Hallux valgus (bunion) and hallux rigidus

Definition

What is a hallux valgus?

Hallux valgus is the most common deformity of the forefoot and toes. Because of its conspicuous shape it is also called a bunion. It is a malalignment of the first metatarsophalangeal joint. The big toe deviates outward and displaces the other toes. At the first metatarsophalangeal joint a painful, inflamed prominence often forms. The severity of the deformity is defined by the hallux valgus angle. A hallux valgus angle over 15 degrees is considered hallux valgus.

What is a hallux rigidus?

Hallux rigidus is a degenerative disease of the first metatarsophalangeal joint in which wear of the articular cartilage leads to arthrosis of the big toe joint. Hallux rigidus denotes advanced osteoarthritis in the first metatarsophalangeal joint. Due to inflammatory processes in the joint, stiffness and bone spurs (osteophytes) can develop. These additionally cause friction, inflammation and restricted movement. The upward extension (dorsiflexion) is particularly limited in the first metatarsophalangeal joint.

Causes of hallux valgus and hallux rigidus

The causes of hallux valgus and hallux rigidus are closely linked to modern lifestyles and changed environmental conditions. Our ancestors moved holistically and intensively as hunters and gatherers to obtain food and useful tools. These activities mostly took place barefoot on natural, uneven ground, which optimally challenged and strengthened the foot and leg muscles.

Over the millennia, lifestyle has changed dramatically. Today, lack of exercise and a predominantly sedentary life are widespread. When movement does occur, it usually takes place on hard, flat surfaces like concrete or asphalt — often in rigid, supportive shoes. These changed conditions affect both the quantity and quality of movement and lead to bodily adaptations that can mis- and overload the first metatarsophalangeal joint. The following describes the effects of these changes on the development of hallux valgus and hallux rigidus.

Lack of exercise and sedentary lifestyle

Modern lifestyles characterized by lack of exercise and prolonged sitting lead to improper loading of the musculoskeletal system. Lack of movement and a sedentary lifestyle cause bodily adaptations that can promote hallux valgus and hallux rigidus. The following changes significantly contribute to the development of hallux valgus and hallux rigidus:

• Weakened muscles

  Lack of exercise and a predominantly sedentary lifestyle cause essential muscles to atrophy. Weakness in the foot and lower leg muscles can decisively contribute to the development and worsening of hallux valgus and hallux rigidus. Muscular balance plays a central role in hallux valgus. The small stabilizing muscles of the foot, above all the abductor hallucis, lose strength through inactivity and prolonged sitting. As a result, the balance of forces between the medial and lateral pull on the big toe is disrupted. Consequently, the big toe is gradually pulled outward while the first metatarsal head shifts inward — the typical bunion forms.
  Weak muscle function also negatively affects hallux rigidus. Lack of stability and insufficient support for the natural rolling motion lead to incorrect and excessive loading of the joint. These unilateral or excessive loads accelerate wear of the joint cartilage. At the same time, reduced movement deprives the cartilage of important stimuli for nutrition and maintenance, which further promotes degenerative processes.

• Foot deformities

  Weakened muscles can also lead to foot deformities. Malalignments change the statics and dynamics of walking and cause incorrect and excessive loads on the first metatarsophalangeal joint, promoting structural changes that favor the development of hallux valgus and hallux rigidus.
  For example, in a splayfoot the transverse arch of the forefoot spreads, causing pressure during walking to be distributed unevenly across the forefoot. The first metatarsal head is then overloaded, leading to instability in the first metatarsophalangeal joint. This instability promotes lateral deviation of the big toe — the typical hallux valgus. In addition, lowering of the transverse arch and altered loading change the direction of pull of tendons and ligaments, further increasing the deviation of the big toe.
  Lowering of the longitudinal arch (e.g., fallen arch or flatfoot) can increase pressure on the MTP joint because the longitudinal arch no longer provides its natural shock-absorbing function. This sustained load promotes cartilage wear and inflammatory processes, gradually decreasing joint mobility. Over time the joint stiffens and hallux rigidus develops.
  Reduced foot muscle strength can also cause overpronation and thus an unnatural and excessive load on the first MTP joint, further promoting the formation of hallux valgus and hallux rigidus.
  

