Hallux Limitus

Hallux rigidus is a mechanical arthritic condition of the big toe joint that, overtime limits toe bending motion. At first the condition is not particularly painful and only slightly limiting, but can progress to severe pain and complete joint degeneration with severe blockage of motion. A hallmark of the condition is a ridge of bone that develops on the top of the big toe joint (dorsal bunion). The ridge of bone is an arthritic spur that enlarges as the end of the first metatarsal bone (bone behind the big toe) flattens and loses shape.

While it can take years for the big toe joint to wear out, the destructive damage cannot be reversed. The condition has four stages of destruction, with each successive stage having more limitation and destruction of the joint. The final stage is hallux rigidus where the normal joint anatomy is fully destroyed.

Limitus webWhat is Hallus Limitus?

Like many conditions in medicine it is sometimes difficult to clearly determine the cause of a problem. The following factors seem to be related to the genesis of the problem:

  • Genetics (inherited poor foot structure or mechanics)
  • Trauma to big toe (joint sprain, crush injury, dropped object)
  • Arthritis (i.e. gout)
  • Demanding activities (crouching, sports, ballet)
  • Poor shoes

What are non-surgical treatments?

The goal of any treatment is to slow the progression of the problem and relieve joint pain. The treatments listed below combined together can help to alter the mechanical stress at the big toe joint:

  • Shoe selection: Proper selection in shoes can be critical for preventing further damage to the joint and relieving pain. Selecting shoes with stiff soles such as a hiking shoe is essential and an effective non-surgical treatment.
  • Custom orthotics: Custom orthotics can be very effective when combined with good supportive shoes. Over-the-counter support can be tried, but may be less effective than custom orthotics.
  • Calf stretching: This should be incorporated into a daily routine to decrease pressure at the ball of the foot.
  • Change in activities: Changing from running to bicycling or avoiding crouching activities can be an effective non-surgical treatment.
  • Arthritis treatments: Non-steroidal anti-inflammatory medication can be considered, but should be taken under medical guidance when used long-term due to side effects. Use of dietary supplements such as: glucosamine sulfate, chondroitin sulfate, and/or MSM (methylsulfonylmethane) may also be worth considering.