Hallux rigidis, post surgery, causing pain in proximal phalange

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Hi all,
having had a very quick browse through related threads and mainly finding hallux rigidis pre surgery, just wondering if anyone can help with a patient who has post surgical hallux rigidis, causing extreme pain in the big toe. The surgery was just on 6 months ago and has been relatively pain free, but now, with normal activity, there is extreme pain in the proximal phalange. We are trying a rocker bar on her shoe and I have suggested using rigid soled shoes (i.e.'shape-ups'), does anyone have any other suggestions? Can movement be recreated in the joint with followup surgery/
Thanks

 

what was done?

 

yes, a bit more information on the surgery itself (debride, fusion, implant....) and where exactly is the pain now.
Is the IPJ hyperextended? What's the ankle dorsiflexion like?

Re: shapeups. I would suggest that with the posterior located rocker bottom the shape ups might exacerbate forefoot pain.

Steve

 

I find that for ladies Dansko shoes work quite well as they have a very firm forefoot rocker. More info would be nice though.

 

What was the surgical procedure performed?
Has the patient had physical therapy after the surgery?
What was the event that started the patient’s current pain?
Has the patient worn functional orthotics after the surgery? Possibly with a Kinetic Wedge® modification as discussed by Howard Dannenberg, DPM.
Also consider Deep Heel Seat orthotics with reversed Morton’s extension.
Some factor that may add to Hallux Limitus post surgery pain:
Gastrocnemius-soleus equinus
Functional hallux limitus
Functional hypermobility of first ray
Long first metatarsal length pattern
Metatarsus elevatus.


Roberto