started having symptoms but before I was diagnosed, and I found it to be powerful and inspiring. Yet in spite of that, and in spite of my knowledge, experience and ongoing successes over 9 years, and in spite of increased attention to mindfulness, meditation, and writing that spring, my symptoms kept increasing rapidly, to the point where I was severely disabled. I woke up one day and said "holy crap - this can't be right!"

    So I totally get the desire to treat everything as TMS, but as I'm sure you know, we ALWAYS say that if you have a new symptom which concerns you, you should have it checked out. Which you have done. And you've received a diagnosis, a picture of what is "wrong", and a dire prediction about the future - just as you and many others have received many times before.
    I re-read your post and realized that I misinterpreted this sentence: "Doc says if I don't get aggressive with it now, the cartilage between the two joints in my foot will at some point in the next decade, cease to exist." What does the doc mean by "get aggressive now"? Is he/she recommending an aggressive treatment? Or, as I thought at first, does this mean that you should avoid stressing the joint (being aggressive with it), although in ten years you will still be f***ed, no matter what?

    If this really is similar to arthritis, I guess I would want to know if there is an inflammatory or AI component. Would a rheumatologist (as opposed to a podiatrist) recommend blood tests to rule that out? Osteoarthritis is extremely common with aging, but it's not inevitable - and it really should not be seen in younger people, unless (going back to Dr. Mate) emotional stress has resulted in an inflammatory process well before the body starts naturally dealing with aging.

    Apart from the fact that we all need to de-stress (good luck in these times), none of this is black-and-white. Especially when we all know for sure that the medical folks who interpret joint and ligament and cartilage damage often produce dire predictions which don't need to come true at all. Not only is that your personal experience, but it's also Dr. Sarno's original premise in Healing Back Pain.

    I sure wish we all had better answers.
  9. Duggit

    Duggit Well known member

    When I saw hallux limitus in your post, I wondered if that is anything like my left and right big toe conditions called hallux rigidus. Here is what I found at https://www.healthline.com/health/hallux-limitus (Hallux Limitus: Definition, Symptoms, Causes, and Treatment):

    “People with hallux limitus have limited flexibility in the joint and trouble bending their big toe. The inflexibility leads to pain, especially when walking. As the condition progresses, you can develop bone spurs and arthritis in your big toe, eventually making the toe joint completely rigid. When this happens, the condition is called hallux rigidus, which is osteoarthritis of the big toe.”​

    The cause of my hallux rigidus was a structural problem called subtle cavus foot, which is sort of the opposite of flat-footedness. The arch is too high and the heel is misaligned. This results in underpronation during the gait cycle. When one walks, the heel hits the ground first and then weight bearing moves forward to the ball of foot, with the weight smoothly and rapidly transfering from the head of the fifth metatarsal bone (which connects to the little toe), to the head of the fourth metatarsal bone, then to the third metatarsal head, then to the second metatarsal head, and finally to the first metatarsal head (which connects to the big toe). With subtle cavus foot, the weight does not properly transfer across the metatarsal heads. Right after the heel strikes the ground, the fifth metatarsal head bears too much weight for too long, and the first metatarsal joint ends up having too much mechanical stress because of the limited ability of the big toe to flex.

    I suffered pain at both the fifth metatarsal head and the big toe joint of my left foot and pain at the big toe joint of my right foot. I had surgery on my left foot to accomplish two things: first, raise up the fifth metatarsal head to reduce the weight bearing on it and second, fuse the big toe in a slightly flexed position to reduce the mechanical force on the big toe as weight bearing rolled to the inner side of the foot. I had only the second procedure done on my right big toe.

    This was roughly fifteen years ago. The surgeries did not work, so then I was prescribed expensive custom orthotics for each foot. They did not help, so I went to another expensive custom orthotic maker and tried again but got the same dismal result. I did not know then, but do now, that both of these “professional” orthotic makers were one-trick ponies—they knew how to make orthotics for flat feet but not for subtle cavus feet.

    Several years later, the MD who did my foot surgeries told me about a new off-the-shelf orthotic designed by Arthur Manolii II, MD, who has done pathbreaking research on subtle cavus foot. Although the orthotic is not custom made, it comes in different sizes for people with different shoe sizes. This orthotic did not completely banish my big toe pain but reduced it so significantly in both occurrence and intensity that it did not affect my life in any meaningful way. If you are interested in trying this orthotic to see what happens, it is called Arch Rival and is inexpensive compared to custom orthotics. Amazon has it (as of today’s price) for $58.07.

    I will add, happily, that my situation has improved even more in the last few years. I now have foot pain only on rare occasions—maybe two or three or four times a year. The pain is minor and stops completely after a few days. For example, several weeks ago I was trimming a hedge with an electric trimmer and tripped over an object that I did not see because of the vegetation. I fell forward with the still-running trimmer in my hands so I was unable to break my fall by extending my arms. As a result of falling flat, my big toe was bent way back at an abnormal angle. I instantly had toe pain. But it was fully gone in a few days, as I expected. (I don’t even remember whether it was the left or right toe that was hurting.)

