What is hallux limitus/hallux rigidus?
Stiffness of the big toe joint is termed Hallux Limitus. Hallux is the medical term for the big toe. If left untreated, hallux limitus often progresses and can result in the big toe joint ‘freezing’ and have no motion at all, this is termed Hallux Rigidus.
The base of the big toe, home to a large joint, is the most common site of arthritis in the foot. It is the joint that is actively bending when you walk. When you start to develop stiffening from arthritis in the joint, it becomes painful and difficult to walk. People aged between 30 and 60 years most commonly develop the condition.
Signs and Symptoms
Initially, you will experience a deep ache at the base of the big toe when trying to flex it upward, especially when you push off while walking. Usually, this pain relieves when the joint is at rest.
There may also be swelling, inflammation and redness at the base of the big toe, especially on top of the joint. Eventually, damage to the cartilage in the joint will cause an overgrowth of bone, resulting in a bump at the top of the big toe joint. This is a bone spur and might not be painful, but it can lead to calluses caused by friction between the skin and shoes.
Callus may also develop under or on the side of the big toe or on the ball of your foot. This is due to the change in normal pressure distribution across the foot, as the restriction to the big toe hinders its ability to take the pressure.
Causes of Hallux Limitus/Hallux Rigidus
Some people are genetically predisposed to develop hallux limitus due to their foot type; others develop the condition due to trauma or overuse.
Some causative factors of hallux limitus include:
- Foot type: excessively flat feet (pronated) or high arch (supinated) feet
- Osteoarthritis (degenerative joint disease)
- Rheumatoid arthritis
- Excessively long first metatarsal bone
- Excessively short first metatarsal bone
- Elevated first metatarsal bone
- Repetitive injuries (particularly jamming of the toe)
These factors contribute to excessive wear of the toe joint cartilage, causing limited mobility and deterioration of the joint.
If pain and stiffness in the big toe joint are treated early, often the progression of the condition can be slowed and even halted. Left untreated, hallux limitus can occur and progression of this can eventually lead to hallux rigidus. At this point, conservative treatment options are limited and often less effective. It is important that if you experience pain and stiffness in your big toe joint, you should seek podiatry treatment. Early treatment can prevent, slow or even stop the progression of the condition.
Some conservative treatment options include:
- Wearing adequate footwear: In this condition, the big toe joint is often most painful when bent upward during walking. Footwear with a stiff sole can help reduce the bending of the big toe. Additionally, a rocker bottom shoe can also assist in reducing pressure put on the big toe joint. High heels should be avoided.
- Orthotic therapy: a custom orthotic device placed in your shoe can help address possible causative factors such as flat feet or high arch feet. If hallux rigidus is present, orthotics can also be custom made to splint the big toe joint.
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, can be prescribed to reduce pain and inflammation via your GP
Surgery for Hallux rigidus
If your big toe pain and stiffness is treated early, you can often avoid the need for surgical correction. Once the big toe joint becomes rigid (hallux rigidus) or if you develop severe pain that is non-responsive to conservative treatment, surgery may be needed.