Treating Hallux Rigidus with Rigid Carbon Plates
Soreness in the big toe joint that hurts when walking is generally frequently as a result of osteoarthritis and is frequently given the term more commonly called hallux rigidus when the joint is really rigid or hallux limitus if it is not too inflexible. Hallux rigidus is painful whenever walking, so if its really painful while resting, then it may well more often than not be gout symptoms than a hallux rigidus. Considering the hallux rigidus, while we are walking and the back heel commences to lift up off the floor, the big toe joint must move for this motion to happen. In the event that movement is limited or there’s a painful osteoarthritis in the big toe joint, then this is not going to be as easy to walk. It is logical when that hallux joint is painful when walking, then a plausible solution to help the pain on motion should be to restrict just how much the joint flexes.
There are many methods to try this. One simple method in which Podiatrists use is with felt padding that could be put on the foot beneath the big toe and ball of the foot or strapping can be utilized to strap the big toe joint. These two are usually really good short term measures, but just impracticable for the long run. Should you prefer a foot support for some other reasons, there’s an expansion that a Podiatrist could add on the front edge of the foot orthotic which is known as a Morton’s extension which they can use to restrict up the big toe joint by reducing bending or flexion of the feet. One other way is by using a carbon fibre insert plate that typically are less than 2mm thick so they can fit easily into the footwear and therefore are very inflexible. These kinds of carbon fibre plates are often used to treat hallux rigidus and other issues for example turf toe which need to limit the movement in the joint. The research evidence is these rigid insoles are rather good at reducing the pain in the hallux joint in these kinds of problems. An alternate way to manage the discomfort from the osteoarthritis and hallux rigidus could be to simply use shoes which are more inflexible across the ball of the foot. The more flexible the sole of the footwear is, the more that the big toe or hallux joint will flex and the much more likely it is to be painful when walking. There are a few types of footwear, especially the Hoka running footwear, that have a rocker and additional cushioning included in them which are especially helpful at this. The effect of the rocker in these shoes is that the great toe or hallux doesn’t have to flex just as much as the foot moves forward on the rocker. A pedorthist or footwear tech may add a rocker to many different types of shoes to obtain the same thing.
When you have hallux rigidus or arthritis in the big toe joint, then there are alternatives for the short term to take care of the discomfort and possibilities in the longer term to manage the movement of the big toe joint that it is not as painful.
Fitting Children’s Shoes
Parents so often worry about their kid’s teeth, eyes, and most other areas of the body, but do not get worried so much over the developing feet. Plenty of adult foot conditions can have their beginnings in childhood, consideration to footwear in kids can minimize the risk of these issues in adults.
Significance of the shoe to the child:
Inadequately fitting children’s shoes can cause many conditions in adults such as hammer toes, ingrown toenails, foot corns, calluses and bunions. Considering the high level of pain and discomfort that these disorders can cause, it is obviously logical to attempt to prevent these disorders by making certain that the child’s shoe is fitted correctly. Foot conditions in children are usually preventable.
Fitting footwear for the child:
The most important factor in shoes for a child is that they fit. Preferably, this means that footwear is fitted by somebody who has had some special education in the fitting of children’s footwear.
Tips for the fitting of children’s footwear:
* Children should have their feet measured roughly every three months (thus ensuring the need for new footwear as required).
* Typically, for a shoe to be correctly fitted, there should be a thumb width between the end of the shoe and the end of the longest toe.
* When looking at the bottom (sole) of the footwear, it should be fairly straight (not curved in too much) – feet are straight, so the footwear should be straight.
* The fastening system (laces, velcro, buckles) need to hold the heel securely in the back of the shoe (the foot ought not to be able to slip forward in the shoe).
* the heel counter (back part of the shoe) should be strong and stable.
* the footwear ought to be flexible across the ball of the foot, since this is where the foot bends.
* Leather and canvas are a better material – these are more robust and can breathe. Artificial materials usually do not breathe as well, except if they are of the ‘open weave’ type. Avoid plastics.
* Make certain the footwear have curved toe boxes to allow the toes more room to move and grow.
* Shoes ought not have to be “broken in”. Should they do, they are either improperly designed or badly fitted.
* An absorbent insole is useful, as the feet can sweat a great deal – children are very active!
* A number of stores focus on shoes for the child – make use of them!
* Fitting shoes correctly in adults is also just as crucial
3 tips for examining the child’s footwear:
There ought to be a thumb width between the end of the shoe and the end of the longest toe = length is correct.
