I forgot to mention that I have hallux valgus (left big toe) as well as hallux rigidus (both big toes) and Ledderhose (both feet), and some pain in the other toes of the left foot. Which orthotics would you recommend for running shoes ?
Dr Blake's comment:
First of all, congratulations on 51 marathons, quite a feat (47 more than me!!). Also, for those that do not know, Ledderhose is disease where the plantar fascia gets very scarred and thickened. Typically, Ledderhose can be injected with cortisone without fear of rupture due to the severe scarring, but I am sure there are exceptions.
When you are designing orthotics for a situation like this there are many factors to look at. Let us look at one at a time.
- Hallux Limitus: Need enough of arch support and inversion to get the weight into the middle of the foot at push off. The padding in the metatarsal area should be to off weight the first metatarsal (dancer's padding). Occasionally the reverse needs to happen with padding under the first metatarsal to limit the motion (called "Morton's Extension). Also, how stiff should the forefoot be of the shoe? Should you use the New Balance 928 with a stiff rockerbottom sole? Should the orthotic be full length and stiff, like using a Sole OTC orthotic, and then making the forefoot of the device even stiffer. Should you use a carbon graphite plate under the orthotic to get your stiffness?
- Ledderhose: This is tricky with arch sensitivity. How much pressure can the arch take from an orthotic? Should cortisone be used to reduce the soreness before the orthotic is made? Do you need the arch support part of the orthotic or can you simply use a varus wedge to shift weight for the hallux limitus/big toe joint pain?
Here is the patient's response: