Clinical improvement in functional hallux limitus using a cut-out orthosis.

BACKGROUND: Functional hallux limitus (FHL) has been implicated in the development of metatarsophalangeal joint osteoarthritis. OBJECTIVES: To determine whether cut-out orthosis treatment increases plantarflexion of the first metatarsal by increasing its declination angle. STUDY DESIGN: Cross-sectional study. METHODS: A total of 46 female volunteers with an average age of 25.66 ± 5.70 years (range: 19-42 years) and FHL participated in the study. We assessed the degrees of movement of the first metatarsal and proximal phalanx bones at the first metatarsophalangeal joint without and while wearing the cut-out orthosis using the 3Space Fastrak® via sensors. RESULTS: The movement of the plantarflexión declination angle of the first metatarsal bone was higher using the orthosis 29.84° ± 5.98° versus without orthosis 27.69° ± 5.91° (p < 0.031°). Use of sandals may have minimized the magnitude of movement changes associated with orthosis versus non-orthosis use. CONCLUSION: The cut-out orthosis demonstrated a beneficial effect on non-fixed first metatarsophalangeal and metatarsal cuneiform joints affected by FHL, significantly increasing the declination of the metatarsal angle. Furthermore, use of the cut-out orthosis significantly reduced adduction movement of the first metatarsal bone in the transverse plane. CLINICAL RELEVANCE: The cut-out orthosis demonstrated a beneficial effect on non-fixed first metatarsophalangeal and metatarsal cuneiform joints affected by FHL, significantly increasing the declination of the metatarsal angle. Furthermore, use of the cut-out orthosis significantly reduced adduction movement of the first metatarsal bone in the transverse plane.

[Functional hallux limitus (Fhl): a new explanation for overuse pathologies]. / Hallux limitus fonctionnel: le pied qui fatigue et qui use.

Functional Hallux limitus (Fhl) is still a misconceived and unappreciated clinical entity, being often diagnosed during a clinical examination or a podiatric assessment. In the presence of Fhl, the patient's gait necessitates the unwitting existence of complementary efforts on their part, thus resembling to the gait pattern of someone with elongated foot or feet. The consequences of this dysfunction affect all age groups and manifest themselves in the form of low back pain, impingement, sprain, joint incongruence, or overload tendon and fibro-osseous lesions. An elongated foot gait pattern increases the stress applied to bones and joints and subsequently disrupts equilibrium. The biomechanical changes induced by Fhl mandate a profound reconsideration of our way of thinking and analysis, hence a revision of our reference system. It is indeed a new paradigm shift.

Hallux límitus post-quirúrgico. A propósito de un caso / Post surgical hallux limitus. A clinical case

En el presente trabajo se expone un caso clínico de una mujer de 53 años que acude a la Clínica Podológica por presentar artralgia de la Primera Articulación Metatarsofalángica durante la fase propulsiva, de 4 años de evolución. Tras exploración podológica se diagnosticó de Hallux Límitus Funcional caracterizado por una alteración biomecánica de la 1ª AMTF con disminución de la flexión dorsal del Hallux por debajo de los 65º en dinámica con probable etiología quirúrgica por descenso plantar de la primera cabeza metatarsiana. Dicha alteración biomecánica comporta una serie de mecanismos compensatorios al resto del antepié y retropié causados por la insuficiencia estructural y funcional del primer radio. A nivel podológico, se pueden realizar una amplia variedad de tratamientos pero sin lugar a dudas y en cualquier caso, es de relevancia una minuciosa y planificada exploración y valoración del pie junto a toda la Extremidad Inferior del paciente. El objetivo del trabajo es justificar si existe una relación entre Hallux Límitus Funcional y el descenso plantar de la primera cabeza metatarsiana o se contemplan como entidades patológicas independientes y analizar qué tratamientos serían los más indicados. Para ello, se analizó la exploración la patomecánica, el tratamiento del caso clínico estudiado, y se realizó una revisión bibliográfica de la documentación científica relacionada con dichas alteraciones. Tras exhaustivos análisis se concluye que dichas patologías pueden presentar una relación etiológica si durante la fase propulsiva se produce un momento dorsiflexor de la 1ª cabeza metatarsiana como respuesta a las Fuerzas Reactivas del Suelo, limitándose así la flexión dorsal y la activación del Mecanismo Windlass para convertir el pie en una palanca rígida y producir un despegue del primer radio eficiente. Tanto la exploración como la patomecánica del primer radio, son determinantes para el diagnóstico y tratamiento de dichas patalogías, así como conocer las consecuencias que pueden desencadenar en el resto del pie y extremidad inferior, ya que variarán el tratamiento ortopodológico, quirúrgico y físico. En el paciente, las patologías expuestas se atribuyen a una corrección quirúrgica de Hallux Abductus Valgus que ha provocado un descenso plantar de la cabeza metatarsiana (AU)

