Hallux Limitus/Rigidus: Email Advice

Anonymous has left a new comment on your post "Hallux Rigidus: Surgery or No Surgery": 

Dear Dr. Blake,
I was diagnosed with Hallux Limitus 3 months ago. The first doctor who diagnosed this condition, told me to apply Voltaren gel on the joint are 4 times a day and stop wearing high heels. I told him I do not wear high heels except for special occaisions. He told me that it would continue to get worse and never improve. Also, do not listen to anyone else's opoinion. He said surgery does not work. That was it.


Dr Blake's comment: The world is gray and getter grayer all the time. These black and white statements have no place in medicine, and are wrong. Hallux Limitus can get a lot better, and when needed, there are good surgeries for it. Hopefully, you can keep the treatment in the conservative range. High heels that produce pain in the big toe joint should be eliminated, but may be worn for short periods. High heels that do not produce pain are fine. 

I went to a second opinion. the next doctor said we are going to try the conservative approch. I just picked up my custom orthotics. I was not given much other information. I wanted help with where to find shoes to wear with the orthotics. Also, can I continue to work out? I like to walk three miles in the morning. Is that ok?


Dr Blake's comment: I am assuming that you have foot pain associated with this hallux limitus. When you embark on treatment, try to create as pain free environment as possible. Hopefully, the orthotics will help you take stress off the joint. Definitely send a photo of any X-rays if you want me to look at them. Even with orthotics, learning how to spica tape with the video below and applying dancer's pads to the orthotics can be very helpful. If you have only minor pain, try to ice after workouts, or your walks to work for 10 to 15 minutes. 


 He did not seem to have a very definite set of answers for my questions. I do not want to have the condition get worse by doing the wrong thing.
I live in the Palm Beach area in Florida. I have been trying to find another doctor to get another opinion from. I would like a referral to the top expert with this condition.


Dr Blake's comment: My good friend is at Barry University near Miami, and will not lead you wrong. His name is Dr James Losito, Jim to his friends, and doc to someone. You can get his address from the American Academy of Podiatric Sports Medicine website at www.aapsm.org. 

I have spent hours googling looking for answers. I would greatly appreciate any help you can offer.
Best regards,
Karen
Wellington, Florida 

I get amazing number of emails on Hallux Limitus (less than 60 degrees of dorsiflexion of the big toe joint). And there are many causes including over pronation with jamming of the first metatarsal and long first metatarsals. 





What I didn't show in the video above is how to exactly measure the big toe joint range of motion, but that is a very easy measurement for most health care providers. Below is the video on spica taping.






Karen then left another email which I will answer today in a new post.