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Stiffness and pain of the big toe joint is termed Hallux Rigidus or Hallux Limitus. Hallux is the medical term for the big toe and the terms rigidus and limitus describe the extent to which the toe can move.

One month post op following chielectomy for hallux rigidus/limitus

Typical appearance of forefoot 1 month following podiatric surgery for Hallux Limitus

Many studies have been conducted trying to determine the exact cause of hallux limitus. Theories include, trauma, genetics, poor shoes, elongated metatarsal and biomechanical abnormalities.

Abnormal alignment of the metatarsal bone relative to the proximal phalanx (big toe bone) is the most common biomechanical factor in developing Hallux Limitus/Rigidus. During a normal stride, whether walking or running, the proximal phalanx must most up and over the metatarsal. In order to do this, the metatarsal bone must be slightly lower then the proximal phalanx. If the metatarsal bone is slightly elevated (or higher) then the proximal phalanx, the big toe cannot move up and over the metatarsal. Instead, a jamming of the joint occurs. Repeated jamming over a period of years leads to degeneration of the joint. Cartilage is worn away and large bone spurs form on the top of the joint. The combination of cartilage loss and bone spurring causes loss of motion of the joint.

flow chart progression of hallux limitus with associated stages

Diagnosis by a podiatrist is usually made via clinical exam and x-rays. Sign and symptoms include:

Hallux Limitus/Rigidus in a progressive problem, meaning as time goes on it tends to get worse. There are a defined set of stages to this condition. Each stage generally progress to the next as a function of time. We use the staging system to help determine the best course of treatment.

Stage One Hallux Limitus Arrows indicate joing collapse

Symptoms can vary from patient to patient. Most people describe a burning and throbbing pain in their forefoot which may radiate up into the arch. For women, wearing high heel shoes generally aggravates the problem. Additionally, walking and running tend to cause pain. There maybe a noticeable bump on the top of the great to joint with some overlying redness. Usually, there is little swelling. Moving the big to joint up usually causes pain.

Podiatric patients may experience periods of relatively few symptoms which may last for months at a time, only to be followed by extreme flair ups of pain. The big toe is usually always stiff, even when there are no symptoms.

An easy test patients can perform on their own is to compare the ability of the big toe joint to move upwards. If one side is significantly stiffer then other toe and there is occasional to frequent pain, this is a good sign of Hallux Limitus or Rigidus.

In the early stages on Hallux Limitus/Rigidus, non-surgical care maybe of benefit. This includes custom, podiatrist prescribed, arch supports to better align the first metatarsal relative to the proximal phalanx. Podiatric rockerbottom shoes for non-surgical candidates can also be of use. Cortisone injections into the joint can also temporarily alleviate the symptoms. Generally, however, this condition requires surgery. Surgical management falls into two broad categories, preserving the joint or fusing the joint. The surgery is chosen based on the above mentioned staging system.

Joint preserving:

Bone spur formation in hallux limitus/rigidusArrow indicates large bone spur Appearance following Chielectomy Arrow indicates area of spur removal

Joint Destructive:

Example of fusion of the great toe joint (first metatarsal phalangeal joint)

Fusion of MP joint

crossing screws first mp joint fusion

Fusion of MP joint

Clinical appearance following fusion of great toe joint

Fusion of MP joint

Dr. Richard Perez, DPM - San Antonio Podiatrist Foot Doctor
This content was authored by: Dr. Richard Perez

Dr. Perez is board certified by the American Board of Foot & Ankle Surgery and a Fellow of the American College of Foot and Ankle Surgeons. His clinical interest include sports injuries, aesthetic bunion surgery, heel pain and resident education.