Date of Award

2001

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

School of Graduate Studies

First Advisor

Rita Nacken Gugel

Second Advisor

Bernard Brucker

Third Advisor

Cindy Skaruppa

Abstract

The purpose of this study was to determine the effect of standard physical therapy when combined with sesamoid mobilization, flexor hallucis strengthening and gait training for reducing pain and increasing function in the first metatarsophalangeal joint (MPJ) in persons with functional hallux limitus. Sprains of the first MPJ are common in athletics. Push off, forward drive and running can be significantly impaired after this injury. More importantly, MPJ sprains can also result in persistent pain and loss of range of motion. Given the debilitating nature of this injury, it is important to determine the most effective treatment for hallux limitus.

The participants in this study consisted of twenty individuals with pain, a loss of motion of twenty degrees or more and weakness of at least five pounds in the first MPJ. Subjects were randomly assigned to two groups. Measurements of first MPJ range of motion and strength were performed on the first and last visits. Subjects were also asked to rate their pain level on a scale of zero to ten on those visits. Both groups received whirlpool, ultrasound, first MPJ mobilizations, calf and hamstring stretching, marble pick up, cold packs and electrical stimulation. The experimental group also received sesamoid mobilizations, flexor hallucis isometrics and isotonics and gait training. Treatment was provided three times a week for one month.

Analysis of the results revealed that the experimental group achieved significantly greater range of motion and strength and had significantly lower pain levels as compared to the control group (p<001). The results were also clinically significant in that all subjects in the experimental group achieved greater than sixty five degrees of hallux extension, which is needed for normal gait. In addition, strength of the involved first MPJ was equal to or exceeded the strength of the uninvolved toe. Finally, the pain levels in the experimental group decreased to a zero or one out of ten upon completion of the therapy.

These results indicate that sesamoid mobilization, flexor hallucis strengthening and gait training should be included in the plan of care when treating an individual with hallux limitus.

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