Hallux Limitus/Rigidus

Definition

Hallux Limitus is a painful loss of motion at the first metatarsophalangeal (MTP) joint of the great toe.  It is an arthritic condition of the MTP joint, resulting in bony osteophytes (spurs), loss of joint space, and erosion of the cartilage.  Advanced cases of Hallux Limitus result in flattening of the metatarsal head and loose bodies within the joint, and is referred to as Hallux Rigidus.

Symptoms

Hallux Limitus/Rigidus is a painful condition of the first MTP joint, particularly with extension (dorsiflexion) of the joint.  Dorsiflexion will be reduced, and may feel like a bony block.  The joint itself may be enlarged, which can be palpable through the skin.  Walking in a shoe with an elevated heel or a very flexible sole may make the pain worse.  

Causes

Many cases of Hallux Limitus/Rigidus are the result of a person’s bone structure and foot shape.  It can also be the result of trauma, such as fractures are the joint or sprains, such as turf toe.  Other conditions that may lead to Hallux Limitus/Rigidus include osteoarthritis, rheumatoid arthritis, and gout.  

Treatment

Early cases of Hallux Limitus, particularly when it is identified early, focus on techniques to increase the range of motion of the joint.  This may include non-operative therapies such as functional orthotics with certain modifications, certain exercises to increase range of motion, and physical therapy. Surgical treatment in early cases will also focus on increasing range of motion.  This may include a procedure called a cheilectomy, which is the removal of bone spurs and some of the cartilage on the joint, in an effort to remove the bony block.  An osteotomy (bone cut) can sometimes be performed to alter the mechanics of the joint to allow for more motion.  Early range of motion exercises are important after these types of procedures to help maintain the motion achieved during the surgery.  In some patients, an arthroplasty or partial joint replacement may be beneficial.  In more advanced cases of Hallux Limitus/Rigidus, a joint fusion (arthrodesis) may be necessary to relieve pain.