STAGE DORSIFLEXION
ROM RADIOGRAPHIC
FINDINGS CLINICAL
FINDINGS TREATMENT
PLAN TREATMENT
GOALS
Stage–0 40°-60° Normal No pain, with
minimal stiffness
& loss of motion
on NWB examina-
tion NP foot orthosis
with first-ray
cutout. Standard
footwear Return individual
to full motion, &
prevent progres-
sion
Stage–1 30°-40° Dorsal osteophyte
with minimal joint
space narrowing Occasional/mild
pain and stiffness;
pain at extremes
of dorsiflexion on
NWB examination Orthoses with
first-ray cutout; a
wider higher toe
box to reduce
osteophyte fric-
tion and a com-
mercial rocker-
soled shoe Same as Grade 0,
but also trying to
prevent pain due
to dorsal osteo-
phyte
Stage–2 10°-30° Dorsal, medial,
and lateral osteo-
phytes giving
metatarsal head a
flattened appear-
ance; mild-to-
moderate joint
space narrowing
& sclerosis Moderate-to-
severe pain and
stiffness; pain
occurs just before
maximal dorsi-
flexion & plan-
tarflexion on NWB
examination Orthoses with an
extended medial
shell and/or a
rigid rocker-soled
shoe. This may
require the addi-
tion of a rigid
shank Limit motion in
order to reduce
pain
Stage–3 < 10° Same as Grade
2, but with signifi-
cant joint space
narrowing & scle-
rosis; sesamoids
are enlarged, cys-
tic, or irregular Constant pain
and stiffness at
end range of
motion, but not at
mid-range Rigid, rocker-
soled shoe with
the apex just
proximal to the
MTPJ’s. May
require a rigid
shank and a
thicker sole to
accommodate
the rocker angle
needed for a
smooth gait Allow for smooth
gait, while com-
pletely immobiliz-
ing the 1st MTPJ
to reduce pain
Stage–4 Same as Grade 3 Same as Grade 3 Same as Grade 3,
but pain present
also at mid-range
of motion Same as Grade
3 with the addi-
tion of a MAFO
if restriction of
forward motion of
the tibia is desired Completely
immobilize the 1st
MTPJ while the
joint auto-fuses,
or is surgically
fused/ replaced
Table 1: Classification of Hallux limitus/rigidus with conservative treatment plan and goals.
Current Pedorthics | March/April 2019
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