Hallux Limitus

Did you know that your big toe is known as the “hallux” in medical terms? The hallux is an incredibly important body part which provides propulsion when walking. A normal big toe has a 50 to 90 degree extension range – this is called dorsiflexion. A healthy hallux will be able to move through the full range of motion without any pain. On the other hand, if injured or otherwise not fully functional, other body parts will have to compensate for the big toe when you are walking or running. The tissues and joints of the lower half of your body will be especially affected and will undergo extra strain, ultimately causing pain and tiredness.

The condition known as hallux limitus affects the big toe, limiting the range of motion at the first metatarsal-phalangeal joint. The hallux becomes unable to perform regular dorsiflexion, and this limited movement ultimately results in the jamming of the joint. Over time, this will cause or contribute to the occurrence of a related condition, arthritis, in the first metatarsal-phalangeal joint. The primary visual symptom of hallux limitus is a bump (called an exostosis) at the head of the joint in question. In fact, hallux limitus is often simply called a dorsal bunion.

Hallux Limitus Symptoms

The patient usually begins to feel pain in the top of the joint. This happens as a result of the limited movement and jamming that occurs when walking, running, or performing other day-to-day activities which require the bending of the joint. There are cases in which pain is caused by direct pressure of one’s footwear against the bunion. In other more advanced cases, degenerative arthritis or degenerative joint disease starts to set in. This results in severe pain and aching inside the joint.

Ultimately, however, the symptoms of hallux limitus will depend on which stage of the condition one is in. There are many possible symptoms, and these include the following:

  • Pain, which may be constant and felt even while resting the foot, even without shoes on. Pain will definitely be felt while performing movements that support weight.
  • A grinding feeling may be felt on the joint; this indicates that the bunion is developing.
  • The unmistakable development of bunions or bone spurs.
  • Stiffness in the big toe.
  • In colder weather, there may be increased pain and stiffness.
  • Difficulty while walking, running, or squatting.
  • It may be hard to bend the hallux up and down.
  • Wearing shoes, especially high heels, may be difficult because of the bone spurs and stiffness.
  • Tightness in the joint.
  • The joint may swell, especially on its upper side.
  • Your gait may change in an undesirable way.
  • Pain and stress in other body parts due to your different gait.

What you should know is that all of these symptoms are characteristic of the early stages of hallux limitus. The symptoms will worsen progressively; eventually you may reach a point where zero movement of the joint is possible. This is called hallux rigidus a.k.a stiff big toe. Therefore, if you have any of these early-stage symptoms, be sure to pay a visit to your healthcare professional or a podiatrist as soon as possible.

Hallux Limitus Causes

How does the condition come about? When the first metatarsal-phalangeal joint does not habitually bend enough while walking or when wearing a shoe with heels, the joint will eventually jam and cause pain. Over a period of time (probably years), the cartilage in the joint will become worn out. This causes bony protrusions to grow on top of this joint (osteophytes), or causes the whole joint to become enlarged. These joint changes are known as degenerative arthritis, which will progress further if not treated.

Hallux limitus may be a result of the overuse of the joint, but may also be due to genetics. Those with a predisposition to limited joint movement will eventually experience pain and jamming as described above. Others without a genetic predisposition simply develop the condition from trauma, injury, or overuse. The condition results in a vicious cycle of decreased motion, jamming, arthritis, and extra bone formation.

Hallux limitus and hallux rigidus are known as idiopathic conditions – in other words, unknown factors cause them. However, there are specific risk factors that increase one’s chances of having the conditions. They include:

  • Trauma
  • Faulty biomechanics of the foot
  • Genes
  • Inflammatory diseases such as gout and rheumatoid arthritis
  • Overuse

The most significant risk factor, however, appears to be the repeated use of inappropriate, ill-fitting footwear – particularly those that constrict the toes.

Hallux Limitus Treatment

The treatment of hallux limitus may be surgical or non-surgical. Non-surgical treatment aims to alleviate pain and to prevent the bunions or spurs from progressing. Surgical treatment, on the other hand, usually aims to correct the deformities and to alleviate pain as well. The non-surgical treatment options usually will not correct any deformities.

Non-surgical treatment

In the majority of cases, treating the condition early will either postpone or eliminate the need for surgery later on. Mild and moderate cases may be treated as such:

  • Footwear modification: Usually, the patient experiences the most pain when the joint is bent upwards, towards the shin. Therefore, stiffening the sole of the shoe to minimize bending can help a great deal. “Rocker bars” can also be fitted to the bottom of the shoe, to create a rocking motion while walking, instead of having the toes bend. Appropriate shoes will also include ample room for the toes, to ensure there is no pressure on them. High heels and footwear with pointed toes are a big no-no.
  • Custom-made footwear: Custom orthotics are very helpful, particularly if your condition is caused or aggravated by the abnormal biomechanics of your foot. Orthotics will help alter your foot’s biomechanics.
  • NSAIDs (Nonsteroidal anti-inflammatory drugs): Ibuprofen is an example of an NSAID that will reduce the inflammation and pain.
  • Corticosteriods: These may be injected directly into the affected joint, also to reduce pain and inflammation.

Hallux Limitus Surgery

When deemed necessary, surgical treatment is prescribed. Hallux limitus/rigidus treatment options include:

  • Corrective osteotomy
  • Cheilectomy (to remove spurs)
  • The interposition of soft tissue
  • Regnauld’s enclavement procedure
  • The Keller or resection arthroplasty
  • Arthrodesis of the joint
  • Implant arthroplasty

At the consultation with your podiatrist, he or she will discuss the appropriate surgical options with you.