Foot orthotics for hallux limitus

NewsBot · Jun 11, 2015

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Effect by custom-made foot orthoses with added support under the first metatarso-phalangeal joint in hallux limitus patients: Improving on first metatarso-phalangeal joint extension
Luis María Gordillo-Fernández et al
Prosthet Orthot Int June 10, 2015

Background: Hallux limitus is one of the most common disorders affecting foot biomechanics. Custom-made foot orthoses can improve the function of the first metatarso-phalangeal joint.
Objectives: The objective underlying this study was to test whether custom-made foot orthoses increased the range of mobility of metatarso-phalangeal joint in patients with hallux limitus.
Study design: Randomized, double-blinded, and clinical trial.
Methods: The study consisted of 20 participants (40 feet) diagnosed with hallux limitus. A control group and an experimental group both wore the same custom-made foot orthoses and, in the experimental group, a support element under the first metatarso-phalangeal joint was added to the orthoses. Two measurements were made with both groups: the relaxed position of the first metatarso-phalangeal joint and the maximum extension of the hallux. These measurements were made before first placing the foot orthoses and 6 months after application of the treatment.
Results: In the experimental group, the results showed an improvement of 4.5° in the relaxed position and 22.2° in the maximum extension being statistically significant (p < 0.001) for both measurements.
Conclusion: Custom-made foot orthoses with added support under the first metatarso-phalangeal joint were proved to be an effective treatment to restore functionality of this joint in hallux limitus patients.
Clinical relevance Limitation of hallux movement in the joints propulsive phase of gait negatively affects the biomechanics of the lower extremity, causing changes in the rest of the joins. The use of foot orthoses designed in this study restores range of motion of the first metatarso-phalangeal joint.
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Christian McErvale · Jun 12, 2015

Anyone know what this support looked like? Assuming it is NOT a Morton's extension?

Griff · Jun 12, 2015

Like this:

footdoctor · Jun 12, 2015

How on earth did that improve functionality of the 1st mpj?

efuller · Jun 12, 2015

footdoctor said: ↑

How on earth did that improve functionality of the 1st mpj?
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I wonder if they controlled for muscular activity while assessing joint range of motion.

BillyAlexander · Jun 13, 2015

adding a 1st met bar may be a good idea for a pt with a Morton's foot, where the 1st met struggles to contact the ground and therefore increasing pronatory force during forefoot loading. your thoughts?

josefcef · Jun 14, 2015

how can a plantar support to the 1st mpj increase its functionality? I think that it will increase the stiffness of the joint since it is putting more pressure during gait!! As far as I am concerned usually when there is hallux limitus or rigidus a first ray cut out is utilized to spread the pressure on the other mets and reduce it from the 1st mpj which is not functioning properly and if there is no improvement.... pt should be referred for a steroid injection or chilectomy. What do you think?

mike weber · Jun 14, 2015

I would use the above in Hallux limitus when the joint is very painful and the next step in treatment is surgery, I have used it successfully to get patients a few more months before the op time was found , never to improve function in the joint though makes little mechanical sense

Geoffo · Jun 16, 2015

I have always found that by adding a pad to the dorsal surface of the orthotic or creating an orthotic with an increased dorsal lip, ie a ff post built in, it causes the joint to open and reduces pressure on the lipping at the top of the joint. From a pain reduction point of view, it works very well. Personally I wouldn't make the bar as long, as I think you need to allow the toe to plantarflex relative to the met.

Ben Lovett · Jun 16, 2015

What they measured here was the passive non weightbearing extension of the hallux prior to using the orthoses and again after using orthoses for 6 months.
There was no dynamic assessment and no assessment of any change in functional range of motion with the different orthoses.
What they are claiming is that adding a flexible Morton's extension to the orthotic increases the structural non weight bearing ROM after 6 months.
There is no indication as to whether the study population was symptomatic or whether the intervention reduced or increased symptoms.

Ben

56Furman · Jun 17, 2015

I have seen inaccurate 1st MPT dorsiflexion results in PT reports. Initial findings limited 1st MPT, after 2 months of therapy 20-30 degrees. Yet when I exam the the patient there is limited 1st MPT motion. I believe the greater achieved dorsiflexion is coming from measuring hyper flexion at the hallux IPJ at the end of therapy. The authors of this study also probably measured to the most distal aspect of the hallux therefore factoring in the dorsal hyper mobility of the IPJ

Bigfoot09 · Jun 18, 2015

Hi

also it is not exactly this topic. I am looking for this paper. Does anyone know where I can get it?

Juriansz A. Conservative treatment of hallux values: A randomised controlled trial of a hallux valgus night splint. J Br. Podiatry. Med 1996; 51; 119.

or does anyone know other paper for this topic.

