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I recently got a comment/question on hallux rigidus from a reader that angered me so much I had to write this post. I was not angry at the reader, but instead her healthcare provider! The reader is young student who began having right great toe pain after a minor trauma. She was told to buddy tape the toe, but after 5 weeks of taping there was a similar pain in her left great toe. She was told by a Podiatrist that she had immobile toes and she was given some insoles to wear that have lead to “terrible” knee pain. Even when she asked for exercies that would help regain mobility “he simply said I should get better shoes”. She is unable to get a prescription to physical therapy from this Podiatrist, because he does not think it is necessary.

This reader had some questions I would like to address:

I don’t want to use orthotics all my life to solve this, and since I’m young I’d rather deal with the root problem. What kind of specialist would recommend me the right physio therapy ? And what is a comprehensive list of things that must be worked on at Physio Therapy ?

1. I applaud you for wanting to address the problem, and not just take the recommendation of this Podiatrist as the final word. To answer your first question about what type of “specialist” would I recommend to ultimately get you to PT, the answer is not a specialist at all. I highly recommend going to your primary care physician. These doctors “specialize” in listening to their patients more than a practitioner who doesn’t know you form a hole in the wall. Explain your situation to your doctor and they will likely appreciate your willingness to take care of your own body. If this doesn’t work, most urgent care doctor’s will listen to you and actually be able to send you in the right direction.
2. A comprehensive list of things that must be worked on at physical therapy is IMPOSSIBLE to provide without a proper evaluation. However, typically this exam will look at your gait, strength, flexibility, joint mobility of the lower extremities and possibly spine, and a movement assessment. They need to determine the cause of your toe immobility and of your knee pain.
3. I typically find that most people at a young age who do not have mobility loss due to severe trauma, actually have hypomobility from a lack of toeing-off of their big toes. This is the part of walking where you push off your big to to propel yourself forward. People who pronate a lot are more likely to lack this, but not all people who pronate a lot will develop hypomobility. To address this issue if it is present, therapists usually utilize neuromuscular re-education. Neuro re-ed is the development of different strategies of movement utilizing newly gains ranges of motion, flexibility, and/or strength. This may be helping you use different gait strategies, or maybe more athletic movements such as running, jumping, landing, squatting, etc.
4. Joint mobilizations – These are the bread and butter of improving joint mobility in the first toe. These are first provided by the therapists, and they may be able to assist you in being able to administer some of the mobilizations yourself for your home program. The PT may find that other joints besides your toe need to be mobilized.
5. Stretching – Muscles that have shortened in response to weeks, months, or years of being used in certain ways may need some stretching to reduce their tension and allow new motor programs to be developed.
6. Strengthening – Strengthening can often be part of neuro re-ed mentioned earlier. If a PT determines that someone’s hallux rigidus is a result of a movement pattern, then the reason the altered pattern exists need to be dealt with, and then the pattern needs to be changed to reduce stressors or threat on the body. This may include progressively loading new movement strategies to allow more freedom of movement.
7. Home programs – PT’s should be able to reduce your treatment sessions into something that you should be doing at home. You need to be the center of care. You need to put the work in to get yourself better. The PT is the guide, but you need to do the work. If you are held accountable for doing your exercises/drills, you are much more likely to get better, and it sounds like you are very motivated!

I hope this answers your questions regarding your hallux rigidus. Please reach out if you have any more questions.

Always Evolve,

Mike