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Monday, March 5, 2012

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 

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


  1. Thank you, Dr. Blake for responding to my post!!!! I am very grateful for your comments!!! I never had any serious pain with this situation until I just started wearing my orthotics. I am wearing them for one hour a day and increasing by one hour each day. Both my feet are killing me. Hopefully that will go away soon.
    I have a copy of my MRI I had done and my X Rays. How do I get a copy of them for you to look at?
    Thank you for your recommendation for Dr. Losito. He looks to be exactly the local doctor I have been trying to find. I will call and make an appointment with him ASAP!!!
    I was wondering if you recommend putting the Voltaren gel on the joint? Mine is swollen from the bone spurs and appears red some days. Of course that is where it is most uncomfortable when wearing a shoe. I have lived in Florida for 6 years. I have spent most of those years wearing flip flops as opposed to shoes. They are all designer, leather flip flops which have been enormously comfortable and easy to wear. Now that I need to wear orthotics it is quite an issue to find shoes to accomodate the orthotics.
    Let me know how I can get my x ray to you, please. I am thrilled to find someone who has given me a glimmer of hope in having to live with this condition. Everything I have read on line has just been gloom and doom!!!
    Thank you so much, Dr. Blake for all your insight!!!!
    Wellington, Florida

    1. Karen, answered in my post today 3/8/12. Hope it helps. Say hello to Dr Losito. Rich

    2. i fell off stairs 6 months ago and had injured my big toe joint & it become so stiff my x ray showed narrowing of joints i had hallux limitus i saw a video of gary moller on you tube & i tried this daily with glucosamine chondroitin & MSM & NOW today i'm walking pain free in my flip flops I just tried it for 10 days its a manipulation technique by gary moller on you tube you can do it by yourself
      good luck

    3. Thank you so very much. Rich
      I will check it out.


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.