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Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Affecting an estimated 1 in 40 adults over the age of 50, hallux limitus is among the leading arthridites of the foot and ankle, with growing incidence reflecting an aging population. Despite its prevalence and disease burden, treatment of the conditi...

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Autores principales: Fung, Jonathan, Stachura, Sara, Sherman, Alain, Eckles, Robert, Doucette, John, Chusid, Eileen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696749/
http://dx.doi.org/10.1177/2473011419S00178
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author Fung, Jonathan
Stachura, Sara
Sherman, Alain
Eckles, Robert
Doucette, John
Chusid, Eileen
author_facet Fung, Jonathan
Stachura, Sara
Sherman, Alain
Eckles, Robert
Doucette, John
Chusid, Eileen
author_sort Fung, Jonathan
collection PubMed
description CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Affecting an estimated 1 in 40 adults over the age of 50, hallux limitus is among the leading arthridites of the foot and ankle, with growing incidence reflecting an aging population. Despite its prevalence and disease burden, treatment of the condition remains equivocal. Many patients fail initial conservative measures (e.g., NSAIDs, physical therapy, corticosteroid injections) and may be averse to or ineligible for surgery. For others, there exists controversy surrounding the indications and outcomes of various surgical procedures. As such, there is demand for new means of non-operative management. The present study sought to examine the impact of a novel in-shoe device, the Hallux Limitus Forefoot Orthosis (HLFO), on plantar pressure, foot function, and pain in patients with hallux limitus. METHODS: Twenty adult patients with symptomatic hallux limitus were recruited for the study. Diagnosis of hallux limitus was confirmed via physical exam and plain radiography. Patients with diabetes, pre-diabetes, peripheral artery disease (Ankle Brachial Index < 0.70), neuropathy (positive Semmes-Weinstein monofilament test), or lower extremity wounds were excluded. At baseline, participants completed the Foot Function Index (FFI) and reported foot pain on a visual analogue scale (VAS) from 0 to 10. Heat map profiles were also generated using a plantar pressure sensor. The HLFO was then issued to participants, who were instructed to wear it in standard athletic shoes. Participants were contacted by phone after 2 weeks for feedback and to inquire about any adverse events. One participant was lost to follow-up. At 4 weeks, participants returned, and FFI, VAS pain, and plantar pressure measurements were repeated with the HLFO on. RESULTS: Mean FFI decreased significantly from 43.0% (± 18.8%) to 11.0% (± 9.8%) following use of the HLFO, t(18) = 6.78, p <0.001. Eighteen of the 19 (94.7%) participants experienced a decrease in FFI. One participant reported an increase of 5.9%. Mean VAS pain score also decreased significantly from 4.87 (± 2.16) to 1.18 (± 1.84) following use of the device, t(18) = 6.57, p < 0.001. Eighteen of the 19 (94.7%) participants experienced a decrease in pain, with 12 (63.2%) reporting a final pain score of 0, indicating “no pain.” One participant experienced an increase in pain score from 5.0 to 5.5. Plantar pressure profiles with the HLFO on revealed redistribution of weight from the hallux MTP joint to the lesser digits. CONCLUSION: The HLFO was well tolerated by participants and effectively reduced pressure on the hallux MTP joint. It resulted in significant improvements in foot function and pain for nearly all participants, with the majority reporting complete resolution of their pain. Based on these findings, the HLFO offers an enticing option for patients seeking non-operative treatment for hallux limitus. Future studies could look at the long-term impact of the device on patients’ foot health, quality of life, and decision to pursue surgery.
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spelling pubmed-86967492022-01-28 Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus Fung, Jonathan Stachura, Sara Sherman, Alain Eckles, Robert Doucette, John Chusid, Eileen Foot Ankle Orthop Article CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Affecting an estimated 1 in 40 adults over the age of 50, hallux limitus is among the leading arthridites of the foot and ankle, with growing incidence reflecting an aging population. Despite its prevalence and disease burden, treatment of the condition remains equivocal. Many patients fail initial conservative measures (e.g., NSAIDs, physical therapy, corticosteroid injections) and may be averse to or ineligible for surgery. For others, there exists controversy surrounding the indications and outcomes of various surgical procedures. As such, there is demand for new means of non-operative management. The present study sought to examine the impact of a novel in-shoe device, the Hallux Limitus Forefoot Orthosis (HLFO), on plantar pressure, foot function, and pain in patients with hallux limitus. METHODS: Twenty adult patients with symptomatic hallux limitus were recruited for the study. Diagnosis of hallux limitus was confirmed via physical exam and plain radiography. Patients with diabetes, pre-diabetes, peripheral artery disease (Ankle Brachial Index < 0.70), neuropathy (positive Semmes-Weinstein monofilament test), or lower extremity wounds were excluded. At baseline, participants completed the Foot Function Index (FFI) and reported foot pain on a visual analogue scale (VAS) from 0 to 10. Heat map profiles were also generated using a plantar pressure sensor. The HLFO was then issued to participants, who were instructed to wear it in standard athletic shoes. Participants were contacted by phone after 2 weeks for feedback and to inquire about any adverse events. One participant was lost to follow-up. At 4 weeks, participants returned, and FFI, VAS pain, and plantar pressure measurements were repeated with the HLFO on. RESULTS: Mean FFI decreased significantly from 43.0% (± 18.8%) to 11.0% (± 9.8%) following use of the HLFO, t(18) = 6.78, p <0.001. Eighteen of the 19 (94.7%) participants experienced a decrease in FFI. One participant reported an increase of 5.9%. Mean VAS pain score also decreased significantly from 4.87 (± 2.16) to 1.18 (± 1.84) following use of the device, t(18) = 6.57, p < 0.001. Eighteen of the 19 (94.7%) participants experienced a decrease in pain, with 12 (63.2%) reporting a final pain score of 0, indicating “no pain.” One participant experienced an increase in pain score from 5.0 to 5.5. Plantar pressure profiles with the HLFO on revealed redistribution of weight from the hallux MTP joint to the lesser digits. CONCLUSION: The HLFO was well tolerated by participants and effectively reduced pressure on the hallux MTP joint. It resulted in significant improvements in foot function and pain for nearly all participants, with the majority reporting complete resolution of their pain. Based on these findings, the HLFO offers an enticing option for patients seeking non-operative treatment for hallux limitus. Future studies could look at the long-term impact of the device on patients’ foot health, quality of life, and decision to pursue surgery. SAGE Publications 2019-10-28 /pmc/articles/PMC8696749/ http://dx.doi.org/10.1177/2473011419S00178 Text en © The Author(s) 2019 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Fung, Jonathan
Stachura, Sara
Sherman, Alain
Eckles, Robert
Doucette, John
Chusid, Eileen
Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus
title Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus
title_full Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus
title_fullStr Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus
title_full_unstemmed Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus
title_short Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus
title_sort evaluation of a novel orthosis for the non-operative management of hallux limitus
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696749/
http://dx.doi.org/10.1177/2473011419S00178
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