Reader Mike writes“I was recently diagnosed with functional hallux limitus after developing a strong interest in hiking (and having never done any other long distance running, or walking type things before that) Do you have any recommendations for a good hiking boot/shoe? I’m currently using Montrail CTC.”
Hallux limitus is a condition whereby the big toe joint becomes restricted during weight bearing but is otherwise healthy, hence the name functional. In this condition you still have cartilage with little to no arthritis in the joint. Pain arises with excessive flexion of the great toe or while standing due to pronation and rolling onto the big toe joint, causing restricted motion.
In Hallux rigidus, the great toe joint becomes arthritic with associated cartilage loss, resulting in bone on bone motion which is very painful. This is a structural problem usually requiring surgery to correct.
In this video, my associate Dr. Sandi Pollard talks more about these conditions.
In hallux rigidus, you want to stop motion, in hallux limitus you want to improve motion. For both conditions an inflexible or stiff soled shoe is usually best which fortunately most hiking boots have. I have several patients with hallux rigidus, who I have wear only hiking boots becuase this eliminates the pain. For my hallux limitus patients I can usually stop the pain by getting them into shoes that are primarily inflexible in the forefoot. Montrail CTC is a classic example of this. Custom orthotics can also help since they improve big toe joint function.
For even more information about hallux limitus read my other post http://drshoe.wordpress.com/2008/01/08/shoe-design-for-hallux-limitus-ie-turf-toe-non-bunion-pain/ which talks about sole design.