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Shoe selection: podiatrists/runners with big toe joint problems

 

   


callofthewild

Mar 30, 11 5:53

Post #1 of 16 (11222 views)
Shoe selection: podiatrists/runners with big toe joint problems Quote | Reply

I have hallux limitus in one foot and have had corrective surgery (cheilectomy) on the other for hallux rigidus. I have been able to run off/on for the past 10 months without any major issues, but I have had to back off quite a few times. The foot with limitus is not an issue yet but the surgically altered foot continues to give me issues. Any time I build up my mileage I start getting a shin splint in that leg and then tight glute. I would guess that I have altered my gait and that is part of the problem but I haven't been able to identify what I'm doing that is problematic (best guess is landing with a flatter foot than normal instead of my usual midfoot/forefoot).

Any way, I have been trying to find a running shoe that has adequate forefoot cushion and got some good suggestions here yesterday - some of which I have already tried, some not. I was thinking about trying out MBT shoes (gasp) for walking around in every day...the thought being that the rocker in the shoe would keep me from toeing off while walking. Oddly enough, I think walking is more painful/causes more problems than the actual running does. Have any of you docs had patients try these? Also, do you recommend specific kinds of running shoes for people with these issues? Am I crazy for thinking about trying the Kinvaras or Newtons for their forefoot cushion?

I realize this is a specific topic but hopefully some of the other people who have had this problem will chime in. Thanks all.


TriBodyboarder

Mar 30, 11 6:27

Post #2 of 16 (11210 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [callofthewild] [In reply to] Quote | Reply

I have some metatarsal issues in one of my feet caused by a bunion, and have moved to the Newton Guidance Trainer specifically because I like what I perceive to be the added cushioning in the forefoot from the lugs. I have an orthotic in them and I'm able to run pretty much pain free. Yes, walking will be harder because you toe off more when walking than running.
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My business-eBodyboarding.com


Kingfisher

Mar 30, 11 6:33

Post #3 of 16 (11206 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [callofthewild] [In reply to] Quote | Reply

Have you thought about trying the Hoka One One Shoes? I just ordered a pair from the Boulder Running Company a few days ago, its the most cushion I've ever seen in a shoe. My pair will be here in a couple days, I have not run in them yet, but the review that is on the front page of Slowtwitch is all I needed to hear to try a pair. They look kinda funny, but if it keeps you running who cares.


callofthewild

Mar 30, 11 6:38

Post #4 of 16 (11204 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [Kingfisher] [In reply to] Quote | Reply

I definitely have thought about these. At this point, looks are out. Especially if I'm wearing MBT dress shoes by day. Yikes.


Kingfisher

Mar 30, 11 6:44

Post #5 of 16 (11198 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [callofthewild] [In reply to] Quote | Reply

I just picked up a pair of Brooks Addiction Walkers for my dress shoes, great for work, but its hard to make a black walking shoe look good with a suit. I'll let you know after I get them what I think. Have you dealt with any gout issues in the past? Also, one thought might be to have someone video you while running so you can look at it later, might be able to pinpoint something in your running form.


(This post was edited by Kingfisher on Mar 30, 11 6:49)


callofthewild

Mar 30, 11 6:48

Post #6 of 16 (11192 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [Kingfisher] [In reply to] Quote | Reply

No gout. Just good old fashioned arthritis/lack of cartilage/spurring in 1st MTPs.


rroof

Mar 30, 11 15:08

Post #7 of 16 (11151 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [callofthewild] [In reply to] Quote | Reply

You never really get "rid" of hallux limitus. Your cheilectomy simply removed the dorsal spurring and cleaned up the spurring around the joint. You likely still have a bad great toe joint that will ache if used too much.

First, you definitely don't want to be a "forefoot runner" (you likely can't). Since your 1st MTP joint arthritis is going to continue to degenerate, you don't want to accelerate it (and running definitely does). So, assuming you are going to continue to run, you want to limit dorsiflexion of the joint. A Morton's extension either a stiff carbon plate (you can find online) or as part of an orthotic can be placed in any running shoe you like. Best running shoe would be one with a very stiff forefoot (or use the extension) and ZERO heel to forefoot drop (or ramp angle or whatever ST is calling it these days).

http://www.orthosupersite.com/view.aspx?rid=75853
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


kdw

Mar 30, 11 15:56

Post #8 of 16 (11137 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [callofthewild] [In reply to] Quote | Reply

I had a pair of custom orthotics made. They are pretty stiff. I move them around to whatever shoe I'm wearing, even when walking around. If I don't, my big toe aches after a short time. Freaking clunky, but knock on wood I haven't had an injury in the three years I've had them and the constant ache in my big toes is mostly gone unless I use regular insoles for a while.


chilld

Mar 30, 11 16:17

Post #9 of 16 (11131 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [callofthewild] [In reply to] Quote | Reply