In this paper, we present a clinical case of a 53 years old woman who comes to the podiatry clinic, suffering from an arthralgia of the 1st metatarsophalangeal joint, during the propulsive stage of gait, for 4 years. After the clinic examination, she was diagnosed as a functional hallux limitus, characterized by a biomechanical alteration of the 1st metatarsophalangeal with a disminution of the dorsal flexion of the hallux below 65º in the dynamic with a probable surgery etiology, because of the descending of the 1st metatarsal head. This biomechanical alteration involves a series of compensatory mechanism for the rest of the forefoot and hindfoot caused by structural and functional failure of the first radio. At a podiatric level, we can executive a wide variety of treatments but, in all cases, we need a planned and through examination and assesment of the foot and lower extremities of the patient. The aim of this paper is to justify whether there is a relationship between Functional Hallux Limitus and the descent of the first metatarsal head, or if they are independent pathological identities and to analyze what kind of treatments are the most suitable. For this purpose, we analyzed the examination, the patomechanics, the treatment and we carried out a bibliographic revision of the scientific documentation related to those alterations. After exhaustive analysis, we conclude that these conditions may have an etiological relationship if during the propulsive phase there is a dorsiflexor moment of the 1st metatarsal head in response to the reactive forces on the ground, thus limiting the dorsal flexion and activating the Windlass Mechanism in order to convert the foot into a rigid lever and produce an efficient launch of the first radio. Both exploration and patomechanics of the first radio are crucial for the diagnosis and treatment for these pathologies, as well as knowing the consequences that can be generated on the rest of the foot and lower limb, as several orthopedic, surgical and physical treatments. The conditions of our patient are attributed to a surgical correction of hallux valgus abductus which led to a lowering of the metatarsal head (AU)

Dynamic splinting for runner's toe: a case report with gait analysis.

We present a case report of runner's hallux limitus and the effect of dynamic splinting in reducing contracture as measured by gait analysis. After 4 months of treatment with dynamic splinting, the patient regained 45 degrees in active range of motion, and the gait analysis showed significant and beneficial changes.

Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait.

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed.

Functional hallux limitus and lesser-metatarsal overload.

The implications of functional hallux limitus for lesser-metatarsal overload are discussed. A new method of treating functional hallux limitus is proposed, and three case histories are reviewed showing adequate resolution of symptoms using the proposed method of treatment. A proposed mechanism for the development of functional hallux limitus is discussed, and different methods of identification are illustrated.

Nonoperative management of functional hallux limitus in a patient with rheumatoid arthritis.

BACKGROUND AND PURPOSE: Functional hallux limitus (FHL) is a condition that affects motion at the first metatarsophalangeal joint and may lead to abnormal forefoot plantar pressures, pain, and difficulty with ambulation. The purpose of this case report is to describe a patient with rheumatoid arthritis (RA) and FHL who was managed with foot orthoses, footwear, shoe modifications, and patient education. CASE DESCRIPTION: The patient was a 55-year-old woman diagnosed with seropositive RA 10 years previously. Her chief complaint was bilateral foot pain, particularly under the left great toe. Her foot pain had been present for several years, but during the past 5 months it had intensified and interfered with her work performance, activities of daily living, and social life. OUTCOMES: Following 4 sessions of physical therapy over a 6-week time period, the patient reported complete relief of forefoot pain despite no change in medication use or RA disease pathophysiology. She was able to continuously walk for up to 4 hours. Left hallux peak plantar pressures were reduced from 43 N/cm2 to 18 N/cm2 with the foot orthoses. DISCUSSION: Patients with RA who develop FHL may benefit from physical therapist management using semirigid foot orthoses, footwear, shoe modifications, and patient education.

The use of osteotomies in the treatment of hallux limitus and hallux rigidus.

Though osteotomies for relief of hallux limitus and rigidus have been around since the earliest surgical corrections, no sound clinical studies have been performed to warrant their use over the standard accepted techniques of cheilectomy and arthrodesis. These operations are surely more technically demanding than such standard procedures, and involve significant increased risk and postoperative immobilization than cheilectomy alone. Sound theories such as metatarsus primus elevatus and excessive metatarsal length contributing to hallux rigidus have never been proven, and no accurate way to diagnose these structural deformities has been proposed. These operations are intriguing and some make clinical sense. It remains to be seen whether the orthopedic community will adopt them based on their merits.