Hallux Limitus
Hallux Limitus - (& Hallux Rigidus)
What is Hallux Limitus?
Hallux 'Limitus' -v- 'Rigidus' is a gradual condition where the movement at the big toe joint decreases with time.
In the early stage, the movement at the joint will have only reduced a little (Hallux Limitus) but as the problem advances the movement becomes less and eventually the big toe joint becomes very [if not completely] stiff (Hallux Rigidus).
In the early stage of hallux limitus, you have limited flexibility in your big toe joint (called the first metatarsophalangeal joint). As your condition worsens, your toe joint becomes rigid (doesn’t move) and walking becomes very painful. At this stage, your toe joint condition is called hallux rigidus.
What is functional hallux limitus?
Functional hallux limitus is stiffness and limited range of motion in your big toe joint only when weight pressure is applied to your foot, like when you’re walking or stepping.
It can be tricky to discover if your provider isn’t familiar with this condition. This is because during a non-weight bearing examination, the motion in your big toe joint will be normal.
Who gets hallux limitus?
Hallux limitus affects an estimated 1 in 40 adults over the age of 50. It’s thought to begin in young adulthood. X-ray evidence shows joint changes in 10% of people between 20 and 34 years of age.
Symptoms and Causes
What are the symptoms of hallux limitus?
Hallux limitus symptoms, which can occur in one or both feet, are mild or even unnoticed in the beginning and gradually get worse.
Common signs and symptoms include:
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Pain (especially on top of your toe joint), discomfort and stiffness in your big toe joint. Pain worsens when walking or during activities that put pressure on your joint.
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Difficulty bending your big toe.
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Numbness or tingling on the top of your big toe or in your foot from pressure on your nerve.
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Development of a callus under your big toe due to increased pressure.
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Development of a bony lump on the top of your big toe joint.
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Development of bone spurs, which is new bone growth off a joint, as your big toe tries to heal itself after an injury.
What causes hallux limitus?
Causes of hallux limitus include:
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Having a long or raised first metatarsal bone. Also, having other unusual foot anatomy that causes increased pressure on your big toe joint.
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Injuries to your big toe, like spraining, stubbing or breaking your big toe. These injuries can cause bone spurs to form.
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Having osteoarthritis, rheumatoid arthritis or gout that affects hip, knee and foot joints and ultimately how you walk.
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Overuse of toes due to high-impact activities that involve repeated pressure on your toes, such as squatting, running, jumping, soccer, basketball, tennis, gymnastics, dancing or ballet.
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Wearing poorly fitted footwear or high heels, which can add stress on your big toe joint.
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Having a family history of hallux limitus.
Diagnosis and Tests
How is hallux limitus diagnosed?
Your healthcare provider will ask you about your symptoms, ask if you’ve had any injuries to your foot or big toe, perform a physical exam of your foot or feet, check your toes flexibility and watch how you walk.
Your provider will order X-rays to evaluate the bones in your foot, confirm any bone spurs and loss of cartilage in your toe’s joints.
How is functional hallux limitus diagnosed?
There’s a simple test to identify functional hallux limitus. While sitting with your foot free of shoe and sock and off the ground, your provider will place their index finger under your big toe and push your big toe up (toward your leg). Your toe should move back very easily. They’ll repeat the process, but this time your provider will place the palm of one hand under your foot and their thumb firmly pressed against your big toe joint. Then, your provider will again try to push your big toe up. If your toe doesn’t move much, you may have functional hallux limitus.
This test — with a hand under the sole of your foot and thumb pressing against your big toe joint — mimics weight-bearing as if you are walking. Having limited toe extension with this test indicates that motion with your full weight on your foot will be even more limited.
Treatment.
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 & the four stages are set out below
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.
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.
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.
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.