• Fascial dysfunction

  Fascia are connective tissue sheaths that surround and link muscles, tendons and joints. They are essential for smooth movement and force transmission in the body. With lack of exercise, improper loading or insufficiently varied movement, fascia can shorten, harden or adhere. In the foot area this especially affects the natural mobility of the first MTP joint.
  Alterations of the fascial structure in the plantar fascia or calf muscles can create persistent tension through myofascial chains, which can gradually pull the big toe outward — typical for hallux valgus. At the same time, shortened or adherent fascia inhibit the deep foot muscles, which play a crucial role in stabilizing the longitudinal and transverse arches and in correct toe alignment.
  Changed fascial structure also impairs a harmonious rolling motion of the foot, promoting stiffening of the MTP joint and thus hallux rigidus. Muscle activity is also inhibited by inflexible fascia, weakening joint stabilization and reinforcing structural maldevelopment.

• Joint stiffness

  Progressive stiffness of the foot joints can significantly contribute to the onset or worsening of hallux valgus and hallux rigidus. Joints need regular, varied movement to maintain full function and mobility. If the foot is underused or used unilaterally due to inactivity and a sedentary lifestyle, it loses flexibility — especially at the first MTP joint. Stiff joints in the foot and lower extremities can increase force transfer to the first MTP joint because force transmission in adjacent joints cannot be properly regulated.
  In hallux valgus this restricted mobility prevents natural rolling over the big toe, causing the foot to compensate via other structures, which disturbs muscles and connective tissue around the big toe. Combined with weak foot muscles and altered force directions, the big toe is pulled outward while the metatarsal bone shifts inward.
  Joint stiffness in the foot limits natural rolling from heel to the first MTP joint. If the first MTP joint is not regularly used through its full range of motion, cartilage nutrition worsens, favoring degenerative changes. The joint becomes increasingly immobile; inflammatory processes intensify pain and movement restriction — a vicious circle begins.

Hard, flat floors and rigid supportive shoes

Changed environmental conditions have a considerable impact on loading of the musculoskeletal system. Hard, flat floors and rigid supportive shoes alter the biomechanics of every step and are therefore an important contributing cause of hallux rigidus and hallux valgus. The following changes significantly contribute to the development of hallux valgus and hallux rigidus:

• Force impact

  When walking on natural, yielding surfaces such as meadows, sand or moss, impact energy is gently absorbed by the ground. Modern hard surfaces like concrete or asphalt, by contrast, reflect the impact energy almost entirely back into the foot. This significantly increases peak loads on the foot structures. Rigid, supportive footwear that further restricts the foot’s natural cushioning and rolling function amplifies these intense focal loads. Particularly at the first MTP joint this results in excessive incorrect and overloading, which can cause persistent pain.

• Hard, flat floors and rigid supportive shoes cause force to reach the feet more strongly and quickly. The unnatural and high loads lead to overload and misuse of the responsible foot muscles. Muscular imbalances can result, causing altered muscle tensions. This in turn can pull the big toe outward. Hallux valgus is the result of increased force impact.
• In hallux rigidus the constant load peaks act directly on the first MTP joint. The cartilage is worn down faster by repeated pressure, joint mobility decreases and painful movement restrictions appear. Over the long term, the joint stiffens more and more — typical for hallux rigidus.

• Unnatural movement sequence

  On natural, soft surfaces the foot constantly makes small adjustments and compensatory movements to adapt to the ground. This actively engages foot muscles and joints and keeps them mobile. Hard, flat floors like concrete or asphalt prevent this natural adaptation because they barely yield. Rigid supportive shoes additionally restrict the natural rolling motion by supporting and fixing the foot arch. Feet no longer actively roll from heel to midfoot and toes but strike almost rigidly. This reduced movement sequence leads over time to loss of important foot and leg muscle function, causing muscle chain imbalances. Altered muscle tension can shift the metatarsal bones and favor lateral displacement of the big toe.
  Because rolling over the forefoot is reduced, the first MTP joint loses flexibility due to insufficient movement, promoting painful stiffening. Simultaneously, reduced movement deprives the cartilage of important stimuli for nourishment and maintenance, further encouraging degenerative processes.

