title: Nonoperative management of functional hallux limitus in a patient with rheumatoid arthritis.
abstract: OBJECTIVE
  Functional hallux limitus (FHL) is a condition that affects motion at the first metatarsophalangeal joint and may lead to abnormal forefoot plantar pressures, pain, and difficulty with ambulation. The purpose of this case report is to describe a patient with rheumatoid arthritis (RA) and FHL who was managed with foot orthoses, footwear, shoe modifications, and patient education.
  
  
  METHODS
  The patient was a 55-year-old woman diagnosed with seropositive RA 10 years previously. Her chief complaint was bilateral foot pain, particularly under the left great toe. Her foot pain had been present for several years, but during the past 5 months it had intensified and interfered with her work performance, activities of daily living, and social life.
  
  
  RESULTS
  Following 4 sessions of physical therapy over a 6-week time period, the patient reported complete relief of forefoot pain despite no change in medication use or RA disease pathophysiology. She was able to continuously walk for up to 4 hours. Left hallux peak plantar pressures were reduced from 43 N/cm2 to 18 N/cm2 with the foot orthoses.
  
  
  CONCLUSIONS
  Patients with RA who develop FHL may benefit from physical therapist management using semirigid foot orthoses, footwear, shoe modifications, and patient education.
authors.affiliation: Physical Therapy Section, Department of Rehabilitation Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Department of Health and Human Services, 10 Center Dr, Bethesda, MD 20892-1604, USA. joseph_shrader@nih.gov
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Shrader
authors.forename: Karen Lohmann
authors.initials: KL
authors.lastname: Siegel
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology; D005260:Female; D020857:Hallux Limitus / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction; D009989:Orthotic Devices; D010146:Pain / Q000209:etiology / Q000534:rehabilitation; D010353:Patient Education as Topic / Q000379:methods; D026741:Physical Therapy Modalities / Q000379:methods*; D011788:Quality of Life; D016059:Range of Motion, Articular; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking; D016474:Weight-Bearing