Q:
Do you have any posts on yoga and hallux limitus, especially for those
also with back issues (osteoporosis, DDD, osteoarthritis)? I use yoga as
a main form of exercise and to aid in pain relief from these issues but
am now faced with limited yoga poses as a result of limiting pressure
on the big toes. Any advice would be welcome!

A:
In the past, I have written posts about conditions of the feet and toes
that can lead to pain and dysfunction (see links below), but I have not
specifically addressed the con
dition of the big toe known as hallux
limitus. In the name of this condition “hallux” refers to your big toe
and “limitus” (related to “limited”) means stiffness. In this case it is
the joint between your long first metatarsal bone and the first phalanx
bone of the big toe itself that is affected. As this condition develops
over time, the stiffness and limited ability of the joint to extend
(bend up away from the floor) can progress to pain, especially when
walking and doing other weight bearing activities on the feet. The
condition is often associated with people who have flat feet and an
elevated first metatarsal bone, and also can develop after an acute
trauma to the foot or recurring trauma, such as “turf toe,” which some
athletes get after kicking the turf and jamming the big toe over and
over again. The presence of stiffness may indicate some arthritic change
to that toe joint, so if you suddenly develop persistent stiffness in
your big toe it may be worth getting an X-ray. 

Hallux
limitus is sometimes also present in those with bunions, a condition
known as hallux valgus, where the toe bones of the big toe shift toward
the little toe side of the foot and swelling occurs in the inner edge of
the joint. The bottom line is that as the big toe gets stiffer, and
usually more arthritic (which an X-ray will indicate), it can affect
your ability to walk pain-free with a normal gait, something you
certainly would like to preserve if you can. 

There
are four progressive stages to hallux limitus, and in the early stages,
stretching the big toe is one of the recommended treatments (along with
RICE—see Acute Orthopedic Injuries
and the use of orthotics). It is at this stage where I believe yoga can
be of greatest help. Here are a few suggested options for you to
consider:

For
an acute phase, where there is stiffness and pain (and maybe some
swelling), I’d recommend doing non-weight bearing poses, especially
where the feet can be up in the air, such as Reclined Leg Stretch pose, version 1 with the leg straight up.

In these
positions, try gently flexing and extending all the toes, with specific
focus on the big toe, to maintain as much range of motion at the joint
as possible. As pain improves, supported standing poses, such as Warrior
2 or Lunge poses with a chair, will to assess your ability safely bear
weight if you can do them without pain.

In
non-acute phases, where stiffness alone or with only occasional brief
pain is present, you can begin to work more actively in your standing
poses. To strengthen the myofascial support along the inner arch towards
the big toe, try doing the standing poses while lifting all the toes as
far up off the ground as possible while the ball of the foot remains
grounded. If you can’t lift your big toe on your own, try slipping a
yoga wedge 
or a folded mat just under the big toe to encourage some extension. Start with short holds of 15-30 seconds and gradually work
toward holds.

Another
way to mobilize your big toes is to use a strap or elastic band under
your big toes in a standing pose, such as Standing Forward Bend or
Pyramid pose, where you have easy access to your big toe or toes. Once
you are in the pose with the strap in place, slowly but actively lift up
your big toe/toes into extension with the strap while keeping the ball
of your foot/feet grounded. If osteoporosis and back pain are a concern,
you can try this in a modified Standing Forward Bend, coming only part
of the way down and not rounding your spine.

In poses
where your back toes are turned under, such as Lunge pose, which
requires more maximal big toe extension, you could try putting a wedge
under the toes of your back foot to decrease the angle of bend a bit and
gradually work your way back to have the toes on the floor.

And
definitely try out other creative ideas that you come up with on your
own to help maintain as much pain-free mobility as you can. At this time
there are no specific studies on the use of yoga for hallux limitus,
but for all you yoga researchers and yoga therapists out there, this is
new territory just waiting for you to look into it further!

Here are my previous posts on feet and big toes:

New Tricks for Old Dogs: Working with Bunions

Friday Q&A: Bunions, A Can, and A Rubberband

Your Feet on My Mind

(I will
not be addressing the other back and bone conditions that the reader has
mentioned, but we have also written about many of them on the blog,
too.)

— Baxter

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