Hallux Limitus Update

I last wrote about my struggles with hallux limitus—arthritis of the big toe—in 2017, and an update is substantially overdue, especially since some of you have kindly taken in interest in the status of my toe.

First, the necessary disclaimer: I am not a doctor, and I am not authorized to give medical advice. What follows is simply a summary of my journey and a reflection on what has worked for me.

Current status

I have not returned to a doctor regarding this condition since 2017 because it no longer bothers me like it did that first year. I still have a bone spur (no resorption, darn it!) and my toe still curves inward, but I rarely experience pain as a result. And when I do experience pain, it is almost always directly attributable to an aggravating factor, such as wearing constricting shoes. My toe hurts moderately only a handful of times a year now and never intensely enough to interfere with my activities. It is not cured by any means, but it has not interfered with my life in a substantial way.

My Biggest Takeaways Two Years Later

Footwear is Crucial

The biggest factor in whether my toe becomes inflamed is what shoes I wear. I theorized in 2017 that the misalignment of my inward curving toe was substantially related to the condition, and my experience these last few years has borne this out. Of the times I experienced pain in my toe, it was usually after wearing shoes with more narrow, tapering toe boxes. As a result, I have come to the conclusion that I can no longer wear most women’s shoes. Even shoes marketed as wide width typically have tapered toe boxes force my hallux inward. I have opted for minimalist shoes (Lems Primal), custom-made shoes, regular sneakers, and shoes made from more flexible materials like suede (Minnetonka moccasins). Finding appropriate shoes for the office has been a struggle. I recently tried knit oxfords and—though the toe boxes are narrower than I prefer—have found them to be a good compromise between professionalism and comfort.

High-heeled shoes are the devil. They wreak havoc on the body even if you do not have hallux limitus, but wearing them with the condition is especially painful. I avoided high heels religiously these last years, but at the end of last year I had an engagement that I felt it would be necessary to wear heels to. Walking in the heels inflamed my toe more than it had ever been since 2017. High heels are unfortunately expected in many professional circumstances, but I am experimenting with pushing the boundaries on what kinds of footwear can be considered professionally acceptable.

While standard medical advice has suggested opting for stiff, immobile shoe soles over thin, flexible soles, I have not found that a thin, flexible sole causes my toe any increased pain or inflammation (though if my toe were already inflamed, I would probably opt for more supportive sneakers over minimalist shoes temporarily). Not only have such shoes not caused my condition to worsen, but I believe they improve my overall foot mechanics by forcing me to use the intrinsic muscles of my foot.

High-Impact Activities

I am happy to report that I have been able to resume many high-impact, physical activities without pain. I continue to avoid tango, which demands high heels and puts a lot of pressure on the balls of the feet, but I do not restrict myself from any other activities. I resumed dancing and hiking, and I have been running regularly for over a year and half.

I have had to be particular about what shoes I dance in. Less supportive shoes are more likely to result in pain, so my dance shoes have the thickest soles of all the shoes I wear. I have hope that this could change since I have at times been able to dance in socks or ballet slippers without any inflammation the following day.

In general, I do have to be more mindful about how much weight the toe bears in barefoot or similar situations.

Bunion Correctors and Toe Spacers

For running, I wear lightweight shoes with as flexible a sole as I can find, and I wear bunion correctors during my run. In the book Run for Your Life, Dr. Mark Cucuzzella noted that he suffers from hallux rigidus and recommended running with toe spacers. After worrying that the toe spacers were causing my toes to grip too tightly during runs, I opted for bunion correctors instead. The choice to wear correctives during my runs arose more from a concern for improving the alignment of my toe than avoiding short-term pain, but recently, for the first time since I started running again a year and a half ago, I ran without them; my toe was inflamed for a few days afterwards, which I did not expect. So bunion correctors are definitely on my must have-list.

Outside of running, I have gotten more lax about using these corrective devices. I wear toe spacers or bunion correctors whenever I remember to or after I’ve worn shoes with constricting toe boxes.

I no longer use metatarsal pads to keep my toe in a more flexed position except occasionally when I know I will be dancing in less supportive shoes, such as ballet slippers.

Nutrition and Sleep

It is hard to say whether my nutritional choices correlate with the condition of my toe. I have continued taking vitamin K2 and glucosamine supplements pretty faithfully since I last posted, and I continue to drink herbal super-infusions (which is tea with a much longer steeping time) that include oat straw, horsetail, nettle, hibiscus, and the recent addition of lemongrass (herbs noted for their recovery properties in the books Body Into Balance and Run Fast. East Slow.). I should add that I eat mostly home-cooked meals (with a lot of homemade bone broth in the colder seasons), focus on eating a variety of vegetables and leafy greens, and have been trying to minimize my sugar consumption. Though I cannot quantify it, I am sure that adequate nutrition and sleep play a role in reducing inflammation in my body and therefore reduce the inflammation in my toe.

Corrective exercise

My corrective exercise prescription has seen the most significant change in my regiment. I have drifted away from exercises focusing solely on the muscles of the foot and have been focusing more upstream on hip mobility and calf relaxation. I think the toe and foot exercises I did in 2017 were helpful in strengthening my foot muscles and laid the foundation for me to return to running the following year. I run in a less over-pronating manner than I previously did, and my historically flat feet are no longer flat. I suspect that my decision to wear thinner, more flexible-soled shoes outside and to go barefoot inside probably helps keep my intrinsic foot muscles in shape in a more holistic, integrated manner. I still take breaks from sitting and have an alarm on my phone to remind me to do so. I no longer focus on massaging the area, although I probably should; it felt good when I used to do it.

Conclusion

I have come to a place where my toe rarely bothers me and no does not interfere with my physical activities, and these are the reasons why:

Very wide toe boxes– much wider than you usually find in mainstream shoes– have been of the most direct benefit to my toe while tapered toe boxes cause a lot of pain. Even if you do not suffer from hallux limitus, I encourage you to ditch shoes with tapered toe boxes so you will never have to!

I have found no reason to eschew flexible-soled shoes in favor of rigid shoes, and I still believe that flexible-soled shoes are a better long-term solution. However, more supportive shoes have their place when the toe is already in a state of inflammation.

Physical activity does not need to be avoided: running, climbing, dancing, jumping, slacklining, yoga, hiking– I’ve been able to do it all except maybe tango and ballet, which I have not yet dared to attempt again since my diagnosis. Someday I may though.

I have successfully abstained from medical orthotics, but bunion correctors and toe spacers have been a big help.

Good nutrition, good alignment and mobility, and good sleep all seem to help improve the condition.

 

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