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Are Orthotics Always The Answer For Hallux Limitus?

A runner recently contacted me about his recent diagnosis with hallux limitus and bone spurs. He shared that he usually runs about 15 miles each week and uses Brooks Ghost running shoes. This patient would like to keep running but would rather not use orthotics. He asked if he might continue running in the Brooks shoes with a medium gel toe separator and avoid additional injury/insult to the joint.

As we know, hallux limitus is a slow, gradual, progressive, degenerative process when there are spurs present. In over 30-plus years in my practice, I have seen runners continue to run with this condition but there is no magic cure. My goals for these patients are to decrease stress on the joint and protect it, ensure they never run with pain over a two out of 10 on the visual analog scale, and that they especially avoid limping. Running itself is very natural for the body. Not only does running build strength in muscles and bone, it has a huge emotional aspect as well. It is part of most athletic participation programs and can be vital to people’s health.

In these cases, I recommend patients continue running their usual mileage while building a program to keep the pain between a zero and two. In my experience, orthotics can both hurt and help in this patient population so they are typically not my #1 treatment unless the patient is a moderate to severe overpronator. Overpronation jams the first MPJ into the ground, increasing the stress on that joint. The correct type of orthotics have to be full-length orthotics. These orthotics require expert attention since the rigidity under the first MPJ in a full-length orthotic device may provide too much pressure and may require modification. 

In order to achieve this minimal pain level without orthotics, I use several modalities that decrease stress on the first MPJ. These modalities include spica taping, dancer’s padding, Hoka One One running shoes with rocker bottoms, Cluffy Wedges, arch supports, Morton’s extensions and shoes with great forefoot cushioning, like the Brooks Ghost.

Of course, each case is different and we all have our individual treatment options. However, in my experience, a diagnosis of hallux limitus in an avid runner does not automatically indicate a need for custom orthotics.

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.

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