• Weakened muscles

  The passivity of the feet on hard, flat floors and in rigid, supportive shoes also leads to loss of essential musculature. Weakened foot muscles can cause the transverse and longitudinal arches to collapse. As these arches lower, bony and myofascial structures change their angular relationships, resulting in misalignment of the big toe. The foot also loses its natural spring, which would normally absorb incoming forces. Consequently, the force acting on the MTP joint is increased, further raising load. Over time this can result in both hallux valgus and hallux rigidus. Reduced foot musculature can also promote overpronation and thus unnatural and excessive loading of the first MTP joint, fostering formation of hallux valgus and hallux rigidus. Furthermore, weakened foot muscles favor the development of a flail foot. Uncontrolled collapse of the forefoot after heel strike can also increase force on the first MTP joint and thus mis- and overload it. Inflamed hallux and joint pain in the big toe can be the result.

Symptoms of hallux valgus and hallux rigidus

It is important to note that the following lists contain the most common symptoms of hallux rigidus and hallux valgus. The list of symptoms is not exhaustive. Atypical symptoms may occur that are not listed here. Symptoms depend on factors such as pain perception, underlying causes, severity of the condition and physical constitution. To obtain a definitive diagnosis for hallux valgus or hallux rigidus, a physician should be consulted.

Hallux valgus:

• Deviated big toe: The big toe increasingly leans toward the second toe — the main characteristic of hallux valgus.
• Painful bunion: A clearly visible, often red and tender prominence forms on the inside of the foot at the first MTP joint. These are typical hallux valgus pains.
• Swelling and inflammation: Friction and pressure (e.g., inside shoes) can cause inflammation of the MTP joint. Consequently, the joint can be swollen and tender. Swelling around the joint is also possible.
• Pressure pain in shoes: Tight or stiff shoes cause pain at the hallux, especially when walking or standing for prolonged periods.
• Reduced mobility of the MTP joint: Joint mobility can progressively decrease.
• Corns or calluses: Misloading often leads to increased calluses or corns — especially on the bunion or between the toes.
• Changes in gait: To avoid hallux pain, gait is often altered, which may cause other complaints (e.g., knee or hip pain).
• Second toe displaced or overlapping: The second toe can be pushed up or displaced by the pressure of the deviating big toe.
• Feeling of instability in the forefoot: Affected persons often feel a loss of control or “giving way” in the forefoot when rolling.
• Midfoot pain: Altered loading due to hallux pain often causes additional complaints in the midfoot bones.

Hallux rigidus:

• Stiff big toe: Mobility in the first MTP joint is significantly restricted — particularly upward dorsiflexion during the roll-off is problematic.
• Pain when walking: Especially when rolling off or pushing off with the big toe, activity-related pain occurs.
• Start-up pain: The joint is particularly painful at the beginning of movement — for example when getting up — but improves after a short time.
• Pressure pain over the MTP joint: The joint is often tender to pressure, especially in tight shoes or on direct touch.
• Swelling at the joint: Inflammatory reactions in the joint lead to visible swelling, occasionally accompanied by redness and warmth.
• Increased pain with cold or damp weather: Many sufferers report weather-dependent hallux pain, particularly with cold exposure.
• Bone spurs (osteophytes): Palpable and visible bony outgrowths can form at the joint.
• Numbness and sensory disturbances of the big toe: Bone spurs or inflammation-related swelling can press on surrounding nerves.
• Altered gait: Due to pain and restricted movement, gait is often unconsciously changed — e.g., by avoiding the medial part of the foot.
• Pain during sports: Activities with many rolling movements (e.g., jogging, hiking) worsen complaints.
• Avoidance postures / compensatory movements: To avoid hallux pain, compensatory movements are used, which can cause further problems in the knee, hip or back.

