What's the best orthotic for hallus limitus?
We had a question from one of our customers this week that was discussed this morning at our all-hands-on staff meeting. The question was this; what's the best orthotic for hallux limitus?
Most of the time when we're asked a question like this, we fall back on our business credo - the right diagnosis and the right product, the right way. So first, what's the right diagnosis? If you read our knowledge base article on hallux limitus you'll find that there are four different stages of hallux limitus and in each stage, treatment may vary.
In stage 1, the only orthotic I'd recommend would be the SOLE Active Insole that is modified with a Dancer's Pad. Stage 1 hallux limitus is a bit unique. In stage 1 there is no dorsal exostosis (dorsal bunion) and x-rays show no radiographic changes. Stage 1 is characterized by a dull ache in the great toe joint. In the vast majority of cases, hallux limitus is going to be caused by metatarsus primus elevatus (refer to the knowledge base article). When hallux limitus is due to metatarsus primus elevatus, the orthotic is used as a foundation to hold the dancer's pad. Use of the dancer's pad will plantarflex the 1st metatarsal correcting metatarsus elevatus and in many cases eliminate pain and slow the progression of hallux limitus. Turf Toe T Straps may be a temporary relief for many.
Stage 2 hallux limitus is a bit different. Clinically, stage 2 will begin to show a wee bit of a dorsal bump on the head of the metatarsal and subtle spurring on x-ray around the periphery of the joint. In stage 2 I'm inclined to go with either the Hallux Trainers or the Spring Plates. Hallux Trainers and Spring Plates are going to enable normal function of the foot but give just a bit of limitation to the range of motion of the great toe joint. The more normal the function of the foot, the more normal gait will be with less load applied to the hip and lumbar spine. Turf Toe T Straps will also be a temporary help in a pinch.
So what's the best orthotic for hallux limitus? First, be sure to have the right diagnosis before you consider the right product. We just think that's the right way to do things.
Jeffrey A. Oster, DPM