A degenerative arthritis and stiffness due to bone spurs that affects the MTP joint at the base of the hallux (big toe) is called Hallux limitus or stiff big toe.
Pain and stiffness in the joint at the base of the big toe during use (walking, standing, bending, etc).
Difficulty with certain activities (running, squatting).
Swelling and inflammation around the joint.
Although the condition is a degenerative condition, it can occur in patients who are relatively young particularly active sports people who have at some time suffered trauma to the joint.
Non-surgical treatment early treatment for mild cases of Hallux limitus may include prescription foot orthotics, shoe modifications (to take the pressure of the toe and/or facilitate walking), medications (anti-inflammatory drugs), injection therapy (corticosteroids to reduce inflammation and pain) and/or physical therapy.
Surgical treatment In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of Hallux limitus. The type of surgery is based on the stage of hallux limitus.
Stage 1 Hallux limitus involves some loss of range of motion of the big toe joint or first MTP joint and is often treated conservatively with prescription foot orthotics.
Stage 2 Hallux limitus involves greater loss of range of motion and cartilage and may be treated via cheilectomy in which the metatarsal head is reshaped and bone spurs reduced.
Stage 3 Hallux limitus often involves significant cartilage loss and may be treated by an osteotomy in which cartilage on the first metatarsal head is repositioned, possibly coupled with a hemi-implant in which the base of the proximal phalanx (base of the big toe) is resurfaced. Stage 4 hallux limitus, also known as end stage hallux limitus involves severe loss of range of motion of the big toe joint and cartilage loss.
Stage 4 Hallux limitus may be treated via fusion of the joint (arthrodesis) or implant arthroplasty in which both sides of the joint are resurfaced or a hinged implant is used. Fusion of the joint is often viewed as more definitive but may lead to significant alteration of gait causing postural symptomatology. The implants termed “two part unconstrained” implants in which a “ball” type device is placed on the first metatarsal head and “socket” portion on the base of the big toe do not have a good long term track record. The hinged implants have been in existence since the 1970s, have been continually improved and have the best record of improving long term function.
Pathological overview of ‘Hallux limitus’.
Orthotics for ‘Hallux Limitus’
Implant Surgery for ‘Hallux Limitus’
Foot Health Matters is a HCPC Registered Podiatry Practice in South Belfast. Northern Ireland BT10 0DR Tel: 028-90-611619.