The effect of sesamoid mobilization, flexor hallucis strengthening, and gait training on reducing pain and restoring function in individuals with hallux limitus: a clinical trial

J Orthop Sports Phys Ther. 2004 Jul;34(7):368-76. doi: 10.2519/jospt.2004.34.7.368.


Study design: Clinical trial.

Objective: To determine the effect of 2 conservative intervention approaches for functional hallux limitus.

Background: Metatarsophalangeal joint (MPJ) sprains are common and can result in long-term sequelae such as persistent pain and loss of range of motion (ROM) secondary to bony proliferation and articular degeneration. It is important to determine the most effective intervention for functional hallux limitus to decrease pain and restore function.

Methods and measures: Twenty individuals with first MPJ pain, loss of motion, and weakness participated in the study. All patients received whirlpool, ultrasound, first MPJ mobilizations, calf and hamstring stretching, marble pick-up exercise, cold packs, and electrical stimulation. Ten of the 20 patients (experimental group) also received sesamoid mobilizations, flexor hallucis strengthening exercises, and gait training. Treatment was provided 3 times a week for 4 weeks. Measurements of first MPJ extension ROM, flexor hallucis strength, and subjective pain level were performed on the first and last visits.

Results: Following the 12 therapy sessions, the experimental group achieved significantly greater MPJ extension ROM and flexor hallucis strength and had significantly lower pain levels as compared to the control group (P<.001).

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

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Analysis of Variance
  • Female
  • Gait / physiology
  • Hallux Limitus / physiopathology
  • Hallux Limitus / rehabilitation*
  • Humans
  • Male
  • Pain / prevention & control
  • Pain Measurement
  • Physical Therapy Modalities / methods*
  • Range of Motion, Articular / physiology
  • Sesamoid Bones / physiopathology
  • Treatment Outcome