I was wondering if anyone could tell me if there are any standard types of physiotherapy techniques that are used post-op for cheilectomy/osteotomy? and, any ones that are avoided?

I had my right toe done four months ago (hallux rigidus) - it was thought to be the source of biometric imbalances causing numerous inflammations and degeneration of joints along entire left side of body (trochanteric bursitis; inflamed ITB syndrome; piriformitis; ACL; bursitis in both knees; inflamed Wikipedia reference-linkfacet joints; plantars fasciitis; etc).

My concern is that I've been going to physio diligently for more than three months (since week 3 post-op) and am very unhappy with the progress. I was in the velcro walking shoe for the initial four weeks; then into Asics with custom orthotics from week 4 onwards. I have also been doing my exercises and stretching and strengthening work at home, at least 5x a day - plus pilates techniques (I had to stop swimming at week 6 because of another injury) and some powerplate exercises.

I used to be able to walk 10miles without breaking a sweat - now, I have to take a taxi for a 1mile walk because the pain under my 1st MJ is unbearable. I can manage to force my foot onto tippy-toes, but only whilst sitting down and a bit standing until it shakes and drops. I can walk for longer but then have pain in the cuboid area, overloaded left foot, increased hip pain; tight psoas; swelling in the arch, etc - I still walk but some days, I just can't make it.

My physio does only the following and has only done the following since the op and beginning:
[INDENT]Plantar flexion of the entire foot
[INDENT]Plantar flexion of just the big toe
[INDENT]Dorsal flexion of the entire foot
[INDENT]Dorsal flexion of just the big toe
[INDENT]Pulling the big toe
[INDENT]and half of the foot plantar whilst the toe is dorsal and reverse.

Occasionally she has rubbed the 2nd MJ as it is inflamed. She has not examined or treated the flexors even though one is bulging in the arch. The area under the 1st MJ is completely flat, the fat pad is gone and there is no tone ever since surgery. I'm not exaggerating when I say she only does those five things (2x a week for half hour each time).

I have complained since week 4 about the unbearable pain in the sesamoid area and am now completely unable to walk normally - my gait and roll-through are wrong as the foot transfers weight to the outside of the foot to avoid the area. I consciously try to walk through it and force weight bearing but my foot has a mind of its own. I've developed new calluses between 2nd and 4th MJs where I'm over-loading. Pronation on both ankles has also increased since op.

My physio continues to force the foot down and then immediately up - both extremes are so painful I have cut my hands with my nails. Even worse, now when she moves between the two stretches, the bone in the joint catches on a piece of another bone and then snaps before moving out.

Range of motion isn't too bad - fairly good in both directions (sorry, I don't know the angle % - but my physio never measured it either) but residual numbness in the top of the toe makes it difficult to make this joint move. The bone catch mentioned above now occurs when moving toe up and down without force.

My concern or questions are really around the following:
1. Should physio encompass more than just forcing the foot up and down?
2. Should forcing the extension be so painful to make someone cry?
2a. If someone complained about pain around the sesamoids, would you consider flexing the foot then putting hard pressure on this same area?
2b. Is it possible to injure someone doing this? I'm wondering if she has hyperextended the tendon and torn or ruptured it or caused some soft-tissue damage? (I am quite vigorous with my own stretching and do push myself but not to the same level)
3. Should the pain on walking be raised to the consultant earlier than 2mons after?
4. What do any of you suggest to improve my chances of healing and returning to activity? Are there any exercises or techniques that you would do on a patient with a similar injury?
(she has also refused to treat any of my other issues whilst the toe is 'healing' - walking with a limp and with bad technique has really not done any wonders for the long list of problems!)

I'm not looking for evidence of a bad practitioner; I just want to know if I'm getting the right treatment and what else can I do to fix things? I will not identify my physio. I have stopped seeing her now as I've lost confidence in her ability to do anything other than push my foot up and down. Believe me, I have asked all of the above to her with very little by way of answers!

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