Effectiveness of Vayli Danenbergs for hallux rigidus

really you think that after 2 or so years of discussions

Oh well.

I´ve no idea I don´t think it would be .

I thought I was making an interesting point re the changes in Kinetics and Kinematics which might occur if the joint was fused in hallux rigidus - it appears not.

I will leave you guys too it and let you return to normal action.

Ps Ian how much you benching these days ?

 

On the use of a kinetic wedge in a hallux rigidus foot prior to surgery. It's entirely possible the pain come from compression of the joint and not necessarily the motion. It may also hurt in the maximum dorsiflexed position. But the pain can occur when there is no demand for dorsiflexion motion. Ground reaction force can unwind the windlass and create tension in the plantar fascia. This tension will compress the joint surfaces together and this may be what's causing the pain. I'd have no problem trying a treatment that was designed to reduce tension in the plantar fascia for hallux limitus.

Eric

 

I like to think about hallux limitus about hurting because the joint does not bend when it should, vs having it simply hurt via movement. Repetitive jamming of the joint during the gait cycle can create an environment of repetitive healing! The inflammatory response begins daily, and this leads to the chronic pain associated with structural hallux limitus/rigidus. By changing the movement process in this joint, pain can resolve and movement can substantially improve. However, the one thing that I also recommend is to examine peroneal strength, particularly peroneus longus. When the peroneals are inhibited, there is insufficient stabilization of the 1st MTP joint and pain develops. To re-establish peroneal strength, ankle manipulation is required. You can go on www.vasylimedical.com website or search “Dananberg manipulation” on Youtube for an instructional video.
I have no problem using 1st ray c/o orthotics in the management of hallux rigidus, and have seen changes when combined with peroneal “strengthening” that are often astounding. There are times when a very stiff joint hurts to move and in the early days of care, either NSAID’s or a single cortisone injection can be very helpful to get over the hump. Using Morton’s extensions may help for short periods, but will eventually result in a stiffer, and more difficult to treat 1st MTP joint.

Howard

 

Hi Rach,

I know slightly off topic now but if you really wanted a prefab orthotic specifically for Hallux Rigidus there is the Salts S90. I have only very occasionally used these but did once for a golfer with bilat painful Hallux Rigidus trying to avoid surgery for as long as possible and he got on fantastically with them. I know this case is more complicated but may be useful in the future!

Hope all is well in Cornwall!

Jack

 

This has been a very important learning curve for me and i want to thank everyone for their contributions, I feel very humbled and grateful...it certainly seems an area for further research and study...the whole matter is a lot more complex than I 1st thought. However I feel better equipped now to help my patient and provide the best advice grounded in current podiatric thought...thank you

 

I enjoyed comments above. However, let me state something obvious. There is nothing wrong with a trial an error approach. Put the prefab orthotic in the shoe, remove one or both plugs, add a heel lift if necessary, or whatever. Ask the patient to walk in the device and listen to the feedback they give you. Watch the patient walk and see if they are moving faster, has arm swing increased? Is the gait more symmetrical? Video and/or in-shoe pressure analysis can assist here, but no everyone has this or uses it. If the prefab device doesn't work, try a different prefab like Salts S90, then maybe a custom foot orthotic.

Using trial an error may give you additional information. Maybe you tried a heel lift and patient could not tolerate it, so now you have to ask why? Hope that helps.

 

Now thats a way to keep both companies happy!!!!