Functional hallux limitus occurs when the hallux range of motion is limited as a result of jamming of the 1st metatarsophalangeal joint.
Hallux limitus most commonly occurs when 1st ray plantarflexion is restricted during gait. Contributing factors to this condition are excessive force under the 1st ray, excessive heel eversion (subtalar joint pronation), or an everted forefoot. Over time, repetitive jamming can contribute to arthritis of the 1st metatarsophalangeal joint (structural hallux rigidus) or formation of a bunion deformity (hallux abducto valgus or HAV).
Clinical Goal for Orthotic Treatment
To decrease excessive ground reactive force under the first ray and to allow the first ray to plantarflex. The orthosis should be designed to decrease the everted position of the calcaneus when an everted rearfoot is present. In the case of an everted forefoot, the orthosis should support the lateral forefoot (forefoot valgus).
To prescribe this device check “Hallux Limitus/HAV” under the Pathology Specific Orthoses section (Part A) of the prescription form.
Functional Hallux Limitus Prescription Recommendations
- Polypropylene Shell – semirigid
- Standard Heel Cup
- A standard heel cup is generally sufficient. Consider changing this to a deep heel cup in the presence of an everted heel.
- Wide Width
- The increased surface area under the arch with a wider width is more effective in preventing arch collapse and plantarflexing the first ray
- Minimum Cast Fill
- An orthosis with minimum cast fill conforms to the arch, preventing arch collapse and plantarflexing the first ray
- Medial Heel Skive – 4mm
- The medial heel skive increases force medial to the subtalar joint (STJ) axis to reduce excessive STJ pronation and heel eversion
- Inversion – 2 degrees
- Inversion of the positive cast increases arch height under the base of the first metatarsal resulting in plantarflexion of the first metatarsal
- Rearfoot Post
- The rearfoot post will help stabilize the orthosis in the shoe
- EVA Cover to Toes
- The topcover allows the addition of the reverse Morton’s extension
- Reverse Morton’s Extension
- A reverse Morton’s extension improves first ray plantarflexion
The orthosis for functional hallux limitus described is based on the literature (see references below). It promotes first ray plantarflexion, reduces compression in the 1st MTP joint, and improves hallux range of motion.
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- Grady JF, Axe TM, Zager EJ, et al. A retrospective analysis of 772 patients with hallux limitus. J Am Podiatr Med Assoc 92:102, 2002.
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- Scherer PR, Sanders J, Eldredge D, et al. Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait, J Am Podiatr Med Assoc 96(6):474, 2006.
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