When I saw hallux limitus in your post, I wondered if that is anything like my left and right big toe conditions called hallux rigidus. Here is what I found at
https://www.healthline.com/health/hallux-limitus (Hallux Limitus: Definition, Symptoms, Causes, and Treatment):
“People with hallux limitus have limited flexibility in the joint and trouble bending their big toe. The inflexibility leads to pain, especially when walking. As the condition progresses, you can develop bone spurs and arthritis in your big toe, eventually making the toe joint completely rigid. When this happens, the condition is called hallux rigidus, which is osteoarthritis of the big toe.”
The cause of my hallux rigidus was a structural problem called subtle cavus foot, which is sort of the opposite of flat-footedness. The arch is too high and the heel is misaligned. This results in underpronation during the gait cycle. When one walks, the heel hits the ground first and then weight bearing moves forward to the ball of foot, with the weight smoothly and rapidly transfering from the head of the fifth metatarsal bone (which connects to the little toe), to the head of the fourth metatarsal bone, then to the third metatarsal head, then to the second metatarsal head, and finally to the first metatarsal head (which connects to the big toe). With subtle cavus foot, the weight does not properly transfer across the metatarsal heads. Right after the heel strikes the ground, the fifth metatarsal head bears too much weight for too long, and the first metatarsal joint ends up having too much mechanical stress because of the limited ability of the big toe to flex.
I suffered pain at both the fifth metatarsal head and the big toe joint of my left foot and pain at the big toe joint of my right foot. I had surgery on my left foot to accomplish two things: first, raise up the fifth metatarsal head to reduce the weight bearing on it and second, fuse the big toe in a slightly flexed position to reduce the mechanical force on the big toe as weight bearing rolled to the inner side of the foot. I had only the second procedure done on my right big toe.
This was roughly fifteen years ago. The surgeries did not work, so then I was prescribed expensive custom orthotics for each foot. They did not help, so I went to another expensive custom orthotic maker and tried again but got the same dismal result. I did not know then, but do now, that both of these “professional” orthotic makers were one-trick ponies—they knew how to make orthotics for flat feet but not for subtle cavus feet.
Several years later, the MD who did my foot surgeries told me about a new off-the-shelf orthotic designed by Arthur Manolii II, MD, who has done pathbreaking research on subtle cavus foot. Although the orthotic is not custom made, it comes in different sizes for people with different shoe sizes. This orthotic did not completely banish my big toe pain but reduced it so significantly in both occurrence and intensity that it did not affect my life in any meaningful way. If you are interested in trying this orthotic to see what happens, it is called Arch Rival and is inexpensive compared to custom orthotics. Amazon has it (as of today’s price) for $58.07.
I will add, happily, that my situation has improved even more in the last few years. I now have foot pain only on rare occasions—maybe two or three or four times a year. The pain is minor and stops completely after a few days. For example, several weeks ago I was trimming a hedge with an electric trimmer and tripped over an object that I did not see because of the vegetation. I fell forward with the still-running trimmer in my hands so I was unable to break my fall by extending my arms. As a result of falling flat, my big toe was bent way back at an abnormal angle. I instantly had toe pain. But it was fully gone in a few days, as I expected. (I don’t even remember whether it was the left or right toe that was hurting.)
Why did I improve so incredibly the last few years and why did I just say the pain stopped “as I expected”? I have been a follower of Sarno since 1991 with great success regarding other ailments, such as chronic low back pain. In the last few years, I have updated my concept of TMS with Howard Schubiner’s neuroscience-oriented work, especially his current iteration of it that is anchored in predictive coding (also known as predictive processing). We all know that pain is a sensation, and in Schubiner’s words: “the brain creates the sensations it expects us to feel.” I expected the toe pain to go away within in a few days after the accident, and it did.
Predictive coding is a fancy “neurosciency” version of what Sarno called Pavlovian conditioning. For example, Sarno wrote the following in
The Divided Mind: “One of the prime characteristics of TMS is that the pattern of symptoms will develop as a result of Pavlovian conditioning. People will experience the kind of symptoms they
expect to experience, just as Pavlov’s dogs learned to associate the presentation of food with the ringing of a bell.” He then gave the example of a TMS patient who had pain with walking and another one who had pain with sitting that was relieved by walking. Sarno continued: “Experience with large numbers of patients at our clinic makes it clear that these are programmed responses that bear no relationship to anything beyond what the patient is conditioned to expect.”
How I came to expect my toe pain to stop within a few days on those rare occasions when I tweak one of my big toes is too long and technical a story for me to tell here. The point I want to make, avik, is that just because you have a structural problem called hallux limitus, which might well worsen into hallux rigidus, does not mean you are doomed to a life of chronic toe pain trouble. An orthotic or surgerical fusion might solve solve your problem, but if not, you can still get rid of the pain with a TMS approach.
By the way, I once met a guy whose surgeon fused his big toe so that it was straight, rather than with the end of it tipped up a bit. The guy had a lot of pain walking. If you have surgery, pick a surgeon who knows not to fuse the toe straight.