You ought to be able to pinch the upper of the footwear between your thumb and forefinger (this can depend on the character of the material) = width is proper.
Does the shoe fit snugly around the heel and arch? How stable is the footwear when trying to ‘pull off’ the footwear? = good fit.
Chilblains
Chilblains area common problem in some countries and unheard of in others. They tend to commonly occur in colder climates.
Once they occur, it is important to keep the foot warm (link to advice) and prevent it from happening again. There is not a lot of research done on them despite how common they are (link to the research). They are more common in females, so that suggest hormonal issues, but the do occur in males. Lots of questions gets asked in forums and often the answers for a “cure” are just not there, so a lot more research is needed to get to the bottom of this small, but annoying problem.
What is a plantar plate tear?
The plantar plate is a strong ligament under the joints at the base of the toe in the ball of the foot. It is reasonably common to strain that ligament or have a small partial tear in it.
Typically, this starts as a slight ache under the ball of the foot that can be quite painful on palpation. The toe of the affected joint also tends to lift up off the ground.
Many questions get asked in forums and message boards on how to treat this, especially if it can heal on its own. It can’t. Treatment is almost always needed. Most the best way to treat it, is with strapping:
If that conservative approach is not helpful, there surgery is often needed.
Do bunion correctors work?
Bunion correctors are splints that are supposed to hold the big toe in a correct position and fix bunions. Lots of questions get asked online if they work (see here and here for examples). There does seem to be a moderate consensus that they may help a small amount.
Bunion correctors probably do not fix bunions, but will improve the angle of the big toe a small amount. Only surgery will make it go away.
There is a lot of marketing hype around the selling of these. See this: Bunion corrector gullibility. Don’t fall for it. At best, they will improve the ankle of teh big toe by a small amount and may be helpful with the pain in the joint. That may be a good thing.
Archies Arch Support Thongs
Firstly, in Australia they call flip flops “thongs”! The Archies Thongs are are proving very popular in Australia for those who do and do not need foot orthotic support and want to wear a flip flop type of footwear to to the warmer climates. The flip flop has a built in arch support that is both effective and comfortable.
A number of podiatry clinics are stocking them and you can get them online.
They were design by a phsyiotherapist in Melbourne, Australia. The amount of arch support in them is comparable to a typical ‘over-the-counter’ premade foot support, which is why they are so popular.
Gowers Sign
Gower’s sign is a neurological symptom that was first described in how a child with the sign gets up from the floor:
(i) the child initially adopts a prone position on all fours before they attempt to stand
(ii) the child uses their hand to ‘walk up their legs’
Gower’s sign occurs when there is a weakness of the core or pelvic muscles. The most common reason for the sign is Duchenne’s muscular dystrophy.
The Ipswich Touch Test
The loss of sensation in the foot in those with diabetes is a significant problem. There are many different ways that a podiatrist can assess that, ranging from the use of sophisticated tools to simple tests. The recently validated Ipswich Touch Test is one of the simplest:
The Ipswich Touch Test is done by lightly touching the tip of the 5th, 3rd and 1st toes of both feet and seeing if they can feel the touch. Its that simple – it has been shown to be valid and have good sensitivity and specificity for sensory loss. It is not too difficult to imagine what could happen to the foot if they can not feel it being touched. Check these resources on it.
Ankylosing Spondylitis and the Foot
Ankylosing spondylitis is a problem that mostly affects the spine with a form of arthritis. It can also affect other points and some other organs. The problem in the spine affects mobility and creates a progressive deformity that will need a lot of physical therapy to manage.
It affects the foot in three ways:
1. The arthritis like symptoms can affect the joints in the foot
2. Pain in the heel similar to plantar fasciitis is common
3. Due to the affect on the spine, the ability to reach the feet and do self-care is difficult.
What is an Abductory Twist?
An abductory twist is an observation made during gait in which there is a sudden abduction of the heel just as the heel comes off the ground. Some call this a medial heel whip.
There are two schools of thought as to what causes an abductory twist:
1) The one described in the video is the most commonly believed reason and is due to a foot that is overpronating as the leg is externally rotating. As soon as load comes of the heel, this causes the foot to suddenly abduct. The pathomechanics of this is discussed in detail here. Those who subscribe to this reason tend to call it an abduct0ry twist.
2) The other believed cause is that there is a weakness of the hip abductors. Those who subscribe to this view tend to call it a medial heel whip.