Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
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.
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
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.
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.
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
The Following User Says Thank You to efuller For This Useful Post:
I'm just wondering what kind of conservative treatment would be appropriate for rigid hallux limitus?
Izza:
Ever heard of hallux rigidus?
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
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
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
The Following 2 Users Say Thank You to drsarbes For This Useful Post:
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,
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
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
The Following User Says Thank You to MicW For This Useful Post:
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
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?
__________________
“Body: A thing of shreds and patches, borrowed unequally from good and bad ancestors and a misfit from the start”
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
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
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
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
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.
Quote:
Originally Posted by drsarbes
.... Replies here would be much more helpful and correctly directed if those responding knew the status of the original "poster"
Steve
I agree. One of the reasons for my dislike of pseudonyms.
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
__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.
Last edited by David Smith : 16th May 2012 at 10:35 AM.
Reason: extra info
Rigid hallux limitus
Linear Mode
