Hallux limitus and rigidus refer to a form of degenerative arthritis causing stiffness at the metatarsophalangeal joint of the big toe. The big toe joint is primarily responsible for the propulsion (push-off) of the foot during the gait cycle and dysfunction of this joint can impact on the ability to walk and balance.
In the early stages, when motion of the big toe is only somewhat limited, this condition is referred to as hallux limitus. As degeneration and damage to the joint continues, the joint range of motion reduces further, making it harder to bend the toe. Once there is a complete loss of motion, it is referred to as a hallux rigidus.
Like every other joint in the body, the joint surfaces of a healthy big toe are lined with a smooth, well-lubricated layer of cartilage. Damage to the joint either through gradual degeneration over time or acute trauma can wear away the cartilage, exposing the bone underneath. This reduces the range of motion of the joint and causes inflammation and pain. In addition, bone spurs form around the joint, further limiting the toe’s ability to extend (move upwards).
There are certain risk factors which can increase the risk of developing this condition:
– History of acute trauma (eg. turf toe injury, dropping a heavy object on your big toe joint etc.)
– Repetitive microtrauma from activities requiring excessive loading on the joint (eg. ballet, running, squatting, soccer/football)
– Flat feet or high arched feet
– Length of first metatarsal bone (excessively long or short)
– Poor footwear (wearing shoes which increase pressure on the joint such as high heels)
– Inflammatory diseases affecting the big toe such as gout or rheumatoid arthritis
Some symptoms may include:
– Pain and stiffness with movement of the big toe
– A bony bump on the top (dorsal) surface of the big toe joint
– Difficulty with activities that require the big toe to flex or extend
– Deep ache during rest, particularly at the end of the day
– Swelling and inflammation around the joint
Podiatrists are often able to diagnose this through history taking and thorough clinical examination. We may also refer for an x-ray to assess the degree of arthritic change in the first metatarsophalangeal joint.
– Short term use of anti-inflammatory drugs
– Applications of ice and contrast baths (alternating hot and cold water soaks) can ease symptoms
– Taping, braces or insole modifications to splint the toe
– Orthotics to address underlying biomechanical issues and facilitate motion at the big toe joint
– Stiff soled or rocker bottom shoes that reduce bending at the big toe.
– Surgery may be considered conservative treatments fail. Options may include arthroplasty (joint replacement), cheilectomy (removal of spurs), and arthrodesis (joint fusion)
Functional hallux limitus is a precursor to structural hallux limitus, referring to impaired functional movement of the first metatarsophalangeal joint. This means that extension of the big toe is restricted while weight bearing, however, while seated or non-weight bearing the toe is able to move freely within a normal range. Structural hallux limitus refers to the joint range of motion being restricted in both weight bearing and non-weight bearing positions, due to a physical block in the joint (ie. arthritic change or bony spurring).
Once degeneration of the cartilage has occurred, the joint changes are irreversible. Functional hallux limitus and mild/moderate structural hallux limitus are able to be treated successfully with conservative measures to protect the joint and slow the progression of disease… and of course, reduce symptoms!
While the two conditions may look similar, they are quite different in terms of the way they develop. Bunions are the result of an inward rotation of the first metatarsal, forming a bony prominence on the inside of the big toe joint, whereas hallux limitus or rigidus develops a bump on the dorsal surface (top) of the joint. Both can result in stiffness of the big toe joint.