Best regards

Bigfoot.

jane grey · Oct 3, 2016

Kisses

NewsBot · May 29, 2020

Non-operative Management of Hallux Limitus Using a Novel Forefoot Orthosis
Jonathan Fung, DPM et al
JFAS

Hallux limitus is among the most common arthritides of the foot and ankle, with increasing incidence in the aging population. Despite its prevalence and disease burden, treatment of the condition remains poorly understood. Many patients will fail initial conservative management, whereas controversy exists surrounding indications for and outcomes of surgery. The present study sought to examine the impact of a novel forefoot orthosis on foot function, pain, and plantar pressure distributions in patients with symptomatic hallux limitus. Nineteen adult patients completed a questionnaire consisting of the 23-item Foot Function Index (FFI) and a 10-point visual analogue scale (VAS) measuring pain. Standing pedobarographic maps were generated using a foot scanning system. Participants were instructed to wear the orthosis in athletic shoes for four weeks. Eighteen participants (94.7%) experienced improvements in foot function and pain, with 12 (63.2%) reporting complete resolution of pain at the end of the four-week trial. Mean FFI scores improved significantly from 43.0% at baseline to 11.0% with the orthosis ( p < 0.001). Similarly, mean VAS pain scores decreased significantly from 4.87 to 1.18 ( p < 0.001). Pedobarographic analysis while wearing the orthosis demonstrated increased ability of participants to bear weight on the arthritic hallux MTP joint and restoration of physiologic stance. Compared to existing products, the device was well-tolerated and did not require footwear modifications or impede normal gait. Overall, the orthosis offers an appealing solution to patients dissatisfied with existing treatment options as well as those who may be averse to or ineligible for surgery.
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NewsBot · Feb 14, 2021

The efficacy of shoe modifications and foot orthoses in treating patients with hallux rigidus: a comprehensive review of literature
Gabriele Colò et al
Acta Biomed. 2020 Dec 30;91(14-S):

Hallux rigidus (HR) is a degenerative disease of the first metatarsophalangeal (MTP1) joint and affects about 2.5% of people older than 50 years. The real etiology of this condition remains under debate. Clinical symptoms, physical exam, and instrumental evidence are important in assessing and grading the disease. The anatomy of the first metatarsal is unique and its configuration may play a significant role in the HR development. The first approach usually begins with shoe modifications and foot orthoses, designed to limit irritation from the dorsal osteophytes, reducing motion and the mechanical stresses on the joint. To prevent or delay the development of HR, shoes should be sufficiently long, comfortable, with high toe box and broad toe-boxed, and should bear an allowed space for the orthotic device. The ideal orthotic appears to require a 3-mm thickness with a correct stiffness, and also increasing and extending the medial metatarsal arch just proximal to the metatarsal head, raising the first metatarsal and allowing the proximal phalanx to rest in a more plantarflexed position, decompressing the dorsal aspect of the joint. The increased foot pronation moment with medial column overload should be corrected. In addition, the maximum follow-up found by the analyzed studies was of 14.4 years, so the Authors cannot conclude how long conservative care can keep a patient free from pain and able to perform normal daily activities. However, the use of shoe modifications and foot orthoses may be considered a safe treatment and then should be always offered to patients.
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NewsBot · Jan 1, 2024

Case study: Gait assessment of a patient with hallux rigidus before and after plantar modification
Roberto Tedeschi
Int J Surg Case Rep. 2023 Dec 24

Introduction and importance: Hallux rigidus (HR) is a degenerative arthritis affecting the first metatarsophalangeal joint (MTP), leading to pain and functional impairment, particularly during the propulsive phase of walking. The prevalence of HR is about 2.5 % in individuals over 50, but younger individuals can also be affected, as demonstrated in this case.

Case presentation: We report the case of a 26-year-old patient with a body mass index (BMI) of 20.2, who has been suffering from HR for 5 years. The patient presented with walking difficulties, characterized by a limp and impaired propulsion phase, and pain in the right foot due to HR. A comprehensive gait assessment was conducted using a baropodometric platform and integrated smartphone motion sensors. Following the diagnosis, a non-surgical intervention involving the application of a compressed cotton felt foot orthosis at the MTP plantar area was initiated. This intervention aimed to alleviate pain and improve the functional mobility of the right big toe. Post-treatment assessments showed an increase in the big toe's mobility from 0 degrees to 35 degrees, as measured by a digital goniometer.

Clinical discussion: The application of a soft support, such as compressed cotton felt, at the plantar area of MTP, demonstrated a potential non-surgical therapeutic approach to improve gait and reduce discomfort in HR patients.
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Foot orthotics for hallux limitus

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