    Why did I improve so incredibly the last few years and why did I just say the pain stopped “as I expected”? I have been a follower of Sarno since 1991 with great success regarding other ailments, such as chronic low back pain. In the last few years, I have updated my concept of TMS with Howard Schubiner’s neuroscience-oriented work, especially his current iteration of it that is anchored in predictive coding (also known as predictive processing). We all know that pain is a sensation, and in Schubiner’s words: “the brain creates the sensations it expects us to feel.” I expected the toe pain to go away within in a few days after the accident, and it did.

    Predictive coding is a fancy “neurosciency” version of what Sarno called Pavlovian conditioning. For example, Sarno wrote the following in The Divided Mind: “One of the prime characteristics of TMS is that the pattern of symptoms will develop as a result of Pavlovian conditioning. People will experience the kind of symptoms they expect to experience, just as Pavlov’s dogs learned to associate the presentation of food with the ringing of a bell.” He then gave the example of a TMS patient who had pain with walking and another one who had pain with sitting that was relieved by walking. Sarno continued: “Experience with large numbers of patients at our clinic makes it clear that these are programmed responses that bear no relationship to anything beyond what the patient is conditioned to expect.”

    How I came to expect my toe pain to stop within a few days on those rare occasions when I tweak one of my big toes is too long and technical a story for me to tell here. The point I want to make, avik, is that just because you have a structural problem called hallux limitus, which might well worsen into hallux rigidus, does not mean you are doomed to a life of chronic toe pain trouble. An orthotic or surgerical fusion might solve solve your problem, but if not, you can still get rid of the pain with a TMS approach.

    By the way, I once met a guy whose surgeon fused his big toe so that it was straight, rather than with the end of it tipped up a bit. The guy had a lot of pain walking. If you have surgery, pick a surgeon who knows not to fuse the toe straight.
    Last edited: Sep 23, 2022
    BloodMoon, TG957 and JanAtheCPA like this.
  10. Katia

    Katia New Member

    You are so right! The vein dr. I saw suggested that the heat intolerance/redness/swelling may have an autoimmune component. I haven't had any tests yet, but I think I'll have a chat with my primary doc about this.

    Thank you so much for sharing your experience with RA and also Dr. Schechter's advice. The thing about protracted stress resonates with me. I was grappling with my symptoms a lot last night and identified fear as a driver behind so many of the stressors I experienced at the onset of these symptoms. I immediately started re-reading Claire Weekes. I first read her book maybe 5 years ago. It was enlightening then, but now this re-read is helping me see the impact of the huge pile of stress (and fear) I've been steeped in for years. Your powerful words and experience about how stress is not just a thing we cope with hit me between the eyes. I am retired. I've gone through some tough ups and downs in life. Those years of life, work, and stress have taken a toll. I hear you!

    Thank you!
    JanAtheCPA likes this.
  11. TG957

    TG957 Beloved Grand Eagle

    I will not claim that all autoimmune conditions are TMS (and very likely they have a very substantial genetic component to them), but there is evidence that mindbody methods can help either control or even significantly reduce symptoms.

    Shannon Harvey was diagnosed with autoimmune disease and was told that she had, if I remember correctly, ~10 years to live. Since then, she fully recovered, had two children, lives a busy life, and has no plans to die anytime soon. She made a fantastic documentary about her experience: https://www.shannonharvey.com/pages/the-connection-documentary (The Connection Documentary).

    As for osteoarthritis, I have had bunions (which are considered a form of osteoarthritis) for decades. What is interesting, the one that is much bigger rarely hurts, but the other one is often painful - remember the study quoted by Dr. Sarno, where they compared painful spines and non-painful spines? Even more so, I described my recent experience with the pain in my big toe in this thread: https://www.tmswiki.org/forum/threads/tms-is-a-trickster.26264/ (TMS is a trickster!). Since then, I had faced a very stressful family situation for about a week, and during that week, my toe became very painful again, despite me not walking much during that time. Once the stressful situation resolved, my toe is pain-free again.
  12. JanAtheCPA

    JanAtheCPA Beloved Grand Eagle

    So far there is no substantial evidence for a genetic component to RA, although I have no doubt there is an inherited one - just like anxiety and TMS are "inherited".

    What I find laughable is that even the most conservative medical authorities say that reducing stress is important in managing RA - but they still won't admit the possibility that RA could possibly be caused by by an excess of stress.

    I really hope I live to see the day when stress is finally viewed as the primary trigger for many conditions. Unfortunately, that day is unlikely to come as long as Big Pharma has a stranglehold on the medical industry and medical research.
    TG957 likes this.
  13. TG957

    TG957 Beloved Grand Eagle

    I would say that Big Pharma is not the only culprit. The technological advances in treating many deadly illnesses created unreasonable expectations in the society, to which Big Pharma and doctors respond with their "magic pills'. People unfortunately do not understand that lifestyle diseases cannot be treated by magic pills. The other problem with our society is stigma surrounding mental health. Having something "in your head" is not cool. Having anxiety is embarrassing. Having depression is shameful. Unless it changes, we will be forever stuck with Big Pharma.
  14. avik

    avik Well known member

    Duggit-apologies for the late reply here. Thank you for this comprehensive reply.
    Im a bit confused-you mention a structural issue at the beginning of your post but then allude to it being TMS at the end.
    Its possible I misunderstood; what do you think ultimately cause your Hallux Rigidus?

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