Hallux Limitus  –  Big Toe Joint Arthritis


· The big toe bears a tremendous amount of stress—a force equal to about twice your body weight.

· Hallux Limitus (“Hallux” is the big toe & “Limitus” means limitation) is a condition where movement of the big toe is restricted to varying degrees. This can be disabling, since we use the all-important big toe whenever we walk, stoop down, climb up, or even stand. If you have pain and/or stiffness in your big toe, you may have this condition.

· It is actually a form of degenerative arthritis (a wearing out of the cartilage within the joint) that occurs in the foot.

· Sometimes called a “frozen joint” and only gets worse with time.

· It is called Hallux Rigidus (rigid) in severe forms where no joint cartilage remains and the toe does not bend at all.


What Causes Hallux Limitus? 



· Faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint.

· Those with fallen arches or excessive pronation (rolling in) of the foot are susceptible to developing hallux limitus.

· This condition runs in the family through inheriting a foot type

· It is associated with overuse—workers who often have to stoop or squat are prone.

· It can result from an injury—even from stubbing your toe.

· Your Doctor of Podiatric Medicine can determine the cause of your hallux limitus and recommend the best treatment.



Early signs and symptoms include:

· Pain and stiffness in the big toe  during use (walking, standing, bending, etc.)

· Pain and stiffness aggravated by cold, damp weather

· Difficulty with certain activities (running, squatting)

· Swelling and inflammation around the joint 

· Pain, even during rest

· Difficulty wearing shoes because bone spurs (overgrowths) develop. Wearing high-heeled shoes can be particularly difficult.

· Dull pain in the hip, knee, or lower back due to changes in the way you walk

· Limping, in severe cases


Diagnosis of Hallux Limitus


· The sooner this condition is  diagnosed, the easier it is to treat.

· You should see a foot specialist the first time you notice that your big toe feels stiff or hurts when you walk, stand, bend over, or squat. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.

· Your Foot Specialist will examine your feet and manipulate the toe to determine its range of motion.   X-rays are often required to determine how much arthritis and boney spurring is present.





Non-Surgical Approaches

· Early treatment may prevent or postpone the need for surgery in the future.

Treatment for mild or moderate cases:

· Orthopedic Footwear. A large toe box put less pressure on your toe. Wear stiff or rocker-bottom soles & stop wearing high heels.

· Custom Orthotics improve the function of your foot and can slow the progression of arthritis.

· Shockwave therapy is now available at our office. High intensity sound waves target the big toe joint and accelerate healing.  This treatment does not involve any incisions and has been shown to be effective in pain reduction and increased joint mobility. There is no down time after treatment.  


Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) and supplements such as glucosamine-chondroitin sulfate may help.

· Injection therapy. Injections of corticosteroids help reduce the inflammation and pain. A newer injectable treatment called Suplasyn may help reduce pain by supplementing the joint fluid.

· Physical therapy. Ultrasound and phonophoresis may help decrease inflammation & pain



When Is Surgery Needed?

In some cases, surgery is the only way to eliminate or reduce pain.

· The goal of surgery is to eliminate painful motion in the joint and provide a stable foot.

· Some procedures reconstruct and “clean up” the joint. The surgeon removes the arthritic damage accompanying bone spurs, designed to preserve and restore normal alignment and function and reduce or eliminate pain.

· More aggressive procedures are used when the joint cannot be preserved.   These may involve fusing the joint or replacing it with an implant, such as is done for the hip or knee

· Many factors, including the cause of the condition and the severity, as well as the patient’s age, occupation and activity level are taken into consideration.