Can Shoes and Orthotic Devices Produce Normal Motion in a Patient with Structural Hallux LImitus?
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Patients will present with Functional and Structural Hallux Limitus all the time. The basis of this study is to attempt to compare barefoot, minimalist shoe Orthotic #1, and minimalist shoe Orthotic #2. Since shoes produce a huge difference in foot mechanics, comparing any type of orthotic device worn with a shoe and barefoot makes no sense. That being said, those of you interested in first ray biomechanics can see that the two different orthotic devices did have differing effects on structural hallux limitus (defined as 30-60 degrees of non weightbearing first MPJ motion of dorsiflexion). The article is worth reading.
What do we try to do with structural hallux limitus patients? Why do they come into our offices? Typically their feet produce a propulsion and they hurt in their big toes joints. We usually do want some arch support to shift their weight laterally. I typically design two orthotic devices for them, one for when they are in pain and one for when they are not in pain. One typically has a Morton’s extension to limit first MPJ motion and one has dancer’s padding (aka Reverse Mortons) to off weight the big toe joint freeing it up. My more functional orthotic has Dr. Dananberg’s device of dynamic wedging (which seems to have some version in this study), and my less functional orthotic limits big toe motion and accompanied with rocker shoes like the Hoka design.
The paper presented two orthoses with different designs. It looks like, even the one that has the first ray cut-out, that they both block some MPJ motion by having material extend to the sulcus. They seem to want to prove that orthotic devices should increase MPJ dorsiflexion and the resultant ankle plantar flexion, but the orthotic design blocked motion too much. Zero drop minimalist shoes can also, in some patients, since the heel is lower than in traditional shoes, make it harder to walk across in the sagittal plane (easier running in these shoes).
I have to ask those of you reading this what you feel about this statement from the paper. I won’t tell you my answer now in order not to influence you. The statement is:
“ Some researchers propose that FHL serves as a precursor to SHL [7,8,11]. Understanding the progression from FHL to SHL is essential for early intervention and prevention strategies.”
