I was recently diagnosed by a podiatrist and orthopedist with hallux limitus, or osteoarthritis of the big toe. It means that my toe no longer has the range of motion to fully dorsiflex. The pain so far has been minor, especially compared to the mental experience. I like to be very physically active, and now I feel unsure of my body, unsure of what I can handle safely and what will cause further damage to my first metatarsal joints.
I am a bit frustrated by the lack of information I received from the doctors concerning the possible biomechanical causes of hallux limitus and the efficacy of treatment options. It seems that for most medical professionals, treatment of hallux limitus is a routine matter of masking the dysfunction with orthotics and and cortisone until the pain becomes so unbearable that the patient wants surgery. And then, even if successful, the surgery might only buy a few years before the cycle starts over again. This is not satisfactory to me. I, naturally, want a cure for hallux limitus. But even absent a cure, none of the traditional options appeal to me because none of them address whatever underlying dysfunction is causing or contributing to the problem. Without addressing that factor, I’m basically fighting a painful, Sisyphean battle against hallux limitus.
I believe that I if I can target the underlying biomechanical issues, I can stop the deterioration and pain and hopefully resume my usual physical activities. Because the medical industry places little focus on corrective treatment, I am undertaking my own n=1, physical therapy experiment culled from what I know so far.
Clues to Understanding My Hallux Limitus
This is what I about my condition:
- Weak, flat arches as demonstrated by my habitual over-pronating during running and my inability to distribute my weight evenly across my foot when I pivot in tango.
- Weak posterior chains, especially my glutes and hamstrings. This has led to knee pain during running in past years.
- Toe distortion. My big toes both turn inwards from years of shoe-wearing. They are not bunions– they curve in at the interphalangeal joint rather than at the metatarsal joint. There is no pain, but I am sure they contribute to the issue. I notice when I press my arthritic hallux down, it turns further inward rather than straight down.
- Pain after tango. The pain first and continually resulted after tango dancing. Rather than direct pain, though, the observable symptoms was tenderness and inflammation that was not noticed until I massaged my feet. Other activities have less impact on the joint.
- Ankle and knee tenderness/instability on the affected leg. Lends credence to the idea that my whole kinetic chain is off.
- No one else in my family suffers this issue, suggesting that this is particular to my body and activities.
My theory is that the biomechanics of my foot has been off for years without my being aware of it. My feet, weakened from intrinsic inactivity and shoe-wearing, could not adequately cope with the more substantial forces I threw at it when I went running, dancing, and hiking. Various muscle chains, including the intrinsic muscles of my foot, failed to fire properly as they should, and my big toe had to pick up the slack, often carrying all of my body weight as I pivoted in turns for my very frequent dancing (It is no coincidence that this is a condition common in ballerinas.). My hallux was being overtaxed without my realizing it because it compensated so effectively.
Hallux Limitus Action Plan
This is my hallux limitus action plan to stabilize the joint, hopefully:
- Stop tango, swing dance, running, parkour (anything high impact on joint)
- No high heels or constrictive shoes
- Stop dancing outdoors and in flat, minimalist shoes
- Continue other activities with great caution
- No chair sitting longer than 30 minutes (weakens posterior chains)
- DIY orthotics: As needed, typically when dancing or when the joint is inflamed. The medical industry advises against flexible, minimalist shoes for this condition. So far I have not experienced pain or seen an increase in inflammation in connection with wearing minimalist shoes, so I do not plan to stop at the moment. The idea of wearing rigid, immobile shoes as suggested by the medical establishment seems counterproductive to me, since that would weaken all the muscles of the foot, including the muscles that would stabilize the first metatarsal joint. Instead, I am experimenting with homemade orthotics that keep my hallux in a more plantarflexed position while allowing the rest of the foot to move freely.
- Massage/Ball mobilization: This is crucial. My pain, thankfully, has not been at all acute. The only sign I have most of the time that my joint is inflamed is irritation upon massage. I will use this to monitor the condition of my joint.
Nutrition & Health
- Sleep: I have spent most of the year getting inadequate sleep. I am certain that the sleep deficiency contributed to my body’s inability to heal. I have successfully committed to seven hours of sleep this past month, and I plan to keep it up.
- Turmeric: The curcumin in turmeric is anti-inflammatory, so I try to add use it in my cooking as much as possible
- Nutritive tea: Nettle and oat straw are calcium-dense herbs with magnesium, potassium, silica, and iron. I suspect I may be deficient in some of these nutrients. My excellent Body Into Balance book says these herbs’ nutrient potential is best realized when they are steeped in boiling water for at least four hours.
- Glucosamine: For cartilage support.
- Vitamin K2: This essential nutrient supports bone health. I suspect I may be K2 deficient since I do not eat organ meats or natto, and I do not eat enough eggs, cheese, pickles, or grass-fed animal products everyday. Vitamin K2 is supposed to be useful for arterial decalcification. I have heard anecdotes about bone spurs, which have developed over my first metatarsal joints, resorbing into the body. To be clear, the medical literature does not seem to support this at all. But if there is any chance it could happen, I figure I’ll need sufficient K2 for my body to do it.
- Bone broth. I plan to incorporate it into my cooking where I can for additional collagen support.
- Ice as necessary
- Herbal salves as necessary. I’ve read that frankincense and myrrh can be effective in alleviating arthritis pain and inflammation.
- Epsom baths regularly.
I culled these exercises from multiple sources, including this article from the Journal of Orthopaedic & Sports Physical Therapy, which provided the foundation for the exercise component of my program. I also pulled inspiration from Katy Bowman, Dr. Ray McClanahan, and others.
- Toe spacers/bunion splints (as long as tolerable)
- Calf stretches 3×30
- Supine hamstring stretch 3×30
- Psoas/Iliacus release
- Ankle circles
- Toe mobilization and massage
- Top of foot stretch 3×30
- Sesamoid mobilization 2 min
- Foot and Toes
- Marble pick-up (30)
- Towel Drag
- Toe yoga
- Resistance band toe training
- Multi-faceted walking
- Seated heel raises 3×30
- Short Foot 3×10 (10 sec)
- Resistance strap inversion/eversion
- Toe lifts
- Heel drops/Calf raises
- Leg & Hips
- Hamstring bridges
- Kneeling lunge
- Foot and Toes
- Single leg exercises
Eventual Reintroduction of Activities (Hopefully!)
- Distribute weight while pivoting
- Relevé down to double toe stand while keeping chest lifted’
- Neutral pronation
I have been working on this program for a month now, and I feel fairly optimistic. I went partner dancing twice last month without orthotics (though also not in minimalist shoes), and neither time did I experience pain or inflammation during or after the dance. That was the first time in months that I was able to go dancing without experiencing pain.
Also, I was shocked to discover that a ganglion (a noncancerous, fluid-filled cyst) I’ve had on my hand for years has suddenly reduced in size for the first time since it appeared four years ago! It remained so steady these past years that I gave up on it ever going away on its own. I was shocked when I looked at my hand today and had to struggle to locate it. This further indicates in my mind that I am on the right track, that the changes I am implementing are providing my body the resources it needs to recover. I’ll keep you apprised of my progress in battling hallux limitus.