Conventional therapies - What helps for hallux valgus and hallux rigidus

Various therapeutic approaches are available for treating hallux rigidus and hallux valgus. Below are some common therapies for hallux valgus and hallux rigidus. The list is not exhaustive. Different measures can also be combined. A medical consultation is recommended to determine the appropriate therapy. Conservative measures should always be considered before hallux surgery.

Hallux valgus:

• Wide shoes with a soft upper: Relieve pressure on the bunion area and reduce pressure on the big toe bunion.
• Shoe inserts with metatarsal pad: Support the foot arch and unload the big toe.
• Toe orthoses / hallux valgus splints: Mechanically realign the big toe slightly and help prevent progression of the deformity.
• Foot exercises and strengthening routines: Strengthen foot muscles, support natural toe alignment and improve foot mechanics.
• Adjustment of running and walking habits: Analysis of gait can help identify and correct misloading to avoid future complaints.
• Fascial therapy and mobilization: Release adhesions, improve circulation and support foot mobility.
• Walking barefoot on natural ground: Promotes foot muscles and natural rolling.
• Physiotherapy: Individual movement exercises and manual therapy to improve foot function.
• Weight reduction in overweight individuals: Relieves the forefoot and reduces mechanical load on the MTP joint.
• Acupuncture: Can be supportive for hallux pain and muscular tension.
• Kinesio taping: Promotes circulation, supports musculature and relieves pain.
• Hallux valgus surgery: Depending on the cause, severity and activity profile, various surgical procedures are possible. The most suitable surgical option should be discussed individually with a specialist. Surgery should always be considered only after exhausting conservative measures. Although hallux surgery has become routine, outcomes vary.

Hallux rigidus:

• Shoe modifications (stiff soles, roll-off aids): Special shoes or sole relief elements reduce loading at the first MTP joint and thus hallux pain when walking.
• Insoles with rigidus spring or carbon plates: Limit painful toe movement and improve force transmission during roll-off.
• Physiotherapy and mobilization: Maintain or improve joint mobility, release adhesions and strengthen surrounding muscles.
• Foot exercises and muscle strengthening: Activate foot musculature and improve pressure distribution.
• Fascial therapy and stretching exercises: Release tension and improve circulation around the first MTP joint.
• Adjustment of running and walking habits: Gait analysis can identify optimization options for a natural roll over the big toe.
• Cooling for acute inflammation: Reduces swelling and pain in acute irritative states.
• Medication (NSAIDs): Nonsteroidal anti-inflammatory drugs like ibuprofen relieve pain and reduce inflammation.
• Kinesio taping: Supports joint function and circulation, reduces pain.
• Acupuncture: Can be helpful as an adjunct for chronic hallux pain.
• Weight reduction in overweight individuals: Reduces load on the first MTP joint.
• Hallux rigidus surgery: Depending on the severity of joint wear, various surgical procedures are possible — from removal of bone spurs and friction points to fusion of the first MTP joint (arthrodesis) or joint replacement. Surgery should always be considered after exhausting conservative measures. Although hallux surgery is now routine, experiences following surgery vary.

Often these measures unfortunately do not lead to long-term reduction of complaints because the underlying causes of hallux rigidus and hallux valgus are not addressed. The aim of any hallux valgus and hallux rigidus treatment should therefore be elimination of the causes. As described above, lack of exercise, a sedentary lifestyle, hard flat floors and rigid supportive shoes should be addressed. The kybun mode of action appears to be a suitable therapy for hallux valgus and hallux rigidus because it can eliminate these underlying causes.

