Hallux rigidus is a big toe joint that does not move. Invariably this is due to osteoarthritis in the joint that has progressed to the stage that the joint hardly moves. Hallux rigidus makes not only the joint painful, but as the joint is not moving properly, other joints get forced to move at a time when they should not be moving. These compensation in other joints can also be painful. The big toe joint is so important for forward motion as this is the joint that the body pivots forward over the foot when the foot is in the ground. The treatment for hallux rigidus is to somehow restore that motion, which in a joint with osteoarthritis is not really possible. The only options are to add some sort of rocker to the shoe, so the foot can pivot forward over the rocker and not need to use the joint. The other option for hallux rigidus is surgical, in which the joint is either fused or replaced with a spacer so there is still some movement.
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The Cluffy Wedge is an extension for a foot orthotic that has been getting some attention lately. All it is aimed at doing is slightly dorsiflexing the hallux, which many call preloading the hallux. The effect of this is to bring the windlass mechanism into effect earlier, which is really helpful for those with a delay in windlass action (they require more dorsiflexion before the resistance of the windlass is felt). It is also use for functional hallux limitus. The Cluffy Wedge was developed by Dr James Clough who published a paper on it in JAPMA and has lectured on it. There are a number of You Tube Videos on the Cluffy Wedge.
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The windlass mechanism is a mechanism in the foot first described by Hicks in 1954. In yachting, the windlass is that lever system that is used to pull in sails. In a wishing well, it is the pulley system that is used to raise and lower the bucket. In the foot, the hallux is the lever that pulls the plantar fascia or aponeurosis around the head of the first metatarsal. The effects of the windlass mechanism, which occurs when the heel comes off the ground are to elevate the arch of the foot and supinate the foot. This has to co-ordinate with many other functions, such as external rotation of the leg during late in the stance phase. Any dysfunction of the windlass mechanism interferes with this process and can cause problems. Foot orthotics needed to incorporate design parameters that enhance the function of the reverse windlass mechanism.
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Functional hallux limitus is defined as a limitation in the range of motion of the first metatarsophlangeal joint when functioning (ie walking). It is not present on a normal weightbearing examination, where there is a full range of motion at the joint. The controversy surrounding functional hallux limitus is, is it a primary or a secondary problem? Does the functional hallux limitus occur first and cause the midfoot to collapse or does the midfoot collapse and this causes the functional hallux limitus? Both theories are rational and depending on your world view (ie root theory vs sagittal plane theory) as to which one you believe in. Unfortunately, the research is not much help either in deciding the primary or secondary nature of functional hallux limitus.
On a different note there has been an attempt to reconceptualise functional hallux limitus as one end of a continuum and consider functional hallux limitus, structural hallux limitus, hallux rigidus, and the various windlass dysfunction all as a problem of the shape of the dorsiflexion stiffness curve of the first metatarsophalangeal joint.
