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Monday, October 1, 2012

Hallux Limitus/Rigidus: Email Advice

I am suffering from hallux rigidus since maybe 5 years. I try to use my feet as normal as possible and has experienced that e.g. jogging is not painful and does not make the situation worse. But I am also practicing aikido, a sport when you move a lot from the floor and up. This is more depending on the toes and is difficult to me, both because of stiffness and pain. I try to read about the course of the disease, what to expect. Will the joints eventually be completely stiff and is this good or bad? I really avoid surgery and also wonder what other treatments that can be done e.g. stretching, manipulation etc.

Thank you,

Dr Blake's comments: 

     I am very happy to respond to you. And, I encourage you to read all the blog posts on this subject to get a good handle on this condition. 

     The problem needs to become a project for you. You need to remain active, but respectful of that joint. It is the most important joint in the foot, if you do not include the ankle. You need to avoid activities that cause pain over a level 2, if you can not adjust to that sport. By adjusting, I mean to change routines, shoes, inserts, taping techniques, padding, etc, in order to play without pain. So, you can jog now, and you must modify akido (unless you are getting paid alot of money, I mean alot of money, to participate through pain!). 

     The condition does progress, but there is no correlation to pain that I can find. I treat 1000's of these, and some minor joint problems cause great disability, and more major joint problems do well. There are so many factors that affect this: shoes, biomechanics, activities participated, where the joint breakdown occurs, pain thresholds, etc. Do not relie on too many generalizations about this, because they are just generalizations. 

     Here are some of the truths I believe are true with Hallux Limitus:
  1. There are way too many aggressive surgeries done.
  2. Joint Fusions should be the last resort (at least, after one other surgical attempt).
  3. Honor the Big Toe Joint and work on finding out how to minimize pain.
  4. The joint will continue to breakdown, and as long as you honor the pain level, you should do as much activity as is possible. 
  5. All patients with Hallux Limitus/Rigidus need to: learn to spica tape, have custom made orthotic devices to protect the joint, learn to self mob, honor their pain if the symptoms go above 2 with any activity, and use anti-inflammatory measure daily with smoldering daily arthritic pain. 
 I sure hope this helps some. Rich

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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.