Big Toe Joint Pain and Stiffness (Hallux Limitus/ Hallux Rigidus)
The Hallux is the medical term for the big toe; the joint at the base of the big toe joint is known as the metatarsophalangeal joint. This is the most common site for arthritis in the foot and for this reason it is a very common source of foot pain.
The big toe joint is of paramount importance during walking and running, in the picture above you can see the left big toe joint bending normally. Restriction of this normal upwards joint motion (known as dorsiflexion) can cause many problems.
Symptoms
- Pain and swelling of the joints of the big toe
- Stiffness and/ or tightness around the big toe joint
- Calluses or areas of hard skin or corns on the inside of the big toe and under the 2nd toe
- Toenail problems can occur as a result of the joint between the metatarsal and phalanx (see pictures) bending upwards to compensate for the lack of motion at the metatarsophalangeal joint
- Postural pains including back pain
- Foot pains such as plantar fasciitis
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 which is needed while walking and running.
- Functional hallux limitus is the loss of the normal motion to the big toe joint, usually from jamming it during the course of 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. Essentially the joint is stiff and does not bend at all (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.
Possible 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 1st metatarsal
- Long or short metatarsals
- Short shoes or high heels
- Stubbing the toe, football, dropping heavy objects on toe
- Improper running technique
- Repeated bouts of gout
- Degenerative arthritis
What treatments are available?
- Manipulation of the joint to encourage greater movement in the joint
- Acupuncture and steroid injections to reduce pain and inflammation
- Footwear modification
- Foot orthoses to either encourage normal motion in the joint if suffering from hallux limutus or to splint the joint if movement causes discomfort
- Surgery such as cheilectomy
How can foot orthotics help?
Foot orthotics also known as orthoses allow the foot to function correctly and more efficiently. A foot orthotic designed to help an individual with functional hallux limitus would allow the metatarsal head to drop downwards towards the floor unrestricted so the proximal phalanx bone (labelled as phal in the diagrams) is able to rotate around it and therefore not collide with the metatarsal bone as is seen in the functional hallux limitus picture.
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.
