The hallux is a fancy word for ‘big toe’!
When the hallux is functioning normally it is able to reach at least 65 degrees of what is known as dorsiflexion, which can be seen in the image to the right.
When the big toe can no longer achieve this range of motion, the condition is described as hallux limitus.
When hallux limitus becomes very severe, it can also be referred to as hallux rigidus, although these terms are often used interchangeably.
Hallux limits can be broken down further into functional hallux limitus and structural hallux limitus:
- Functional hallux limitus describes when a person’s big toe can achieve 65 degrees of dorsiflexion when they are not walking, such as your podiatrist moving your toe while you sit in a chair but cannot achieve this when walking or running. Thus, there is a problem with how your foot functions.
- Structural hallux limitus is when you cannot achieve adequate range of motion whether you are weight bearing or not. The reasons for this will be investigated further in this blog.
Who is affected by Hallux limitus and/or rigidus?
Hallux limitus is a condition that becomes more and more common the older we get.
It is also slightly more common in females.
Research has suggested that 1 in 45 middle aged people will have this condition, and up to a whopping 60% of the population aged over 65 will have hallux limitus.
What causes Hallux limitus?
The limited range of motion we see in patients with hallux limitus is generally due to the development of osteoarthritis in the first metatarsophalangeal joint (MTPJ), as can be seen in the image below.
Osteoarthritis can cause a loss of cartilage in the joint, as well as the formation of what is known as dorsal osteophytes (also seen in the image below). Dorsal osteophytes is basically a spike of bone that builds up on top of the joint, and will stop the joint from moving through its natural range of motion.
Many causes of osteoarthritis in the first MTPJ have been suggested, such as: a longer than normal 1st toe/metatarsal; hypermobility of other joints in the foot; flat feet; and foot deformities such as bunions.
Some of these have been shown to have more merit than others, but the true pathophysiology of osteoarthritis is still up for debate.
What are the symptoms of Hallux limitus?
Patients with hallux limitus will experience joint stiffness, some swelling and pain in the joint.
Symptoms will be exacerbated by putting the joint in a dorsiflexed position, such as having to squat down so that you are standing on your forefoot, as well as wearing high heels.
These symptoms can also be caused by other forefoot disorders, so it is important to have the joint accurately assessed, as your podiatrist will be able to differentiate this disorder from others. A podiatrist will do this with a range of clinical assessments such as passive range of motion testing, palpation and muscle testing to rule out other conditions.
This can be confirmed with the use of imaging, where narrowing of the joint space due to a lack of normal cartilage, and osteophyte formation can be seen.
How is Hallux limitus treated?
There is no magic fix for hallux limitus, as it is generally caused by osteoarthritis.
However, there are a range of treatment modalities that should be trialled to get your foot functioning better and reduce levels of pain.
At first, your podiatrist may advise you to trial NSAIDs such as Nurofen to see if this relieves the pain.
After this, your podiatrist may trial a range of conservative therapies, dependent on your individual foot and what is causing you pain.
This may involve the use of taping and orthotics to change the biomechanics of the foot, the use of corticosteroid injections, or changes to footwear.
One footwear modification that has been shown to be somewhat successful is the use of rocker bottom footwear. Rocker sole footwear has a curved bottom and fairly stiff sole, which helps the foot glide through its gait, and reduces the required range of motion at the 1st MTPJ to walk normally and pain-free.
A rocker bottom device can be seen in the image to the right.
If conservative management fails, or rocker bottom soles are considered too dangerous due to the decreased stability and increased falls risk, then surgical intervention will generally be offered to the patient.
A range of surgical procedures may be considered for your hallux limitus, which will depend on your age and the severity of the condition.
Some joint salvaging procedures will attempt to get more range of motion out of the foot whilst decreasing pain, whilst others will actually fuse the toe in a slightly more functional position, which should also completely reduce pain.
Could my pain be caused by anything else?
Whilst hallux limitus is a very common condition, it is not the only cause of pain at the 1st MTPJ.
Conditions such as gout, synovitis, hallux abducto valgus and tendinopathy of flexor or extensor hallucis longus can all cause severe pain at the 1st MTPJ.
If you are experiencing pain at the 1st MTPJ, come see us today to have this properly diagnosed and a management plan put in place.
Book an appointment with one of our expert podiatrists by booking online or calling us on (03) 9432 2689.
