Hallux is the Latin term for the big toe, and limitus indicates reduced or limited movement. The joint between the 1st metatarsal and the 1st phalanx is very important for gait, specifically in the propulsion phase. It is also much in demand in many sports involving jumps, changes of direction and running. Limitation of movement indicates irritation in the joint, degenerative changes (arthrosis) and this can lead to ankylosis of the joint and, in the long term, almost complete loss of movement (Hallux rigidus). This is the joint most affected by osteoarthritis in the foot. Hallux limitus is often confused with Hallux Valgus, whereas the latter involves joint deviation linked to faulty biomechanics, a genetic component and aggravated by the wearing of tight shoes. Hallux Valgus can have osteoarthritis and limited movement, which means that hallux limitus can result from hallux valgus.
What causes Hallux limitus?
The cause may be related to :
- Bone structure (genetics)
- Biomechanics
- Traumatic
- Metabolic (gout attack, infection)
- Iatrogenic (secondary to surgery),
- Neuromuscular
- Neoplastic (tumor)
What are the typical clinical symptoms?
- Pain on passive movement of the joint
- Swelling and inflammation of the joint
- Pain on the dorsal portion of the toe or plantar region
- Pain when squatting
- Pain on prolonged walking and running
- Pain when walking barefoot or with softer shoes
How to diagnose and establish the cause?
Radiography is a very useful imaging tool for confirming clinical suspicions of hallux limitus, but above all for identifying the cause. Several radiological measurements and angles can be used to establish the biomechanical cause and whether the damage is minimal, moderate or severe. These results and radiographic analyses may influence treatment. (See Figures 1 and 2 for mild to moderate involvement. We can see what is known as exostosis (calcification deposits following irritation in the joint; this process occurs gradually if there has been no trauma to the joint). Ultrasound is an excellent tool for assessing inflammation in the joint and performing infiltration treatment under ultrasound to increase treatment precision. (See figure 3) A pressure point analysis is also performed to determine if there is any additional pressure below the 1st metatarsal (as seen in figure 4 on the right foot). The aim of treatment will be to distribute pressure to prevent joint degeneration and minimize long-term symptoms.
Figure 1 Figure 2
Figure 3
Figure 4 (Increased pressure under the right 1st metatarsal )
What treatments are available for hallux limitus?
Short-term :
- Stiffer soles and shoes to reduce stress on the big toe joint
- Activities that place less strain on the big toe, such as cycling and swimming
- Oral or topical anti-inflammatories, or infiltrations when pain and inflammation are more severe
Long-term:
- Joint mobilization and stretching exercises to prevent joint ankylosis
- Plantar orthoses to distribute pressure and increase the range of motion of the Hallux
- Surgical treatment is an option to correct the structural cause of painful, advanced hallux limitus and to clean up osteoarthritis in the joint.
Consult your podiatrist for diagnosis and the right treatment plan. We have X-rays and ultrasounds on site. You don’t need a doctor’s bill or referral to see a podiatrist, make an appointment now.
Article written by Dr Olivier Daigneault, podiatrist
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Références :
Hamid KS, Parrekh SG. Clinical Presentation and management of hallux rigidus. Foot Ankle Clin. Sept 2015; 20 (3) : 391-399
Welsh BJ, Redmond AC, Chockalingam N, Keenan AM. A case-series study to explore the efficacy of foot orthoses in treating first metatarsophalangeal joint pain. Journal of Foot and Ankle Research 2010, 3:17
Luis María Gordillo-Fernández, Mercedes Ortiz-romero, José Valero-Salas, José Luis Salcini-Macías, Salomon Benhamu-Benhamu, Raquel García-de-la-Peña and Jose Antonio Cervera-Marin. Effect by custom-made foot orthoses with added support under the first metatarso- phalangeal joint in hallux limitus patients: Improving on first metatarso-phalangeal joint extension. Prosthetics and Orthotics International 2016, Vol. 40(6) 668–674
Zammit GV, Menz HB, Munteanu SE. Structural Factors Associated With Hallux Limitus/Rigidus: A Systematic Review of Case Control Studies. journal of orthopaedic & sports physical therapy. volume 39, number 10, october 2009.
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Dr Olivier Daigneault
Podiatrist and owner
