Suffering from Stiff big toes? You may have Hallux Limitus / Rigidus

The big toe joint is an extremely important joint within the human body. While relatively small compared to our hip, knee and ankle joints it is arguably the most important for gait. Without sufficient movement at the joint, the foot can become unstable and compensatory gait pattern may form resulting in more proximal issues.

Hallux Limitus or Rigidus is a restriction in the big toes ability to bend towards the sky.

Limitations in the big toe joint may be due to trauma, gender, family history, joint shape (flat metatarsal head) and foot function.

This restriction can be broken down in three sub categories.

  • Functional Limitus- where full movement >65 degrees of movement at the joint is available when non-weight bearing, when weight bearing there is an insufficient amount of movement. Often at this stage there may be no pain experienced at the big toe joint itself.
  • Structural Limitus- where there is a restricted or insufficient mobility available in non-weight bearing. This is often bone or joint related.
  • Hallux Rigidus- where there is no movement in the big toe joint at all. Related to a loss of joint space.

An important fact to note is that limitus often precedes a rigidus change over a long period time.

Symptoms of hallux limitus / rigidus

In the early phases of a structural limitus the joint itself may be stiff, grinding or crunching and sore with activities that bend the toes backwards.

Long term as the joint changes, bony lumps may form on the top of the joint. These hard bony lumps are called exostosis and are often confused with a HAV. With exostosis the joint may begin to become more rigid in its movement.

Often Podiatrists see people who have a non painful hallux limitus or rigidus but present with painful areas which have formed due to the resultant compensation. Some common problems may include:

  • Callous’ around the 1st toe or outside of the foot may develop.
  • Pain in the ball of the foot under the lesser toes due to excessive lateral weight bearing
  • neuroma or neuroma like symptoms may develope
  • Excessive wear on the bottom surface of a shoe
  • Plantar arch or heel pain
  • Due to limited movement of the big toe the foot may be picked up off the ground earlier in gait. Due to excessive use of the muscles lifting the foot pain may arise in the front of the legs.

Treatment

Should the joint structure allow, treatment is aimed at restoring a full range of motion within the 1st toe joint. Initially education and activity modification is important. Pressure reduction via strapping and padding, physical therapies such as strengthening, massage, mobilisation and manipulation are all effective. Long term shoe modifications and an orthotic if the structures and function of the foot are an issue may also be required.

If the joint does not allow any movement at all, protecting the surrounding structures is required in order to prevent deterioration in them also. Rigid orthotics and rocker soles shoes may be required. If this is not suitable, surgical intervention may then be considered.

Authored by Backfocus Podiatrist Andrew Apolloni (Podiatry-La Trobe University). Andrew offers Podiatry services at 2 Bacfocus clinics, located in the CBD and Epping districts.

References:

  • HJ Dananberg (1993) Gait style as an etiology to chronic postural pain. Part I. Functional hallux limitus. Journal of the American Podiatric Medical Association: August 1993, Vol. 83, No. 8, pp. 433-441.
  • Craig Payne, Vivienne Chuter, and Kathryn Miller (2002) Sensitivity and Specificity of the Functional Hallux Limitus Test to Predict Foot Function. Journal of the American Podiatric Medical Association: May 2002, Vol. 92, No. 5, pp. 269-271.
  • Joseph A Shrader, Karen Lohmann Siegel, Nonoperative Management of Functional Hallux Limitus in a Patient With Rheumatoid Arthritis, Physical Therapy, Volume 83, Issue 9, 1 September 2003, Pages 831–843
  • Dananberg HJ: Method for treating Hallux Limitus. United States Patent, Patent number 4,608,988. Sep. 2, 1986
  • Bart Van Gheluwe, Howard J. Dananberg, Friso Hagman, and Kerstin Vanstaen (2006) Effects of Hallux Limitus on Plantar Foot Pressure and Foot Kinematics During Walking. Journal of the American Podiatric Medical Association: September 2006, Vol. 96, No. 5, pp. 428-436.
  • HJ Dananberg (1993) Gait style as an etiology to chronic postural pain. Part II. Postural compensatory process. Journal of the American Podiatric Medical Association: November 1993, Vol. 83, No. 11, pp. 615-624.
  • Michael J. CoughlinD., Paul S. Shurnas, M.D.: Hallux Rigidus: Demographics, Etiology, and Radiographic Assessment. Foot & Ankle International  Vol 24, Issue 10, 2003