Hallux limitus is a term used to describe a decrease in motion around the big toe joint. When the big toe possesses no movement, it is termed hallux rigidus. As the condition progresses, a degenerative type of arthritis (osteoarthritis) can develop in the big toe joint producing pain. Genetics can play a big role in the formation of hallux limitus.
There are 2 main causes of hallux limitus— a structural misalignment of the first metatarsal bone or a functional abnormality of the first ray. In a functional type of hallux limitus, a person will typically have an excessive amount of pronation (flattening) of the arch. This abnormal foot function can cause instability of the first metatarsal and again cause an increase in jamming across the joint. Inflammation, cartilage damage and spurring can also occur with functional hallux limitus. In a structural hallux limitus, the first metatarsal bone is typically elevated or excessively long. This deformity causes an increase in jamming at the big toe joint as the toe moves upward with walking. Over time, this process can cause inflammation, damage to the cartilage, and a spurring across the top of the joint.
Diagnosis of hallux limitus is typically made by physical examination and radiographic evaluation of the foot. Examination usually will show a decrease in upwards movement at the big toe joint. Pain and inflammation is also usually present. In advanced cases, there is very little movement at the joint and “cracking” or crepitation will be present when moving the toe. Radiographic evaluation typically shows spurring across the top of the joint and in advanced cases, a decrease in joint space and “loose bone” fragments within the joint.
What we can do to help you solve this problem
If you have pain in your big toe joint, we recommend that we see you as a patient. The longer that you let the pain go without treatment, the more chance you will have for permanent damage to the cartilage in the joint.
Initially, we will perform a complete history and physical examination to understand the cause of your problem. We will perform a comprehensive biomechanical examination to determine if excessive pronation could contribute to the formation of hallux limitus. Digital x-rays will be taken to assess the bones and joints and to look for any structural deformities of the bones.
If your symptoms are mild, conservative treatment is indicated. We can help to educate you on the proper shoe wear to help control your symptoms and we can advise you on activities that may aggravate your problem. We sometimes will recommend prescription anti-inflammatory medication to help reduce the inflammation in the joint. A cortisone injection also sometimes can be performed to help with the pain.
Functional hallux limitus often responds well to the proper arch support or prescription orthotics. If your symptoms are mild, we may be able to use a pre-made arch support to control the abnormal flattening of your arch. We carry arch supports in our office that are typically much better than what you will find in the store. Some cases of hallux limitus are more severe and may require the use of a prescription orthotic. This is a custom-made arch support that is made from a plaster impression or digital scan of your foot and arch. Unlike pre-made arch supports, however, an orthotic completely controls abnormal pronation and most effectively stabilizes the first metatarsal to remove jamming of the joint. Read more about custom orthotics.
If the condition has become advanced, it may be necessary to consider surgery. Surgical options include a procedure called a cheilectomy in which the excessive spurring is removed surrounding the joint. If the condition has advanced to the hallux rigidus stage, it may be necessary to perform a joint replacement procedure or a fusion or arthrodesis of the joint to completely eliminate the motion.
If you are having pain in your big toe joint, it is important that we see you for treatment to prevent this problem from worsening. The doctors at Council Bluffs Foot & Ankle Care are experts in the management of this painful condition. Call today to make an appointment.