Services & Treatments
Do you suffer from limited joint movement, pain and immobility?
Hallux limitus is a mechanical condition characterized by limited extension of the big toe. There are a number of classifications of Hallux Limitus which describe the (impaired) ability of the big toe to flex; Functional Hallux Limitus, Hallux Limitus, and Hallux Rigidus.
Hallux is the medical term for the big toe. The joint that allows movement of the big toe is the first metatarsophalangeal joint.
Functional Hallux Limitus is impaired functional movement of the first metatarsophalangeal joint. This means that big toe extension is reduced or limited in weight bearing or simulated weight bearing conditions. Without resistance (non-weight bearing) the joint is able to move normally through the full range of motion.
Hallux Limitus means that the first metatarsophalangeal joint is permanently unable to move through the normal, full range of motion. Hallux Limitus may often be found in conjunction with a bunion, otherwise known as Hallux Abducto Valgus.
Hallux rigidus is the ‘end-stage’ of the condition whereby any noted range of motion is negligible. The first metatarsophalangeal joint has degenerated to a point whereby it has fused, or mostly fused. In other words, the first metatarsal and the proximal phalanx of the toe have joined together and a joint is no longer present.
The limited joint motion of the hallux can be attributed to degenerative changes within the first metatarsophalangeal joint (arthritis), or the formation of extra bone on the upper joint margin (exostosis) which form a physical block to joint motion. It is important to distinguish this joint condition from other common conditions of the first metatarsophalangeal joint, such as gout and rheumatoid arthritis, which may underlie the presence of Hallux Limitus.
Functional Hallux Limitus may be found in people of any age and is often related to the shape and positioning of the first metatarsophalangeal joint.
Hallux Limitus results due to wear and tear of the joint and is therefore usually seen amongst the adult population. As Hallux Rigidus is the end-stage of joint disease it is typically seen in the older population. In unusual cases it may be seen in young adults and rarely in children if the joint has been traumatically injured or fixed surgically.
Causes and Contributing Factors
The first metatarsophalangeal joint is responsible for bearing most of the weight during the toe-off phase in running and walking activities. Movement of this joint helps to propel us forward. Poor alignment and excessive loading of the joint can lead to early wear and tear, particularly in the presence of Functional Hallux Limitus. This wear and tear then leads to Hallux Limitus, and later on to Hallux Rigidus. The rate of deterioration however can be influenced by several factors:
- Structural anatomy of the foot; particularly the alignment of the first metatarsal and the joint articulation with the big toe bone, or proximal phalanx of the hallux
- Shoes that are fitted inappropriately or that change the function of the joint when worn (such as high heels or flats with pointed toes)
- Poor foot and/or lower limb biomechanics
- Structural anomalies in the foot or lower limb
- Direct trauma to the first metatarsophalangeal joint or hallux
- Frequency and intensity of weight-bearing activities
- General health and well-being
- Auto-immune conditions such as Rheumatoid Arthritis
- Family history
Symptoms of Hallux Limitus
Hallux Limitus is typically the only classification of this condition which is likely to cause any noticeable symptoms among individuals. The extent of joint destruction may influence any pain or discomfort involved. There are always exceptions, but in most instances, the pain experienced will often diminish as the joint progressively fuses. Some people experience:
- Joint pain during or after physical activity
- Stiffness in the joint, or an inability to flex the toes without discomfort
- Feeling of being unable to propel properly when walking
- A hard, sometimes painful lump overlying or around the first metatarsophalangeal joint
At Central City Podiatry, treatment is aimed at managing and preventing pain, and preserving the joint to prevent disease and deformity. Your Podiatrist may recommend the following:
- Rest and ice
- Anti-inflammatory medications
- Functional foot orthotics to improve the function of the first metatarsophalangeal joint and address any other biomechanical problems
- Footwear advice
- Gentle mobilization (under specific circumstances)
- X-ray referral to assess joint damage and structural problems
- Referral to a podiatric surgeon for surgical assessment and advice
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