Improved step length symmetry and decreased low back pain with the use of a rocking-soled shoe in a patient with unilateral hallux rigidus

Abstract

DESCRIPTIONA 53-year-old African-American man presented to a local podiatry outpatient clinic with a chief symptom of unilateral pain in the first metatarsophalangeal joint (MTPJ) of his left foot as well as a secondary concern of chronic low back (lumbosacral) pain. He stated that the onset of the foot pain several years ago was insidious, but has been gradually increasing in intensity. He stated that the foot pain was proportionate to the amount and speed of ambulation, and was decreased with non-weightbearing. He also related that he noticed that the foot pain was also somewhat lessened if he 'slowed down', and took shorter steps. He stated that he had tried several types of corrective foot orthotic devices, both over the counter and custom made, none of which provided any significant relief. With regard to his back pain, the patient reported that he was told by his chiropractic physician that he had 'arthritis' at the L4-L5 disc level. The patient stated that his back pain also was not the result of any precipitating trauma, but rather seemed to have increased over the years. He denied any sciatic radiation of pain. While surgery was offered as an option for his foot pain, the patient declined and was seeking any possible non-surgical options.Figure 1 Dorsoplantar radiograph of the left foot: arrow reveals degenerative changes at the first metatarsophalangeal joint.Video 1 Baseline in-shoe pressure and timing analysis (F-Scan) revealed a planus foot, with a complete arthrodesis of the left first MTPJ. In-Shoe pressure and timing analysis with the patient wearing rocking-soled shoes reveals markedly increased active propulsion on the left.Video 2 Video gait analysis with the patient barefoot reveals a decreased step length on toe-off of the left foot when compared with toe-off of the right. There is decreased time in the propulsive phase of gait, a decreased stride length, and a decreased dorsiflexory range of motion at the left MTPJ.