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Friday, October 4, 2013

Hallux Limitus: Email Advice

Hi Dr. Blake,
I discovered your web site a few weeks ago and have found it very informative and helpful.
I have had hallux limitus in my left toe for about 6 years and have tried many things to manage it.  These include NSAIDS, steroid injections,
orthotics (OTC such as Superfeet and Sorbothane as well as custom orthotics), carbon plates, stiff shoes.  In the past year or so, I've noted that
stiff-soled shoes don't seem to help as much.  My podiatrist suggested shoes such as Sketchers Shape Ups or MBT--I've tried these but they
seem to rock in the wrong place (still get painful movement in my toe).  On top of this, I'm having pain at the base of my other toes on both feet
(possibly Morton's neuromas?).
I have tried some of the suggestions on your web site with varying degrees of success.  Icing the joint sometimes helps, but at times increases the pain. 
The joint mobilization does help for short periods.  I have tried the spica taping too, but don't think I'm doing it correctly or else I can't limit the motion of the
toe enough.  I bought Yogatoes and find them beneficial.  I use either iboprofen or naproxen for pain when needed.
I would appreciate your input on next steps in managing my condition.  I've been told my surgical option is fusion, and I'm trying to put that off as long as possible
(I'm 53).  I have wondered if things like the dancers' pad you mention may be helpful or if there are other orthotic/shoe options I could discuss with my
podiatrist and perdorthist (I'm in Atlanta, GA area).  With shoes, I'm wondering if I should try a max motion control shoe like the Brooks Beast.  I'm neutral to slightly
overpronating with a moderate arch, but do have a prominent callous on the inside edge of my left toe.  I ask because early in my treatment, I had a perdorthist who put me
in the Brooks Addiction--this helped, but I realized over time I was walking on the outside edges of my feet and thought it may be doing more harm than good.
Thanks so much for your time.

Dr Blake's comment: 

     I agree with your fighting spirit, since undergoing a unreversable fusion seems too much. Glad you have found some things to help. Perhaps we can arrange that  you send your MRI, so I can see that if surgery is needed, perhaps cheilectomy or joint implant should be considered. These are not permanent, and can get you many years of a more comfortable joint if you are a candidate. Let me know what the dorsiflexion range of motion you have in this joint compared to the other foot. Since the same person measures it, the difference is almost as important as the overal amount. It is important to continue to perfect each technique. Try 3M Nexcare Waterproof tape for more support while spica taping. Definitely start using dancer's pads (get a roll of 1/8th inch adhesive felt from Moore Medical) in all your shoes. If you have stable orthotics, they can be added to the orthotic devices. Definitely ice for 10 minutes 3 times a day the top of the joint. Definitely go to the Brooks Beast for stability. In a month, let me know if this is helping. You can simply add a comment to this post. I hope it helps. Rich


  1. Hi Dr. Blake,
    Just a quick note to let you know where I'm at--I had an appointment with a podiatrist about 2 weeks ago to discuss surgical options. I was referred by my primary physician after I went in for increased pain across the base of the toes in both feet. They took new x-rays and it appears the big toe arthritis fortunately has not progressed much since 2011. I have developed a 2nd toe hammertoe on the left foot, which the podiatrist thinks is producing some of my forefoot pain. He did not think I had neuromas. He thinks I am a candidate for joint resurfacing surgery (HemiCAP) vs. fusion; he also would fix the hammertoe. I am giving serious consideration to having the surgery in the next few months.

    In the meantime, I am primarily using ice, rest, NSAIDS to manage the hallux limitus. I have not tried making dancer's pads yet. The Nexcare tape does provide more support. Outright rest, when possible, seems to quiet the joint down the most.

    Thanks again for your time and help.

    1. Thanks for your update. Glad that the arthritis is not getting worse. If you have surgery, consider that Implant over the fusion initially, since it is reversible if it does not work down the line. What is your present disability? Rich Blake

  2. I have good days and bad days. It does limit my ability to be active--I can't tolerate walking for long periods and can't really run. Shoe modifications (e.g., carbon plates) and orthotics still provide relief, but not as well as in the past. My gait has changed, which is likely causing problems elsewhere (e.g., my hammertoe; my IPJ on the left big toe gets very sore at times; now getting symptoms in my right forefoot). In the interest of full disclosure, I do have spine issues at L5-S1, so could be driving some of the right foot stuff.

  3. Thanks for your comment. When you hit a plateau of 6 months, when you are controlling symptoms but allowing great disability, you have to decide if it is best to consider changes in treatment. What are the pros and cons? Should surgery be considered at my age and disability? Rich


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.