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Saturday, February 24, 2018

Hallux Limitus: Email Advice

Hi Dr. Blake,

I am a 34-year-old runner with Hallux Limitus and am hoping that you could help me. I have seen two podiatrists in my area (Lynchburg, VA) and they both have told me to just stop running. I run 20-25 miles per week (I did do a couple of 50k trail races last year but found that the steep up and down trails in the mountains irritated my toe). I am okay with not running these long races if it means that it will make my condition worse but I would love to be able to continue to run for many years.
Dr. Blake's comment: Hallux Limitus is either functional (which can be totally reversed with some arch support and dancer's padding to off weight), structural (meaning some degenerative process which will get worse and you still try to keep your pain between 0-2 and experiment with off-weighting and arch support), and structural and functional combined. If your big toe joints have some structural damage (typically diagnosed by x-ray or MRI), I would still run as long as you can in that 0-2 pain level. If long races increase pain, then you must avoid, but if 5-10 miles is fine, it is actually better for joints to have a pain-free high-level loading for cartilage nourishment.  

I do not want to ignore this and make it worse but rather run responsibly.
I have been running in Hoka Bondi's but I'm finding with the orthotics inserts a PT suggested I use (she has said I can continue to run), that the toe box is too small. I did try on Brooks Glycerin and Altra Paradigms and both shoes felt great but I'm not sure if they're great for this condition.
Dr. Blake's comment: There are some many factors that jam up the big toe joint, so it is experiment time for you. Definitely, find the wider Hoka One One shoes, they are out there. Hoka should be a great shoe for some of your running. Also, get a medium gel toe separator to see how holding the big toe in the center of its joint makes you feel while running. I love Brooks Addiction or Beast for the varus cant off the big toe, but of course, we do not want you to roll your ankle. Definitely, you want to see if those shoes, along with a 1/8th-inch dancer's pad to keep the weight in the center of your foot at push off. The zero drop shoes are good for metatarsal pain, but not good usually for hallux limitus. They put you back on your heels more, for pain reduction, but in most make it harder to push off. Some of my patients push off hard, and others hardly at all. 

Do you have any suggestions that will keep me running without irritating my toe or cause this condition to progress? Above If I take care of it and am cautious, does this condition always get worse? I would rather be proactive now than later.
Dr. Blake's comment: Have some weight bearing xrays taken of your feet, take photos of each frame, and send. Again, if it is primarily structural, you will have more work to do keeping in the 0-2 pain range. You would want to re-x-ray in 2 years and see what is happening. Arthritis is made worse faster by not using it, then if you can use in a pain-free environment. Look up the nutritional theory of cartilage development. Yes, if you have arthritis, and you push through pain, you will speed up the need to have joint replacement surgery. 

Also, do you know of anyone in the Central Virginia area that is up to date on this condition? 
Dr. Blake's comment: Call Richie and Company, an orthotic lab in Charlottesville, and ask who are the good biomechanics people in your area. They would know. Use my name. The owner is Brett Richey. 

Thanks so much. This whole thing has been frustrating and disheartening, to say the least. Also, I attached a picture of my most recent xray.
Dr. Blake's comment: The x-rays were poor quality and not sure if weight bearing. Have AP, Oblique, Lateral, and Plantar Axial xrays taken of both feet at some time and send me 8 individual photos. Please make sure they are weight bearing. Good Luck, Rich
Thanks again,

1 comment:

  1. Hi,
    I have very mild Hallux Limitus and I'm worried about how fast it will worsen. I have found the new trend in carbon plated shoes to help, but if it gets worse are there no surgical options that will restore mobility to the joint or do those of us with the condition need to learn to accept or new malformed biomecanics?


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.