Firstly be very clear on definitions, so we speaking the same language:
Hallux rigidus - no motion at first MPJ
Structural hallux limitus - reduced motion at MPJ both weightbearing and non-weightberaring
Functional hallux limitus - adequate ROM non-weightbearing, but appears to have inadequate ROM (even temporarily) during weightbearing.
The orthoses prescription for a structural and functional hallux limitus is very different.
In a structural hallux limitus, the ROM can not generally be altered by an orthoses (manip and mobs may be able to), so prescriptions tend to incorporate a mortons extension or some kind of rocker to prevent the full range of motion of the joint (if its problematic) and faciliate sagittal plane motion.
In a functional hallux limitus, the ROM can generally be altered by an orthoses and this will involve anything to plantarflex the first ray; ie:
Invert the rearfoot (wedging or posts)
Plaster modifications to positive model for steeper slope to shell under medial column
First ray cuts outs (big ones)/thinner shell material below medial column
Kinetic wedge
Cluffy wedge/pre-load the hallux
Plantar fascial groove (deep and anterior)
Forefoot valgus posts/2-5 bars/reverse mortons/met domes
Lateral column support
Heel raise
Windlass enhancing running shoe
Last edited by a moderator: Mar 11, 2006