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Rigid hallux limitus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by aussiepodiatrystudent, May 9, 2012.


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    Hi,

    I'm just wondering what kind of conservative treatment would be appropriate for rigid hallux limitus? This is in the case of very painful dorsiflexion of the 1st MTJ. I would thus like to limit propulsion about that joint. I'm thinking of prescribing an orthotic with some add-ons, but I'm just not sure what exactly.

    Would gladly appreciate some help! Thank you! :)

    Izza
     
  2. Griff

    Griff Administrator

  3. Robertisaacs

    Robertisaacs Well-Known Member

    A rigid Hallux limitus is a hallux rigidus. A hallux rigidus has no dorsiflexion, painful or otherwise. I thus assume you're talking about a painful hallux limitus.

    In which case you have several choices. A device which encourages the 1st met to plantarflex should reduce internal plantarflexion moments and decrease IA compression. A device which dorsiflexes the 1st met should increase the internal plantarflexion moments and may reduce movement. A rigid sole with a rocker (either as an insole or a shoe like an MBT) will do both.
     
  4. efuller

    efuller Well-Known Member

    I would maintain that what hurts in these patients is intra articular compressive forces. To paraphrase Robert, anything that reduces pronation moment from the ground or reduce dorsiflexion moment on the first ray will decrease intra articular compression forces. A rigid rocker bottom shoe works by decreasing demand for dorsiflexion of the Hallux. When the hallux is dorsiflexed there will be increased compression forces at the MPJ because of increased tension in the plantar fascia. The rigid rocker shoe will also tend to shift the center of pressure posteriorly which will also decrease dorsiflexion of the 1st ray.

    Eric
     
  5. Kevin Kirby

    Kevin Kirby Well-Known Member

    Izza:

    Ever heard of hallux rigidus?:wacko:
     
  6. My bad, what I meant was structural hallux limitus (limited dorsiflexion on both weightbearing and non-weightbearing, from what I understand).

    Thanks for all the input! :)
     
  7. Admin2

    Admin2 Administrator Staff Member

  8. Boots n all

    Boots n all Well-Known Member

    Send their favorite shoe to your local Pedorthist and ask for them to modify them with a carbon fiber inlay(placed inside the sole) and a rocker sole.
     
  9. Peter

    Peter Well-Known Member

    Rocker sole/carbon fibre midsole stiffener, add periosteal acupuncture if needed for potential pain relief.

    With a unilateral rocker sole, make sure you get the contralateral heel balanced, if the pelvis is level.
     
  10. drsarbes

    drsarbes Well-Known Member

    Izza:

    Are you a Podiatrist?

    If not, please disregard the rest of this post.

    Pathology at the 1st MTPJ is very very common.
    Among those Hallux rigidus/limitus from various arthritic processes is very common.

    I'm wondering how it is that you are not trained in treating this if you are seeing podiatry patients?
    This should be Podiatry 101.

    I'm curious how your patient would feel if he/she knew that when presented with a common podiatric condition you have the need to seek help on a message board.

    Steve
     
  11. musmed

    musmed Well-Known Member

    Dear all
    There is a very simple way to improve movement and reduce pain in less than 5 minutes of your time.
    You perform a myofascial treatment to the great toe.
    How:
    pretend the toe is a computer game joy stick and slowly =operative word, move it in all directions
    first in neutral
    then with slight compression
    then with slight joint distraction

    just keep repeating small movements until the ROM increases and the pain reduces.

    Just tell them it will hurt a bit but nothing as much as it will when it goes fully stiff

    Show them how to move it around (self treat self empowerment!), review them in 2 weeks and hey presto, problem solved.

    done this many hundreds of times to hundreds of startled and happy patients.It works a treat,

    Regards
    Paul Conneely
    lovely day down here!
    www.musmed.com.au
     
  12. MicW

    MicW Active Member

    What an unhelpful comment. For all you know Izza may be studying Podiatry 101. Did you fail to notice Izza is a student who is most likely treating patients in a training clinic. Sometimes if one has nothing positive to add then silence is the best option. I feel it is actually commendable for students to approach the forum to expand their knowledge.

    Mic
     
  13. Peter

    Peter Well-Known Member

    Izza only changed his name after Dr Sarbes post, so how were any of us to know he/she was a podiatry student when using the name Izzatiqa?
     
  14. G Flanagan

    G Flanagan Well-Known Member

    Quote
    "Dear all
    There is a very simple way to improve movement and reduce pain in less than 5 minutes of your time.
    You perform a myofascial treatment to the great toe.
    How:
    pretend the toe is a computer game joy stick and slowly =operative word, move it in all directions
    first in neutral
    then with slight compression
    then with slight joint distraction

    just keep repeating small movements until the ROM increases and the pain reduces.

    just tell them it will hurt a bit but nothing as much as it will when it goes fully stiff

    Show them how to move it around (self treat self empowerment!), review them in 2 weeks and hey presto, problem solved.

    done this many hundreds of times to hundreds of startled and happy patients.It works a treat"

    So you are able to manipulate a hallux rigidus? Your right, it will hurt a bit when you fracture that exuberent dorsal osteophyte and irritate the cartilage defect
     
  15. drsarbes

    drsarbes Well-Known Member

    I did not know the poster's status, as Peter was so observant to realize, that the "Podiatry Student" was added after my reply was made.
    Thank you Peter.

    I DID state that if you were NOT a Podiatrist (since I had no way of knowing) to disregard my post.

    Mic: You apparently did not read my entire post.

    I stand by my comment. Replies here would be much more helpful and correctly directed if those responding knew the status of the original "poster"

    Steve
     
  16. blinda

    blinda Well-Known Member

    Yep, a well meaning colleague tried this on my rather superb degenerative hallux rigidus (when I was anaesthetized after a pod conf). Didn`t quite fracture the spur, but boy did it smart the next day.

    I agree. One of the reasons for my dislike of pseudonyms.
     
  17. David Smith

    David Smith Well-Known Member

    Guys

    This is very simple but it works every time for me

    Make a full length 5mm thick (or thicker if it will go in the shoe) firm EVA insole with the hallux aspect cut out. This leaves a little ledge drop off that allow the rigid or limitus hallux to plantarflex and so add a fee extra degrees of metatarsal plantarflexion after heel lift before the GRF acts on the distal hallux i.e. a little rocker for the big toe.

    There are more sophisticated ways of reducing GRF of the hallux but this one is so simple and quick.

    Oh and you can add fan taping to add extra external dorsiflexion stiffness

    Regards Dave
     
    Last edited: May 16, 2012
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