kybun mode of action - What helps for hallux valgus

kybun products aim to eliminate the harmful effects of hard, flat floors and rigid supportive shoes and to actively counteract lack of exercise and a sedentary lifestyle. Thus kybun shoes offer an alternative treatment for hallux to the many hallux rigidus and hallux valgus surgeries. Due to the elastically springy properties of kybun products, the feet are on the one hand relieved and on the other hand activated. The relief reduces hallux rigidus and hallux valgus pain in the first step. Activation addresses the underlying causes so that complaints can be resolved in the long term. Kybun shoes can also be worn after hallux surgery once the feet are able to bear load again. Kybun shoes are well suited for hallux valgus and hallux rigidus because the following mechanisms help in treatment:

• Activation of foot muscles through the elastically springy property

  The elastically springy characteristic of kybun products creates a deliberate instability that forces the body to perform small compensatory movements. This automatically activates and strengthens the deep foot muscles. Strong foot muscles play a central role in stabilizing the foot arches, preventing overpronation, reducing load peaks and aligning the toes.
  In hallux valgus the big toe often shifts outward because stabilizing muscles are too weak to counteract asymmetric loading. If the foot muscles are regularly activated and trained — for example by walking on an elastically springy surface — they can better resist the pull on the big toe and help prevent malalignments (such as pes planovalgus). Muscles that support the big toe pad and keep the toe aligned particularly benefit from this targeted activation. In this way the risk of developing hallux valgus can be significantly reduced or its progression slowed.
  Slow and controlled sinking of the heel into the elastically springy material creates a myofascial pre-tension in the involved muscles. Due to this pre-tension and improved muscular activity, a flail foot can be prevented and the forefoot can be loaded in a controlled manner, protecting the MTP joint from incorrect and excessive loads. The controlled lowering of the foot has a positive effect on both hallux valgus and hallux rigidus.
  The elastically springy sole forces the foot into a gentle but complete roll-off from the heel over midfoot to forefoot. This keeps the MTP joint mobile, evenly loaded and benefits from improved blood flow and nutrition through activated musculature. In this way degenerative changes can be delayed or ideally prevented, effectively counteracting development of hallux rigidus.

Balance and EMG

Balance ability was measured with a force plate by recording movement of the centre of mass forwards-backwards (ant-post) and side-to-side (med-lat) while standing. An electromyography (EMG) simultaneously recorded muscular activity.

• Natural foot roll thanks to muscle activation and roll-off function

  With a healthy roll-off all foot structures are loaded evenly, promoting uniform distribution of the acting forces. In addition, the big toe is engaged in its natural extension and support function. This stabilizes the MTP joint and prevents lateral deviation of the toe — typical in hallux valgus. Moreover, the natural roll activates the foot muscles, especially those that support the longitudinal and transverse arches and keep the joint aligned.
  
  During natural roll-off the movement is evenly distributed from heel over midfoot to the big toe. The MTP joint is regularly used through its full range — particularly in extension during push-off. This repeated functional movement keeps the joint mobile, promotes blood flow and stimulates production of joint fluid which is essential for cartilage nutrition (especially relevant for hallux rigidus). At the same time the surrounding musculature is activated and strengthened, supporting joint stability and unloading.

• Reduction of force impact from hard, flat floors through cushioning effect

  On heel contact in kybun shoes the elastically springy material is compressed. Due to this slow sinking of the heel into the kybun sole, load rises more gradually. This time gain can be used by the muscles for proper stabilization so that the foot does not collapse uncontrollably after heel strike and thereby mis- and overload the MTP joint.
  Thanks to the elastically springy property, the impacting force can be temporarily absorbed and then released for forward motion and an active roll-off. The benefits of an active roll-off were discussed in the previous section.
  The damping effect of the elastically springy soles also unloads the MTP joint during the roll-off phase by softly damping and more evenly distributing ground reaction forces instead of transmitting them unfiltered to the joint. Conventional load peaks are smoothed by the elastically springy function, reducing stress on the MTP joint.

• Optimized pressure distribution

  When walking and standing in kybun shoes the entire sole of the foot is surrounded by the elastically springy material. This leads to optimized pressure distribution across the feet, so that acting forces are distributed more evenly over the entire plantar surface. Excessive pressure peaks at the first MTP joint — especially on the medial side in hallux valgus or directly over the joint in hallux rigidus — are avoided. This helps prevent unilateral overload and irritation of the joint.