I had a cheilectomy on my left mpj about 6 months ago and the return to running and walking was really painful. Even though the range of motion in the joint had improved and the spurring was removed, every step on the left foot hurt - much worse than before surgery. I thought it was the increase in ROM causing the pain (I don't have much cartilage left), so I tried some orthotics with a morton's extension for a few weeks (stiff carbon plate) and it actually made it worse. Then I found the following post on the Runner's World forum, and tried the insole modification he described (cutting out the area under the joint all the way to the front), and it helped immediately. It seems that allowing the 1st mpj to "drop down" lower than the other toes was the solution for me. I even glued an extra layer of cut insole (about 1/8" thick) onto the running shoe insole so the joint could sit even lower relative to the other toes. I now have modified insoles in all of my shoes - work, walking, and running. I still have pain when running, but it's more manageable and I'm even doing some track workouts now. I didn't try the shoe modification described (yet), but that's another option for later.

http://www.runnersworld.com/...allux-rigidus-relief

Good luck!


rroof

Mar 30, 11 17:22

Post #10 of 16 (11113 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [chilld] [In reply to] Quote | Reply

You are describing the "other" treatment, called a 1st ray cutout. This serves to plantarflex the 1st metatarsal/ray to increase dorsal excursion of the hallux over the joint. This works if your hallux rigidus/limitus is from a 1st met elevatus (which you likely do, hence your lack of relief with the Morton's extension) or possibly a compensated foerfoot varus. If you simply have a degenerative joint, then anything that "increases" motion will make it worse. You found a solution, but this is why internet research doesn't always work ;-)
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

(This post was edited by rroof on Mar 30, 11 17:47)


testy3000

Mar 30, 11 19:02

Post #11 of 16 (11091 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [rroof] [In reply to] Quote | Reply

Not necessarily can't run on forefoot. I have advanced hallux rigidus in both big toe joints with about 10 degrees of dorsiflexion or less in each one. I still run comfortably on my forefeet in the Vibram sandals. My feet peel off to the sides instead of doing a full toe off.


callofthewild

Mar 31, 11 4:58

Post #12 of 16 (11072 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [rroof] [In reply to] Quote | Reply

Rod,

As always, thanks for your feedback...I appreciate it.

The orthotics that I'm currently using have a cut out under the 1st MTP and an elevated heel profile (presumably to reposition the metatarsals). No Morton's extension. The cut out has given me great relief and I've been very happy with them in general.

As for causing further damage, I've thought about this a great deal. There was a point last year where I thought about just hanging it up and focusing on cycling. In the end, I decided that I would be cautious and have x-rays twice a year to follow any changes and make sure I wasn't causing more damage. So far so good according to my doctor. I'm certainly not where I'd like my running to be, but I am able to compete.

I think I'm going to give the Kinvara's a crack and possibly the Hoka One Ones. We'll see how it goes.

Thanks everyone for the input.


dongustav

Apr 4, 12 7:42

Post #13 of 16 (9898 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [rroof] [In reply to] Quote | Reply

Hi rroof... I'm digging this thread up because I've been slowly getting hallux limitus since I turf-toed both my big toes playing beach volleyball in college. Especially on the right side I have limited & painful dorsal flexion, lots of crackling in the joint when I work it around with my hand, and I think I'm starting to overcompensate for it & cause other issues.


I believe the fact that my foot has been rolling outwards on toe-off (to limit dorsal flexion of the big toe) is causing other lower leg pain (soleus and peroneal longus) and also some itbs pain. I've got high arches and have always been a mid-foot striker (even before it was stylish)... and this is killing me. After about 40 mins of running, push-off on that side causes acute pain in the toe & mild pain in the soleus, and now knee-drive hurts all around my hip/groin muscles probably from misalignment. I've read up on hallux limitus a bunch both here and elsewhere, i'm going to try throwing a carbon plate into my Kinvaras & Zoom Streaks to see if limiting the toe motion will help me straighten everything out. Any other tips you'd recommend?


rroof

Apr 4, 12 7:50

Post #14 of 16 (9894 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [dongustav] [In reply to] Quote | Reply

I think you are on the right track. If you have crepitus with passive ROM that you are describing, there is joint damage for sure, and that isn't going away. Since you are already compensating for the pain that causes (no way around that), the carbon plate/Morton's extension is a very good idea since that is effectively doing the same thing. Good data/studies to show effectiveness - but not necessarily for endurance runners.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


dongustav

Apr 4, 12 8:12

Post #15 of 16 (9887 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [rroof] [In reply to] Quote | Reply

Thanks. With Rev3 just 9 weeks away and Lake Placid 7 weeks later, I'm hoping to scale back running a little bit right now to let the incidental leg/hip issues heal, then pick back up on the running later this month with the carbon plates and see how it goes. I guess a swim-bike focus is officially in effect.


Mother's Finest

Apr 21, 12 7:09

Post #16 of 16 (9777 views)
Re: Shoe selection: podiatrists/runners with big toe joint problems [callofthewild] [In reply to] Quote | Reply

before you run in MBT, I would try a shoe called Xelero. much more stable and made for 1st ray issues. mild rocker in the forefoot with a built in gait plate.

I am a CPED, I use this shoe instead of modifying orthotics, works really well.


peace
mf

   
 
 
 



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