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A big toe that keeps getting progressively stiffer may not seem like much of a big at first, but living with one provides a much deeper understanding of frustration and pain. Maybe that’s why we refer to it with a much more serious-sounding name: Hallux Limitus.
The joint pain and loss of flexibility typical to Hallux Limitus can be a killer to most any activity that requires flexing or putting pressure on the front of the foot. Trying to fit into a ski boot, perform certain yoga poses, dance, stoop in the garden—there are so many miserable ways this condition can interfere with your life.
The goal of Hallux Limitus treatment is to limit and reduce this interference as much as possible, and we have helped many patients do just that at our Indianapolis office.
What is Hallux Limitus?
Let’s start with a quick look at relevant foot anatomy—especially your toes.
A toe bone can be known as a phalanx, but the big one is specifically known as the hallux. The joint where the hallux (or any phalanx) meets the foot is known as the metatarsophalangeal (MTP) joint.
In a normal, healthy case, this joint has a range of about 80-90 degrees of motion, with normal walking requiring at least thirty degrees.
The MTP joint is where Hallux Limitus develops. If you are familiar with bunions, you will realize they form at this location as well. What is the difference?
Typically, a bunion will drive the MTP joint out of alignment so the hallux tilts toward the second toe, with the bump more on the side of the joint. Hallux Limitus leads to a loss of motion in the big toe, with the bump more on top of the joint.
Range of motion loss due to Hallux Limitus can happen at a rate of up to five degrees per year. In early stages, this loss of motion does not tend to cause many problems—especially in the normal, day-to-day swing of things. Once range of motion drops to around 60 degrees, however, you may start to feel some problems. And when it gets to 30 degrees and less, the symptoms really begin to “shout” at you.
As such, it’s important to recognize the symptoms of Hallux Limitus so it can be treated as early as possible. These include:
- A bump on the top of your big toe’s MTP joint that increases in size
- Stiffness and pain at the base of your big toe, especially while squatting, running, or walking.
- Pain in the bottom of the great toe joint.
- Stiffness and pain brought on by damp, cold weather.
- Swelling and inflammation around this joint.
What Causes Hallux Limitus?
So how does Hallux Limitus occur? There can be several factors that influence its development.
Consider once again our hypothetical gardeners, downhill skiers, and ballroom dancers. Activities that force the big toe joint to bend at its maximum range of motion lead to excessive pressure and force loads on the front of the foot and the first MTP joint. As the foot endures these forces, the body will try to protect itself by building up bone around the joint, leading to restricted motion. The more this pressure is repeatedly endured over time, the more likely it will lead to problems.
Direct injuries, such as a broken toe, a bad sprain, or a really bad stubbing can also create a situation in which Hallux Limitus is more likely to occur. Joint damage from arthritis can play a similar role.
In the sports medicine field, a Hallux Limitus deformity can also called a turf toe. If you haven’t had a toe injury, it might not sound like a big deal, but consider the case of legendary Pittsburgh Steeler linebacker Jack Lambert.
Lambert has a reputation as being one of the toughest football players of all time. This Hall-of-Fame linebacker was instrumental in the success of the Pittsburgh Steelers during the 1970s. (For the Millennials: the NFL announcer, Terry Bradshaw, played for the Steelers during in this ancient time.) On many occasions, he played through some significant injuries. The one that ended his football career, though, was hallux limitus – a toe injury.
Other causes you can’t help include being born with an abnormal foot structure, such as a first metatarsal bone that is too long and impairs flexibility. If you have a family history of Hallux Limitus, such a genetic disposition may be part of your situation.
Treatments for Hallux Limitus
The bone and arthritic changes form this deformity will dramatically shorten this life of the joint. Early treatment for Hallux Limitus is ideal, since it frequently leads to much easier and faster results.
Generally speaking, we can address Hallux Limitus by either protection (changing the environment) or correction (changing the foot).
“Changing the environment” is a matter of using conservative treatment methods to relieve symptoms and prevent the condition from progressing. In this case, options we may consider include (but are not limited to) carbon-fiber plates or certain stiff-soled rocker bottom shoes which can keep excessive pressure off the front of your foot.
The more a case of Hallux Limitus has progressed, the more challenging it will be for “changing the environment” to have significant results. If the limits to motion are too severe, we may consider the second option.
When it comes to “changing the foot,” we are looking at surgical procedures. If range of motion is largely degraded, fusion of the joint may be the best option to provide lasting reduction or relief of pain.
Artificial joints are considered in some circles, but it is difficult to recommend for Hallux Limitus. This is the most abused joint in the body, and a synthetic replacement is not going to work as well as years of evolution.