• Protection against fascial dysfunction thanks to physiological movement sequence

  Thanks to the slow sinking at heel strike and controlled roll-off, a physiological gait is enabled, which also protects the fascia from structural changes. A well-functioning fascial network can prevent hallux valgus and hallux rigidus by providing necessary tension, elasticity and coordination in the musculoskeletal system — especially in the foot. Fascia surround muscles, tendons and ligaments and transmit forces across joints. If this network is supple, well hydrated and free of adhesions, the muscles and ligaments that stabilize the MTP joint can work optimally. This keeps the joint aligned and prevents lateral deviation of the big toe — as seen in hallux valgus. For prevention of hallux rigidus healthy fascia are also relevant so the MTP joint can move freely during roll-off. This avoids unilateral pressure loads and movement restrictions that can lead to joint stiffening over time.
  

• Improved circulation through increased movement activity

  The elastically springy characteristic of kybun shoes increases range of motion via the deliberate instability and active roll-off. Increased movement activity enhances circulation in the foot and toe area, which is crucial for preventing hallux rigidus. Good blood flow supplies the joint and surrounding tissues with oxygen and nutrients, maintaining cartilage health and inhibiting inflammatory processes. At the same time, removal of metabolic waste is promoted, which otherwise can lead to irritation and degenerative changes in the absence of movement. Regular activity also keeps the MTP joint mobile, prevents gradual stiffening, and supports the gliding capacity of joint surfaces — central factors to avoid development of hallux rigidus.
  

• Promotion of movement and reduction of sedentary behaviour

  The elastically springy kybun products increase enjoyment of movement because their unique material relieves the MTP joint when walking and standing. Regular, varied movement activates and strengthens foot and leg muscles. The associated benefits have already been discussed. Movement also stimulates production of joint fluid, which nourishes and protects the cartilage in the first MTP joint. Less sitting and more walking also improve circulation and increase fascial elasticity. These positive effects have been described above.

Tips for use with hallux valgus and hallux rigidus

Before wearing kybun shoes for the first time, you should consider some tips for use. Correct application of kybun shoes for hallux rigidus and hallux valgus can help relieve complaints. In addition, treat hallux valgus and hallux rigidus with targeted therapy as explained in the next section.

• Start by wearing kybun shoes only as long as your body tolerates. Introduce breaks if pain increases or if the musculoskeletal system becomes fatigued. Treatment takes time. Because kybun products activate muscles, initial reactions can occur, especially at first.
• Press your heel slowly and controlled into the elastically springy material so you feel the heel sink and the foot and leg muscles engage. A conscious and controlled heel strike protects the MTP joint from uncontrolled collapse of the mid- and forefoot. In the beginning, ensure the mid- and forefoot are lowered slowly and avoid excessive roll-off over the forefoot. This is particularly important with hallux rigidus.
  
• Start with small, controlled steps to adapt to kybun shoes and to relieve the MTP joint. Gradually increase foot range of motion when possible. Try to roll off in a controlled manner over the MTP joint. For hallux rigidus test the available range of motion of the MTP joint and use it where feasible.
  
• Try the following exercises to enhance the effect of kybun shoes and increase the chance of recovery. These are intended as complementary therapy for hallux rigidus and hallux valgus pain and should be part of the overall treatment plan.
  

Helpful exercises for hallux valgus and hallux rigidus

To enhance the effectiveness of kybun shoes and increase the likelihood of recovery from hallux rigidus and hallux valgus pain, we recommend the following exercises. The exercise selection is not exhaustive and can be supplemented by other exercises. In general, pains should not increase during exercises. If any exercise intensifies hallux pain, it should be stopped. Pleasant, releasing sensations outside the pain point (e.g., in the sole) are desirable. The exercises are divided into: “Correct walking in kybun shoes”, “Muscle length training”, “Fascia rolling” and “Strengthening”. Ideally, these areas are used complementarily as therapy for hallux valgus and hallux rigidus.

