How To Treat Hallux Rigidus In Runners
- Volume 22 - Issue 4 - April 2009
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In ten healthy people, the average dorsiflexion range of motion of the first MPJ during walking gait was 42 degrees. The average passive dorsiflexion range of motion with non-weightbearing (most commonly used by podiatric physicians) was 57 degrees. This measurement overestimated the actual range of motion during gait. The active dorsiflexion with weightbearing was 44 degrees and most accurately predicted the dorsiflexion range used during gait by the study participants.
This study by Nawoczenski dispels previous notions about clinical evaluation of range of motion of the first MPJ. Furthermore, a new standard of “normal” range of dorsiflexion range of motion of the great toe joint should now be set at approximately 45 degrees. However, this dorsiflexion range has only been verified for walking gait, not running.
Deconstructing The Myth About Great Toe Motion In Running Gait
The assumption that running amplifies everything more than walking is somewhat true. Impact forces, muscular activation and joint moments are just a few factors that are substantially greater during running in comparison to walking. However, the assumption that all of the joints of the lower extremity go through greater range of motion during running, in comparison to walking, is simply not true.
Early on in my career, I became aware that many of my runner patients with hallux rigidus would report less symptoms during running than walking. A review of the literature has shown no valid study of measurement of range of the motion of the first MPJ during running gait. However, conversations with many respected podiatric physicians confirmed a belief that running gait would require greater range of motion of the great toe joint than would walking gait. Accordingly, one would expect that hallux rigidus symptoms would become worse during running. My experience has been just the opposite.
Mari Adad, DPM, has provided further insight with unpublished data from a study of six healthy individuals. Using the same type of electromagnetic tracking system utilized by Nawoczenski to measure range of motion of the first MPJ, Adad measured an average of 34 degrees dorsiflexion of the great toe joint during walking and only an average of 26 degrees dorsiflexion during running.
In regard to understanding the reduced dorsiflexion range of motion of the first MPJ in running in comparison to walking, Sasaki and Neptune used computer modeling to predict joint angles and forces of the lower extremity segments during running.15 This study confirmed that ground reaction forces peak earlier under the forefoot during running in comparison to walking when the ankle is in a less plantarflexed position. A reduced ankle plantarflexion angle during running, in comparison to walking, puts less dorsiflexion demand on the first MPJ during the heel rise portion of the gait cycle.
The earlier and greater peak ground reaction force in running is partly due to increased muscular activation of the ankle flexors including the flexor hallucis longus. Early and greater activity of the flexor hallucis longus will restrict dorsiflexion of the first MPJ during running in comparison to walking. In other words, runners with hallux rigidus may use greater muscle activity to restrict painful dorsiflexion of the first MPJ and minimize symptoms in comparison to walking.