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Thursday, December 5, 2013

Hallux Limitus/Rigidus: Email Advice

Hi Dr. Blake!  

Thank you for this wonderful blog!  I have been dealing with an injured (and re-injured) left MTP joint for years now.  It recently felt bad enough that I sought out my GP.  X-rays showed mild-moderate 1st MTP joint degenerative disease with joint space narrowing, subchondral sclerosis & cystic changes and osteophyte formation.  I tried googling all this, but would love it if you could explain these in lay person terms. 
Dr Blake's comment: You have arthritis in your big toe joint which is causing pain. Below are some links to Hallux Limitus/Rigidus which are degrees of restricted range of motion that develop as the arthritis worsens.

 I have a little range of motion loss compared to the other side, but I still think it's around 60 degrees.  Am I on the road to hallux limitus? 
Dr Blake's comment: Yes, and you need to daily do the self mobilization technique in my video below. Also, if you pronate, get orthotics for your most strenuous activities. Place dancer's pads in any shoes you can. 

 My main complaints are the pain and swelling that occur after walking around with  shoes with 1" or 1-1/2" heels as well as after tap dancing.  I am currently not tapping, but would love to return to it, but am worried about irritating the joint.  Lastly, I see you mentioning dancer's pads often.  Do you have instructions on how to craft one?  I appreciate any advice and help!
Here a dancer's pad to float the first metatarsal head is made of Spenco material and glued to the bottom of the shoe insole. 1/8th inch to 1/4th is normal, but you should never feel like you are falling into the hole created.

Here the 1/8th inch adhesive felt from is being used to change weight bearing off of the 5th metatarsal. 
Dr Blake's comment: You should do just fine with tap dancing with icing twice daily to reduce the inflammation, dancer's padding with 1/8th inch adhesive felt from, use of Hapad Longitudinal Medial Arch Pads for the shoes from You may also need to learn to spica tape. 
Here Small Longitudinal Medial Arch Pads from the Hapad company are used as an arch support to transfer weight from the big toe joint into the arch and also into the 2nd and 3rd metatarsals and off the big toe joint. Because it is an adhesive felt, it can be moved around and thinned by peeling when needed. 


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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.