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Friday, January 18, 2013

Hallux Rigidus: Email Advice

Dear Dr. Blake,

I so wished I lived closer to you, I would visit you in a heartbeat.
I hope you can help me with these problems.

History of Hallux Rigidus both feet, right one especially bad.

I have had custom orthotics made at two different provides.

1st pair.  Person handed me them and said "let me know how they work out."
No fitting in shoe, nothing.  I was kind of in shock.  Did not say anything.  My fault for
not asking for help. I did not realize how things were suppose to work.
Also, the plastic extension for the toe joint stops approximately halfway up the toe,
so when I extend my foot in stride, the top part of my toe drops down.
I tried to get them in a shoe when I got home, and they did not go into my shoes, too big.

2nd pair.  Person very professional, tried fitting them 3 times.  The arch is really high.
They indicated the company makes a very generous arch, which they said was not a problem
I needed addressed.  They shaved a bit off the arch several times.  The arch is still too high
and digs into my foot. But the extension for the toe extends all the way to the top of my toe,
or the length of the toe, and then is covered in very light material.

I have compared the two arches.  Pair 1, with the cut off toe extender, has a much lower arch
and seems more reasonable.  But then there is the toe problem.

So after this long, long explanation,  could you please tell me how a typical custom made
orthotic should fit?  

Is the toe extender suppose to extend all the way to the top of the orthotic, or top of toe?
Dr Blake's comment: Yes, the plastic toe extender, when used, needs to go to the end of the toe. 

Is shaving the arch on the bottom of the orthotic actually going to lower the arch?
Dr Blake's comment: Yes, shaving the orthotic on the bottom softens the arch support, allowing it to lower with pressure. 

When I walk, show I be feeling the arch digging into my foot?
Dr Blake's comment: No, pressure is fine since it is an arch support. But digging implies too much pressure, and should be changed. I love to err on too much arch support over not enough when ordering, because it is easier to take away than to add. 

 Should I be feeling the weight of my walking evenly distributed throughtout the stride?
Dr Blake's comment: Typically, but if you pronate too much, then the orthotic will have more arch pressure, if you supinate too much, the orthotic will have more pressure laterally (baby toe side). The goal is to center your foot position, not necessarily even the weight distribution, but striving for both is nice. 

It seems like I need the best of each two orthotics.
Dr Blake's comment: Sounds like the second one, designed by the more professional provider, is going to work with perhaps another adjustment or two. 

Please, any help you can give me would be wonderful.  

I have spent so much money on these, I sure hope one of them can be made correctly.

I am certainly willing you give orthotics a real try, I don't want to have surgery.

Thank you,

Bobbie (name changed)

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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.