• 1

    Bramble D, Lieberman D: Endurance running and the evolution of Homo.. Nature 432::345. ,2004. .

  • 2

    Payne CB, Dananberg HJ: Sagittal plane facilitation of the foot. .Aust J Podiatr Med 31::7. ,1997. .

  • 3

    Dananberg HJ: Gait style as an etiology to chronic postural pain: part 1. Functional hallux limitus. .JAPMA 83::433. ,1993. .

  • 4

    Dananberg HJ: Gait style as an etiology to chronic postural pain: part 2. Postural compensatory process. .JAPMA 83::615. ,1993. .

  • 5

    Dananberg HJ: Functional hallux limitus and its relationship to gait efficiency. .JAPMA 76::648. ,1986. .

  • 6

    Hamilton WG: Foot and ankle injuries in dancers. .Clin Sports Med 7::143. ,1988. .

  • 7

    Michelson J, Dunn L: Tenosynovitis of the flexor hallucis longus: a clinical study of the spectrum of presentation and treatment. .Foot Ankle Int 26::291. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Payne C, Chuter V, Miller K: Sensitivity and specificity of the functional hallux limitus test to predict foot function. .JAPA 92::269. ,2002. .

    • Search Google Scholar
    • Export Citation
  • 9

    Hamilton W: Stenosing tenosynovitis of the flexor hallucis longus tendon and posterior impingement upon the os trigonum in ballet dancers. .Foot Ankle 3::74. ,1982. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Drago JJ, Oloff L, Jacobs AM: A comprehensive review of hallux limitus. .J Foot Surg 23::213. ,1984. .

  • 11

    Feeney MS, Williams RL, Stephens MM: Selective lengthening of the proximal flexor tendon in the management of acquired claw toes. .J Bone Joint Surg Br 83::335. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Hanft JR, Mason ET, Landsman AS, et al: A new radiographic classification for hallux limitus. .J Foot Ankle Surg 32::397. ,1993. .

  • 13

    Clayton ML, Ries MD: Functional hallux rigidus in the rheumatoid foot. .Clin Orthop 271::233. ,1991. .

  • 14

    Shrader JA, Lohmann Siegel K: Nonoperative management of functional hallux limitus in a patient with rheumatoid arthritis. .Phys Ther 83::831. ,2003. .

  • 15

    O’Sullivan E, Carare-Nnadi R, Greenslade J, et al: Clinical significance in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry. .Clin Anat 18::121. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Pisani G: Integrazione funzionale dell’arto inferiore. .Chir del Piede 26::35. ,2002. .

  • 17

    Kapandji IA: The Physiology of the Joints: Lower Limb, Vol 2, Churchill Livingstone, Philadelphia. ,1988. .

  • 18

    Kapandji IA: Physiologie Articulaire 2eme “Tomo”, Miembre inférieur, 5th Ed, Cap. Les mouvements dans la sousastragalienne, Maloine. ,2004. .

  • 19

    Oloff LM, Schulhofer SD: Flexor hallucis longus dysfunction. .J Foot Ankle Surg 37::101. ,1998. .

  • 20

    Lewin P: Painful conditions of the foot and ankle. .Postgrad Med 6::292. ,1949. .

  • 21

    Willens T, Witvrouw E, Delbaere K, et al: Relationship between gait biomechanics and inversion sprains: a prospective study of risk factors. .Gait Posture 21::379. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Halstead J, Turner DE, Redmond AC: The relationship between hallux dorsiflexion and ankle joint complex frontal plane kinematics: a preliminary study. .Clin Biomech 20::526. ,2005. .

    • Search Google Scholar
    • Export Citation
  • 23

    Bojsen-Mollor F: Calcaneocuboid joint stability of the longitudinal arch of the rearfoot at high and low gear push off. .J Anat 129::165. ,1979. .

  • 24

    Muehlemann CD, Bareither K, Huch Cole A, et al: Prevalence of degenerative morphological changes in the joints of the lower extremity. .Osteoarthritis Cartilage 5::23. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    McMaster MJ: The pathogenesis of hallux rigidus. .J Bone Joint Surg Br 60::82. ,1978. .

  • 26

    Nilsonne H: Hallux rigidus and its treatment. .Acta ortho Scand 1::295. ,1930. .

  • 27

    McMurray TP: Treatment of hallux valgus and rigidus. .BMJ 2::218. ,1936. .

  • 28

    Bonney G, Macnab I: Hallux valgus and hallux rigidus. A critical survey of operative results. .J Bone Joint Surg 34-B::366. ,1952. .

  • 29

    Lambrinudi C: Metatarsus primus elevates. .Proc R Soc Med 31::1273. ,1938. .

  • 30

    Jack EA, The aethiology of hallux rigidus. .Br J Surg 27::492. ,1940. .

  • 31

    Shamus J, Shamus E, Gugel RN, et al: The effect of sesamoid mobilization, flexor hallucis strengthening, and gait training on reducing pain and restoring function in individuals with hallux limitus: a clinical trial. .J Orthop Sports Phys Ther 34::368. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Van Dijk CN: Hindfoot endoscopy for posterior ankle pain. .Instr Course Lect 55::545. ,2006. .

  • 33

    Lui TH: Flexor hallucis longus tendoscopy: a technical note. .Knee Surg Sports Traumatol Arthrosc 17::107. ,2009. .

  • 34

    Shereff MJ, Baumhauer JF: Current concepts review: hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint. .J Bone Joint Surg Am 80::898. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Nawoczenski DA, Baumhauer JF, Umberger BR: Relationship between clinical measurements and motion of the first metatarsophalangeal joint during gait. .J Bone Joint Surg Am 81::370. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Saxena A: The Valenti procedure for hallux limitus/rigidus. .J Foot Ankle Surg 34::485. ,1995. .

Functional Hallux Limitus or Rigidus Caused by a Tenodesis Effect at the Retrotalar Pulley

Description of the Functional Stretch Test and the Simple Hoover Cord Maneuver That Releases This Tenodesis

View More View Less
  • 1 Swiss Ortho Clinic, Lausanne, Switzerland.
Restricted access

Functional hallux limitus is a loss of metatarsophalangeal joint extension during the second half of the single-support phase, when the weightbearing foot is in maximal dorsiflexion. Functionally, it constitutes a sagittal plane blockade during gait. As a result, the mechanical support and stability mechanisms of the foot are disrupted, with important consequences during gait. Functional hallux limitus is a frequent, though relatively unknown condition that clinicians may overlook when examining patients with complaints that are not limited to their feet, for they can also present other symptoms such as hip, knee and lower-back pain. The purpose of this article is to present a critical review of the literature on functional hallux limitus and to explain a previously described and simple diagnostic test (flexor hallucis longus stretch test) and a physiotherapeutic manipulation (the Hoover cord maneuver) that recovers the dorsiflexion of the hallux releasing the tenodesis effect at the retrotalar pulley, which according to our clinical experience is the main cause of functional hallux limitus. The latter, to the best of our knowledge, has never been described before. (J Am Podiatr Med Assoc 100(3): 220–229, 2010)

Corresponding author: Jacques Vallotton, MD, Swiss Ortho Clinic, Av du Servan 4, 1006 Lausanne, Switzerland. (E-mail: drvallotton@swissorthoclinic.ch)