Wednesday, June 30, 2010

Functional Hallux Limitis

Functional Hallux Limitis. That is the name. Hopefully I have the fix. I have been trying to get my hip, back and stride fixed for too many years. I now have a name for what has been causing my imbalance, form, functioning, and pain problems. I have to give kudus to Dr. Baroody for identifying the problem. Well, actually I believe it was identified 20 years ago, but I did not understand the issue and could not afford the treatment. Twenty year after seeing Dr. Dananberg the first time, I went back again yesterday. He also identified the Functional Hallix Limitis and fit me in a pair of the Vasyli-Dananberg insoles specifically engineered for FHL. The product is named after Dr. Dananberg as he is known worldwide for his work with FHL.

Named among the most influential Podiatrists in America by Podiatry Management Magazine, and is a founding member of the new Vasyli Think Tank™.

Howard is renowned for his work in the development of the concepts associated with Functional Hallux Limitus. His published articles on Sagittal Plane Biomechanics, his patented Kinetic wedge and work on gait-related back pain is recognized world wide.
Here is a great article which explains FHL, the compenstations the body "invents" in order to "work", and how the insole restores proper function. Dr. Dananberg did not really discuss FHL with me in detail, but fortunately I had done my homework so I knew what he was talking about and referring to as he checked out my feet.

The good news is that he feels that this is treatable with his insoles and I can decide later if I need a more specialized pair of orthotics built up for me. He wasn't worried about the pain over my right big toe. I have had this for about four months now after every run and I was worried that my toe may be going to a more rigid diagnosis that usually leads to surgery. I was very much  thinking he might end up telling me my running days were over. He was not concerend with this at all which puts me at ease. He also said the inverted heel is probably a result of the FHL and things should improve. I am thrilled and hope the insoles really work. They do feel good (they were heat-molded to my feet) and the cutouts and shape very much give my feet balance when standing and certainly let my feet "roll" forward as I run. They are not miracle workers as I used them in the Lowell 5K race last night and was about 20 seconds slower than the week before, but if they allow me to run without the imbalances (over time) then I can get my mileage back up and my race times down. Most important I want to get my running stride back so that I can enjoy just running again instead of trying to constantly figure out what is wrong and how to fix it.

With FHL, the first metatarsal joint does not function correctly. The 1st MTP joint is the joint leading to the big toe. When you stride forward all of your body weight is supposed to hinge forward over this joint and it is suppposed to support your foot and body and raise your heel through the gait cycle (or this is how I understand it). Unfortunately if you have FHL the 1st MTP joint cannot do its job and the body attempts all sorts of compensations to try to correct itself. I have noticed this problem through the years and explained what I thought was happening in my foot to many experts, but I guess no one was informed enough on this condition until Dr. Baroody identified it. I have tried many remedies on my own because they "seemed" to make sense such as cutting out an insole under the 5th (little toe) joint to try to balance the bottom of my foot or running with wedges under the 1st metatarsal and big toe to try to give them support so my foot wouldn't  cave in.  My intution was correct, but maybe not the remedies! With the new insoles an area is cut out underneath the 1st MTP joint which allows it to descend so that the 1st metatarsal head can plantarflex which allows the 1st MTP joint to dorsiflex.

I think what this means is that with the insole my feet can now support my stride. With FHL your 1st MTP joint cannot work properly and so your toe cannot get involved with the stride either. My main compensation on the left foot was that the 1st MPT joint would collapse on contact with the ground giving me no support. The foot would then severely pronate over the toe and evert my foot out to the side throwing off my stride and giving me the constant hip and back problems. On the right foot the pronation wasn't as pronounced, but the joint and toe still weren't doing their job as the toe would stiffen up when bearing weight and again giving me no push off. Dr. Baroody also explained that this is why I have a mutlitude of stiff muscles. That is bad, but it was somewhat good as my body was doing whatever it could to achieve a running stride and protect itself and make itself work in my own unique way. Besides the ART treatments for my muslces, I am hoping that the insoles will take the stress off many of my overworked muscles and allow them to release and function properly.

Dr. Dananberg's article describes walking with FHL as akin to walking with swim fins on your feet. Since the body can't properly go forward with the fins on, it is like stepping upwards with no propulsion forward or a mechanical stride. He suggests four compensations that the body will do to achieve a gait. One, a midfoot collapse with delayed heel lift (the PT did say that my left stride was slower than my right- this is the side with most of my symptoms). Number two is an absence of heel lift during single support phase that can lead to balance problems. Three is inversion compensation (I not sure if this is similar to the inverted heel that Dr. Bardooy suggested). The fourth symptom is abducted compensation. As Dr. Dananberg descibes, when the forward motion over the toe joint is blocked then the foot will find the least path of resistance in order to move forward, So the foot pronates and twists and the effects of that go up the alignment of the skeleton. I certainly hope that the insoles do what they are supposed to do and my body starts fixing itself. My feet feel "strong" under the metatarals for a change once I put them in my shoes and my left hip also felt stronger and in a better position. Let's hope that those are good signs.

Dr. Dananberg also did some manipulations of my feet and ankles to restore lost motion and free restrictions. In these videos he is seen doing similar manipulations and other manipulations. These are to be done by an expert, I am only showing them because they are interesting.

1 comment:

MIke said...

Hi, I am not a runner, but I was diagnosed with FHL several years ago, and I believe it's a big part of the reason for my anterior pelvic tilt and back pain. I had orthotics from the first diagnosis but they did nothing for me. Your post really struck a chord with me and I know that I pronate; all you have to do is walk on sand and you know you are pronating, then the callus that develops under your big toe and little toe. Just wondering if you had any success? Because of my posture, I have structural problems and cannot do exercises like squat and deadlift. I really want to fix this condition if it's possible...