Hallux Limitus/Rigidus: When Do We Allow Motion And When Do We Restrict Motion?

When treating a patient with hallux limitus or rigidus, you want to allow the joint to move as much as it can so it will not freeze up. There are times when patients will do something that requires too much painful motion, and then you should restrict motion. It is like nerve pain: sometimes patients should honor the pain and stop the activity, and sometimes they should push through the pain.

I have made two pairs of orthotics for some of my patients with hallux limitus or rigidus. One pair limits motion and one pair restricts motion. However, I tend to make an orthotic for the majority of your patients with hallux limitus or rigidus with dancer's padding that allows freedom of the joint. When patients need restriction (for example, for an upcoming backpacking trip they know will irritate the joint), I have them slip a flat carbon graphite plate under the orthotic, use spica taping, stiff-soled shoes or a combination that they have found helpful. 

For those with hallux limitus/rigidus, I have used either an extension supporting the entire forefoot or a Morton's type extension of the flat carbon graphite plate. Two stores near me have plates with full foot stiffness so it has been easy for patients to start with that. If it seems plates lead to too much stiffness with irritation somewhere (metatarsals, ankles and knees in particular) from such radical restriction of motion, then I have patients get the plate that is flat but only has a hallux extension for a Morton's neuroma. Again, I am typically going to look for a short-term restriction of motion when it is needed with a return to motion when possible. 

When choosing the stiffness/flexibility or the thickness of the plate, I use a stiff Ottobock plate in the appropriate size. I prefer plates that are stiff (firm) and flat (since the patient is using it under the orthotic device). I also love the spica taping at this time of restriction. 

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2018/03/hallux-limitus-and-hallux-rigidus-when.html and at https://www.drblakeshealingsole.com/2018/04/hello-dr.html. They are reprinted with permission from the author.