Home Functional Hallux Limitus Conservative treatment Foot orthoses
Conservative treatment
New-generation foot orthoses
Conventional orthoses, molded in a static position, immobilize the foot and cause its muscles to atrophy. Research on FHL has led to a radically different concept: a dynamic orthosis that guides the roll-over of the foot and stimulates the foot muscles instead of bypassing them.
Treatments
Conventional orthoses: a foot fixed in a static position
Foot orthoses, or foot supports, are generally prescribed to ensure a better distribution of load across the foot and to relieve painful pressure points. These orthoses are molded in the standing position, on static feet: neither the lengthening nor the physiological tilting of the foot during the roll-over of the step is taken into account.
This type of orthosis remains indicated in cases of diabetes or severe foot deformities, and usefully complements footwear in adapted or orthopedic shoes.
The limitations of static molding
This concept, based on a foot fixed in a given position, bypasses the action of the intrinsic foot muscles which, through disuse, gradually atrophy. Another drawback is the potential worsening of foot tilt, particularly onto its outer edge, caused by molding of the plantar arch that places the foot in supination. Added to a poorer perception of the ground surface, these factors make such orthoses poorly suited to recreational or athletic activities.
A new concept born of research on FHL
Our research on FHL has led to a better understanding of the foot from the standpoint of biomechanics and movement. When walking, the foot stabilizes the entire body, governs postural control, and synchronizes the movement of the other joints — a role comparable to that of an orchestra conductor. Taking these parameters and the disorders caused by FHL into account, an insole offering better dynamic balance was developed.
Conventional approach
Molded static orthosis
Designed with the wearer standing still, it fixes the foot in a given posture. Suitable for diabetes and severe deformities, but it gradually atrophies the intrinsic muscles through disuse and can worsen tilting into supination.
FHL approach
Guided dynamic orthosis
No rigid molding. Calcaneal stirrups for postural feedback, a medial buttress to resynchronize the roll-over of the foot, cushioning under the first metatarsal. The foot remains free to stretch and to play its muscular role.
How the orthosis works
Postural feedback through the calcaneal stirrups — This type of dynamic orthosis was historically developed by Nancy Hylton for hypotonic children and children with neurological disorders. Stimulating the sole of the foot sharpens postural muscle control and improves balance. The stirrups act from the very beginning of the stance phase and prevent the foot from tilting into supination.
Guiding the roll-over of the foot — Physiologically, walking alternates between supination and pronation at a precise moment in the cycle. FHL delays this transition at the end of the stance phase, causing an abrupt tilt of the foot into pronation before push-off. To counter this rocking effect, a rigid buttress on the medial side of the orthosis guides the foot through the roll-over of the step and prevents the abrupt transition.
Cushioning and toe protection — The orthosis cushions ground contact under the head of the first metatarsal and prevents claw-toe deformity through a slight elevation placed under the toes.
In summary
Pain and instability are common in the presence of FHL: the foot, ankle, knee, and back are particularly affected, often because of poor postural alignment due to a lack of balance. The foot orthosis concept proposed here aims to provide better balance without constraining the foot, which can stretch freely since no molding stiffens it.
Stimulating the sole of the foot achieves active support of the plantar arch by the intrinsic muscles, and the medial buttress, through its guiding effect, brings about a physiological roll-over of the step. Proprioceptive feedback stimulates muscle tone and provides a solid base for the alignment of the upper body: the balance and dynamic stabilization of the entire body are positively influenced.
Understanding through video
The presentation of the new foot orthosis concept at the Medicol Congress 2023.
Medicol Congress 2023 — Foot orthoses: a new concept
What if it isn’t enough?
Discover the surgical treatment
Arthroscopic tenolysis of the flexor hallucis longus, a proven minimally invasive technique, when conservative treatment fails.
In practice
Concept
dynamic orthosis
Rigid molding
none
Sensory input
calcaneal stirrups
Guidance
medial buttress
Cushioning
under the 1st metatarsal
Foot muscles
stimulated, not immobilized