Members do not see these Ads. Sign Up.

Wondering if there are some pearls out there regarding 'conservative' management of unilateral hallux interphalangeal joint pain. x-rays show mild joint margin narrowing - nothinhg else of note. pain worse when running. nil subjective recounting of previous trauma.

thanks in advance

Chris Williams

 

If the IPJ is hurting, I'd check what's going on with the MPJ. Is there hyperextension at the IPJ? Any medial roll-off callus?

 

Hi Simon,

Thanks for your reply. No MPJ callous. Ist MPJ ROM seems within normal limits. This lady does however exercise heavily and demonstrates bilateral ankle equinus due to very tight gastrosoleals - a stretching program was implemented some time ago and subjectice recounting reports diligent compliance - links?

Chris

 

Sounds like the equinus could be causing a sagittal plane block with secondary metatarsus primus elevatus and a functional hallux limitus, leading to hyperextension and degenerative joint disease at the first interphalangeal joint. Clutching at straws? Check the running biomechanics, especially proximal first ray function, as the FHL needs only be a fraction of a second to cause pathology.
I've often found that a first ray extension to limit motion along the entire hallux seems to work well to stop the hyperextension. Alternatively, if there is adequate 1st MTPJ motion, and the reason for hyperextension is a FHL, try padding with a plantar cover with a first rat cut out to facilitate more first MTPJ motion insteat of 1st IPJ hyperextension? I'd also be looking at her running footwear and seeing if it is fitted correctly and is appropriate for teh type of training she is doing.
Hope this helps!

 

Chris,

Are you aware of the concept of the functional hallux limitus? Normal range of motion of 1st MPJ non weight bearing, but limited motion/ high stiffness upon weight bearing. These feet will often get IPJ symptoms and "ski-tip toe".

Regards,

Eric Fuller

 

No offense but does the shoe fit? - Have you checked the shoe for adequate length - have seen some "jamming " problems of ipj and mtpj with short running shoes