Improved step length symmetry and decreased low back pain with the use of a rocking-soled shoe in a patient with unilateral hallux rigidus.

To cite: Cusack J, Shtofmakher G, Kilfoil RL, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014206408 DESCRIPTION A 53-year-old African-American man presented to a local podiatry outpatient clinic with a chief symptom of unilateral pain in the first metatarsophalangeal joint (MTPJ) of his left foot as well as a secondary concern of chronic low back (lumbosacral) pain. He stated that the onset of the foot pain several years ago was insidious, but has been gradually increasing in intensity. He stated that the foot pain was proportionate to the amount and speed of ambulation, and was decreased with non-weightbearing. He also related that he noticed that the foot pain was also somewhat lessened if he ‘slowed down’, and took shorter steps. He stated that he had tried several types of corrective foot orthotic devices, both over the counter and custom made, none of which provided any significant relief. With regard to his back pain, the patient reported that he was told by his chiropractic physician that he had ‘arthritis’ at the L4–L5 disc level. The patient stated that his back pain also was not the result of any precipitating trauma, but rather seemed to have increased over the years. He denied any sciatic