Hallux Limitus and Hallux Rigidus

Hallux limitus and hallux rigidus are two terms that are used to describe the progressive loss of motion that is seen in the first metatarsophalangeal joint. For normal function of the big toe, a range of motion of between 50 and 90 degrees is required. In hallux limitus, the range of motion is decreased. In hallux rigidus, there is little to no motion at all at the first metatarsophalangeal (MTP) joint.

The first MTP joint plays a critical role in normal gait. It is the area of greatest propulsion during the gait cycle, and plays a large role in balance. When the range of motion at the first MTP joint (located at the base of the big toe) is lost, significant secondary symptoms can occur, such as calluses across the bottoms of the feet.

Hallux limitus (and later, hallux rigidus) is a specific form of osteoarthritis localized to the first MTP joint. Therefore, the signs and symptoms are similar to that of common arthritis. This includes pain and stiffness in the joint when it is pushed upwards, such as when walking, running and squatting. Swelling and inflammation may be seen as well, particularly on the top of the foot around the joint. In particular, damp and cold weather may make the symptoms worse.

Later findings that are consistent with hallux rigidus include continuous pain in the joint, even when at rest. A person with hallux rigidus may have a visual bump on the top of their foot over the joint. This bump is actually a bone growth known as an osteophyte that can be seen on x-ray, and is common in osteoarthritis. Another common complaint is difficulty wearing shoes, particularly shoes that are tight in the toes, such as high heels.

When the joint becomes too painful to walk on, a limp may be apparent. The attempt to keep weight off the joint can lead to problems with other areas of the foot that are not meant to bear the weight that the big toe is designed for. Knee, hip, back and neck pain are also common conditions associated with hallux limitus and hallux rigidus.

Hallux limitus and hallux rigidus can be treated by either conservative or aggressive treatments, or a combination of both. Conservative treatment relies on stabilizing the foot, taking weight off of the big toe, and alleviating some of the pain associated with the condition. Stabilization of the foot is often achieved with a custom orthotic device or other form of padding. Symptoms may be alleviated with anti-inflammatory medications (NSAIDs), icing, rest, and padding.

More aggressive treatment is focused on the surgical management of hallux limitus/rigidus. The joint can commonly be fused, which takes away motion at the joint and alleviates the pain associated with the motion. Another option may be to use an implant, which can bring motion back to the joint. There are a number of different factors that go into the surgical decision making, so talk to your doctor about the options.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.Winter Haven, FL 33881
Phone: 863-299-4551
www.FLFootandAnkle.com