Hallux Limitus Overview
“Hallux limitus” is a disorder of big toe joint. “Hallux” refers to the big toe and “limitus” refers to limitation of motion at the big toe joint. The joint is located at the base of the big toe and medically it is called the 1st metatarsal phalangeal joint. Hallux limitus causes pain and stiffness in the joint and with time it gets increasingly harder to bend the toe upward. If left untreated, it can lead to “Hallux Rigidus” or rigid big toe joint which is a form of degenerative arthritis.
This disorder, if left untreated, can be very troubling and even disabling, since we use the big toe whenever we walk, run, climb up, or even stand.
Because hallux limitus is a progressive condition, the toe’s motion decreases as time goes on. As the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff and arthritic or what is sometimes called a “frozen joint.” Commonly a bump (dorsal exostosis) is noted on top of the big toe joint.
Hallux Limitus Symptoms
- Pain and stiffness in the big toe joint with activity
- Difficulty and pain with walking, running squatting
- Swelling around the joint
- Bump (dorsal exostosis) on top of the big toe joint
Causes of Hallux Limitus
- Activity or work that increases stress on the big toe joint (squatting, stooping, kneeling)
- Flat feet or excessive pronation
- Long 1st metatarsal
- Elevated 1st metatarsal (metatarsus primus elevatus)
- Traumatic injury to the big toe joint resulting in osteochondral defect of the joint
- Systemic disease that cause joint damage (Rheumatoid arthritis, lupus or gout)
Imaging for Hallux Limitus
- X-rays help determine the presence of arthritis to the joint as well as to evaluate structural abnormalities and bone spurs that may have formed around the joint.
Hallux Limitus Treatment (non-surgical)
Early treatment may prevent damage to the joint.
- Shoe modifications. Stiff or rocker-bottom soles limit motion to the joint.
- Orthotic devices. Custom orthotics devices may improve foot function
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as Naproxyn or Ibuprofen, may be recommended to reduce pain and inflammation.
- Cortisone injection. Corticosteroids injection may reduce inflammation and pain.
- Physical therapy. Physical therapy may provide temporary relief.
- Topical pain relieving gel
Hallux Limitus Treatment (surgical)
In some cases, surgery may be needs to address the condition. A thorough physical exam and review of you x-ray can determine what procedure is needed to address the condition.