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How Orthotics Work to Treat Bunions and Big Toe Joint Pain Video

The video below explains how orthotics work to treat bunions and other big toe joint problems including hallux limitus (jamming and pain in the big toe joint) and hallux rigidus (arthritis of the big toe joint).

This video was made as a training video for podiatrists who want to learn how to make better orthotics, so you may find it somewhat technical. But many patients in our Seattle foot and ankle clinic have requested more detailed information on how orthotics work, so we thought many people might find this useful.

More information on bunions can be found on these pages:
• Bunions and Big Toe Joint Pain
• Bunion Surgery
• Best Orthotics for Bunions and Big Joint Problems
• Home Treatment for Bunions and Big Toe Joint Problems

OTHER VIDEOS
Orthotics for Child Heel Pain Video
Orthotics for Flatfeet Video

VIDEO TRANSCRIPT

Today, we are going to look at a pathology specific orthosis for hallux limitus and bunIons. What we have done is taken a look at the literature and tried to come up with the best prescription for any particular pathologic problem of the foot. This one is one we have designed for the patient with hallux limitus.

Most studies are now showing that with hallux limits our primary goal is to encourage plantarflexion of the first ray. By encouraging plantar flexion of the first ray, we are able to decompress the first metatarsophalangeal joint, enhance windlass function and see better motion within the first MPJ, less compression within the first MPJ, and less pain from hallux limitus.

We want a device that is going to decrease eversion of the calcaneus and then allow the first ray to plantarflex. So as far as the orthotic goes we are going to go with the device with a relatively deep heel cup, so that we can use this orthosis to apply force to the medial aspect of the heel in order to put a supinatory torque across the subtalar joint access. Within the heel cup, we incorporate a medial heel skive. You probably cannot see it within this device here but this is essentially a medial wedge or a varus wedge added into the heel cup of the orthosis itself. In the arch of the orthosis, we have asked the lab to do a minimum cast fill, so that it would conform very tightly to the arch of the foot. When you have your patient back in your office to dispense orthosis you want to put that patient into a neutral casting position and make sure that the orthosis conforms tightly to the arch of the foot. In addition, we will often invert the orthosis a few degrees to further raise the arch and by raising the arch here we let the first ray plantarflexed more affectively. Finally, we are going to add a reverse Morton’s extension, so piece of Korex under the met heads two, three, four, and five that reverse Morton’s lets the first ray plantarflexed. So that is our pathology specific orthosis for hallux limitus.

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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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