Functional Hallux Limitus

Functional hallux limitus is a theoretical construct in which there is a normal range of dorsiflexion of the first metatarsophalangeal joint during a non-weighbearing examination, but during gait (ie when functioning in weightbearing) the first metatarsophalangeal joint does not dorsiflex. Most of the explanatory and theoretical work on the concept of functional hallux limitus was done by Howard Dananberg, DPM and is part of the concept of the sagittal plane facilitation model.

Functional hallux limitus probably does not exist as an either/or and most likely exists on a continuum with a significant functional hallux limitus at one end of the spectrum and no functional hallux limitus at the other end of the spectrum.

Cause of Functional Hallux Limitus:
– restriction in first ray plantarflexion (‘overpronation’; estrinsic factor eg mortons extension; metatarsus primus elevatus)
– windlass mechanism issues
persistent foot guard tendon reflex
– faliure of the long flexor tendon to glide freely behind the ankle (in the retrotalar tunnel) –> increased tension

Consequences of Functional Hallux Limitus:
Compensations: midfoot, ankle, knee, postural

Clinical Diagnosis:
Observation of the compensations
Plantar pressure pattern

Management of Functional Hallux Limitus:
Kinetic Wedge
Cluffy Wedge
Reverse Mortons

Does it really exist?

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Page last updated: @ 7:29 am

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