Correct walking in kybun shoes
The quality of each step is crucial in treating hallux rigidus and hallux valgus to reduce pain and eliminate incorrect and excessive loading. Kybun shoes therefore provide an ideal therapy for hallux valgus and hallux rigidus.

Controlled heel strike

• Press the heel slowly and controlled into the elastically springy material to engage pre-tension of the foot and calf muscles.
• Lower the mid- and forefoot slowly and controlled so the MTP joint is physiologically loaded.
• Maintain controlled foot position so the foot does not collapse inward.
• Start with smaller steps so you do not roll excessively over the MTP joint.

Controlled roll-off

• Gentle roll-off in the forefoot without actively pushing off strongly with the big toe. Active push-off additionally stresses the MTP joint.
• Test the available range of motion in the forefoot roll-off without causing or increasing pain in the MTP joint.
• Increase range of motion where possible and progress to an active roll-off.

Muscle length training
Muscle length training is important in treating hallux rigidus and hallux valgus because these conditions often arise from shortening and tension in foot and leg muscles. Targeted stretches can address these shortenings and tensions and are an ideal therapy.

Big toe correction for hallux valgus

• Place an elastic band (e.g., theraband) around the big toe.
• Secure the band with the other foot.
• While standing or sitting, pull the foot outward so the big toe is straightened.
• 2 minutes per side.
• Perform 1–2× daily.

Plantar surface

• Hold the foot with both hands.
• Actively pull the forefoot toward the shin to produce a stretch in the sole.
• Hold 3×30 seconds.
• Perform 1–2× daily.

Fascia roller
Fascial training with a foam roller is important in treating hallux rigidus and hallux valgus because the origin of symptoms is often shortening and tension of the posterior chain (including plantar fascia and calf muscles). Regularly rolling out the shortened and tense myofascial chain makes the fascia roller a useful active therapy.

Plantar surface

• Roll the plantar surface actively with a fascia roller or ball from heel to toes.
• Perform slowly and controlled.
• Adjust pressure to personal tolerance but go to a tolerable pain boundary.
• Roll more intensively over focal adhesions or hold position at that point.
• 3 minutes per foot.
• Perform 1–2× daily.

Calf musculature

• One leg bent with the other leg on the fascia roller. Increase pressure by stacking the legs. Further increase by placing one leg on top of the other.
• If wrist pain occurs, perform the exercise on the forearms.
• Roll from the area above the heel to just below the knee crease.
• Perform slowly and controlled.
• Adjust pressure to personal tolerance but go to a tolerable pain boundary.
• Roll more intensively over focal adhesions or hold position at that point.
• At least 3 minutes per foot.
• Perform 1–2× daily.

Strengthening
Targeted strengthening of the feet is particularly important in foot deformities (e.g., fallen, flat and valgus feet) to protect the MTP joint from over- and misloading. In general, stronger foot and leg muscles allow physiological loading of the MTP joint and should therefore be part of hallux rigidus and hallux valgus treatment. Targeted strength training is an effective therapy.

Foot muscles — longitudinal arch

• Stand upright with feet hip-width apart.
• Heel and forefoot maintain even contact with the ground.
• Slowly raise the longitudinal arch without losing heel or forefoot contact with the ground.
• Also ensure the movement comes from the feet and the lift is not produced by external rotation of the knees.
• Hold the top position for 4 seconds.
• Lower the foot slowly and controlled.
• 3 sets of 8–12 repetitions per foot.
• Perform 2–3× weekly.

Big toe lifts and toe lifts

• Place feet hip-width on the floor.
• Big toe lift: Actively lift the big toe and lower it slowly. All other toes remain on the ground. Do not lift the medial foot edge.
• Toe lift: Keep only the big toe on the ground. Actively lift and lower all other toes slowly. Do not lift the lateral foot edge.
• It is important that the forefoot and heels maintain ground contact.
• For simplification, the exercise can be performed alternately with one foot only.
• 3 sets of 8–12 repetitions per foot.
• Perform 2–3× weekly.