Big Toe Joint Pain & Stiffness (Hallux Limitus / Hallux Rigidus)

The hallux is the medical term for the big toe. The joint at its base is known as the metatarsophalangeal joint, and this is the most common site for arthritis in the foot, which makes it a very common source of foot pain. The big toe joint is of paramount importance during walking and running, and restriction of its normal upwards motion, known as dorsiflexion, can cause many problems.

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Symptoms

Pain and swelling of the joints of the big toe
Stiffness or tightness around the big toe joint
Calluses, areas of hard skin or corns on the inside of the big toe and under the second toe
Toenail problems, which can occur as the joint between the metatarsal and phalanx bends upwards to compensate for the lack of motion at the metatarsophalangeal joint
Postural pains, including back pain
Foot pains such as plantar fasciitis

Common causes

Excessive flattening of the foot, also known as overpronation
Injury to the joint from sports such as football
Some types of rigid, higher arched feet
Elevated first metatarsal
Long or short metatarsals
Short shoes or high heels
Stubbing the toe or dropping heavy objects on it
Improper running technique
Repeated bouts of gout
Degenerative arthritis

What else can look similar

What you can try at home

How we can help

Manipulation of the joint to encourage greater movement
Acupuncture and steroid injections to reduce pain and inflammation
Footwear modification
Foot orthoses, either to encourage normal motion in the joint in cases of hallux limitus, or to splint the joint if movement causes discomfort
Surgery such as cheilectomy

Which appointment to book

If you have big toe joint pain or stiffness, you are recommended to book one of the following appointments:

A biomechanical assessment, for a full assessment of how your feet and legs move
A musculoskeletal (MSK) consultation

If you are not sure which appointment is right for you, call us on 02920 644900 or email info@feetinfocus.com and we will help.

Hallux limitus, functional hallux limitus and hallux rigidus

Hallux limitus is a condition involving a reduction in the normal motion of the big toe joint that is needed while walking and running
Functional hallux limitus is the loss of normal motion in the big toe joint, usually from jamming it during walking or running as a result of poor foot mechanics. This is often seen in a flatter foot type
Hallux rigidus is a condition where there is no movement in the big toe joint. The joint is stiff and does not bend at all, where 65 degrees is required for normal motion

Some doctors refer to hallux limitus and rigidus as a dorsal bunion, for its most characteristic sign of a lump of bone called an exostosis which forms on the top of the big toe joint.

Diagram of the big toe joint working normally, with the first metatarsal head dropping so the big toe can bend upwards — Normal function

Diagram of functional hallux limitus, with the big toe joint jamming as the foot pushes off — Functional hallux limitus

Diagram of hallux rigidus, with a stiff big toe joint that does not bend — Hallux rigidus

How can foot orthotics help?

Foot orthotics, also known as orthoses, allow the foot to function correctly and more efficiently. An orthotic designed to help someone with functional hallux limitus allows the metatarsal head to drop downwards towards the floor unrestricted, so the proximal phalanx is able to rotate around it and therefore not collide with the metatarsal bone.

Diagram of a foot orthotic allowing the first metatarsal head to drop so the big toe joint can bend normally — How a foot orthotic helps the big toe joint move correctly

When is surgery recommended?

Surgical intervention can be an effective solution, but a period of non surgical or conservative treatment is recommended first in most cases. Cases that do not respond to conservative treatment can be referred on for a surgical opinion. Our podiatrists have valuable connections with many well respected consultant orthopaedic surgeons and podiatric surgeons if a surgical referral is deemed necessary.