Functional Hallux Limitus

[TimVS]

Your opinions again please gents

For FHL in terms of orthotic prescription, would you prefer

a) A Kinetic Wedge
b) First met cut out
c) First ray cut out
d) None of the above
e) All of the above, depends.
f) What's an FHL?

Rationale for your choice. And arguments against the alternatives, if you like.

Cheers podders

Tim

[robertisaacs]

Good question.

For FHL in terms of orthotic prescription, would you prefer

a) A Kinetic Wedge
b) First met cut out
c) First ray cut out
d) None of the above
e) All of the above, depends.
f) What's an FHL?

Rationale for your choice. And arguments against the alternatives, if you like.

Predictably i will go for E: depends.

I've never seen the point in met head cutouts to an orthotic shell.

I like to planterflex the 1st ray when casting (if i want to planterflex the 1st ray.) but i think that in a thin shell orthotic (ie polyprop or CF you need to be very careful not to destabilise the orthotic doing this)

I think you need to make the device a minimum of 3/4 length and have some form of void or cavity under the first met head.

I think you can do a lot to prevent 1st ray dorsiflexion and sunsequent locking with the rearfoot.

I have had lots of success treating this with simple insoles, however my most usual weapon of choice is a 3/4 length shank dependant EVA or lunarsoft device. The rearfoot position depends on the degree of forefoot supinatus / varus / Primus metatarsus supinatus. (depending on which school of though you belong to). I don't neccessarily go for neutral. I generally shoot for about 3-5 degrees inverted from the rearfoot position in which the forefoot can be made plantergrade OR stjn whichever is the more everted.
The cheats way to do this in foam is to stick a strip of tapered 5mm scf to the planter aspect of the 1st met, sink the foot in an inverted position, then evert the forefoot until the felt contacts the ground and check that this is not more inverted than STN. If it is then i will evert the rearfoot until i reach neutral.

But Dave S is the real expert on FHL because he has just done his Masters thesis on it. And its good, its very good indeed.

Regards
Robert

[Admin]

Hi,
A good few years ago Howard Dananberg and I exchanged emails. At that time he was quite certain FHL could not be diagnosed without a vertical loading system. I had just bought my first, a £20,000 Musgrave system, so was quite excited about what it could/could not diagnose. About 4/5 years ago I emailed him about FHL again, and he'd changed his mind. It seems you could now diagnose FHL without a vertical loading system.

It may have changed again - I don't know.

What I do know is that by forgetting all about FHL and balancing my orthoses FF only (usually 2 degrees) - actually I sometimes use RF posts, but only occasionally, and by using a 1st ray cut-out if the 1st ray is plantarflexed, I obtain pretty good results most of the time.

It will be good to see Dave S's Paper (if he has the energy to write one after doing an MScThesis - I know I didn't! ).

Good topic Tim!

Cheers,
david

[dtt]

Hi Davidh (sneezy)

It seems you could now diagnose FHL without a vertical loading system.

I attended a seminar earlier this year where this question was brought up.

I understand the method used now by Howard D is :

To place the thumb under the first met head and maximally dorsiflex it.

With the other thumb on the apex of the hallux, dorsiflex the hallux and if you feel a plantar flexion on the 1st met then that pt has FHL.

It must be an immediate plantarflexion and I found needs a bit of practice to palpate correctly.

I hope this is clear (is to me but ;D)

I will demonstrate in Jan and then you academics can revisit and Discuss

Cheers

Dorfus