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Mike you can have kinetic change at joint without any noticeable change in it's position. So even in hallux rigidus you may alter the kinetics at the 1st mtpj.

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"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

How ?if the joint has destructed and fused so there is no movement ie rigid.

so a MTPJ which has been surgically fused you can alter the kinetics at the 1st MTPJ?

If we are talking true rigid and 1 degree of movement would not be rigid but a limitus

I don´t see how you can alter the mechanics of a joint if that joint no longer is there, which is why I believe people with true hallux rigidus are often not in pain at the 1st MTPJ unless from a thickening of the joint and shoe wear related issues . ie the joint no longer is part of foot mechanics, and the 1st ray is now longer.

see Rachel all learning as I suspect I am about to be learned

Also without movement there is no axis without axis how do we determine what moment would occur ?

Maybe my thinking that true Hallux rigidus is a " self " fusion is not correct ?

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Mike Weber.



Crazy Mary

Rachel, sometimes the best success comes from the little things we give to our pts. Initially, you may wish to advise your pt to obtain a quality walking shoe, with a thick inflexible outsole and forefoot rocker/spring to reduce bending moments of the 1st MTPJ. This alone may make her comfortable, if not, she has purchased the necessary shoe with the volume available within to initiate orthotic therapy.

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“Body: A thing of shreds and patches, borrowed unequally from good and bad ancestors and a misfit from the start”

Ralph Waldo Emerson

Can I change the bending moment in a bone? You might want to check your definition of kinetics.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Mike, it's round about this time I find it helpful to think of fat kids on one end of a see-saw.

Yes of course we can change bending moments in a bone but you were specific and said
and while bending moments may change at that point where the 1st MTPJ was it still does not change the point I was making which was that

Perhaps not is a bit strong mostly likely a better way of saying it

as an aside the point of fusion would have greater stiffness and therefore be able to resist bending moments greater than the rest of the 1st ray.

__________________
Mike Weber.



Crazy Mary

I have no idea what you are talking about. Yet, I suspect you don't know the difference between kinetics and kinematics.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

except this see-saw does not have a fulcrum because the joint is fused - which is why I was suggesting the distal and proximal joints of the now longer 1st ray with Hallux Rigidus would be were the kinetic and kinematics changes would occur by my thinking.

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Mike Weber.



Crazy Mary

Mike I think you are splitting semantics for the sake of it. The joint still exists in hallux rigidus, i.e. the bits inside the joint capsule. The kinetics can still be altered at the 1st MTPJ even in a hallux rigidus without a change in kinematics, in the same way that the bending moments can be altered along a bone without a joint in it. Much as this splitting hairs is interesting, I really have better things to do with my time.

Moreover, lets take your contention that we cannot change the kinetics across the area known as the 1st MTPJ in the case of a fusion / hallux rigidus; this being the case how on earth can orthoses be dangerous as Craig contended in this situation? Indeed, Craig maintained that this type of device may be "dangerous" because: Anyway off to the vets with Boo! now.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Thank you all for your comments.......very helpful. Just wondering though, (as opinion appears to be divided) whether to issue my lady with two orthotics for the hallux rigidus foot, one with a kinetic wedge and the other a mortons extension and ask her opinion as to which one appears to be more effective in managing pain and comfort levels???

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 ?

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Mike Weber.



Crazy Mary

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!!!!