Hallux rigidus typically presents as an isolated arthritis in the adult without a systemic arthritic condition. This suggests the degenerative process is caused by some local pathologic alteration in the first MTPJ. The athlete with hallux rigidus usually complains of pain at this joint. He or she will often complain of stiffness and decreased motion with certain activities. Usually extension of this joint is limited, which reduces an athlete's ability to push off and causes them pain.
Secondary joint degeneration may occur after a recognized traumatic event. Other theories suggest hallux rigidus is caused by extra strain on the first MTPJ in a pronated foot or by an elevated first metatarsal, resulting in a limitation of hallux dorsiflexion. In any case, the condition tends to be progressive. Normal range of dorsiflexion motion of the first MPJ should be 65 to 75 degrees in order to allow for a normal gait. Near the end of the propulsive phase of gait, the leg has a 45-degree position to the floor and the ankle is in about 20 degrees of plantarflexion to the leg. This position requires the hallux to be able to dorsiflex 65 degrees. Anything less requires accommodation or adaptation from the surrounding joints. This compensation can come from gait changes, such as subtalar joint supination and walking on the outside of the foot, subtalar joint pronation with foot abduction, etc.
The treatment of hallux rigidus is aimed at reducing the local inflammatory process at the first MTPJ and decreasing the dorsiflexion forces that lead to painful dorsal impingement. The initial thrust should be to decrease the acute inflammatory reaction by emphasizing rest, NSAIDs and ice. Graceyfeet Sole Commander and Sole Supporter orthoses seek to relieve the painful forces by repositioning the 1st metatarsal head and spreading vertical forces towards the lateral foot. This allows for use of the client's full available ROM at the 1st MTP during forefoot loading in late stance phase of gait. Decreased pain and increased function are the results! Contact Chris at Graceyfeet@aol.com and chat with him about additional ways you can improve performance and prevent injury in your team.
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