Hallux Limitus & Rigidus

Definition

Hallux Limitus: Loss of motion in the big toe (first metatarsophalangeal, or MTP) joint.
Hallux Rigidus: Decreased big toe mobility due to MTP joint stiffness and arthritic joint changes.

General Info

Hallux is the medical term for the big toe. The big toe is one of the most important parts of the body, as it provides propulsive force during gait and helps stabilize the entire foot and body. The big toe should possess between 50 and 90 degrees of extension—also known as dorsiflexion—if it is healthy and injury free, and a person should be able to move his or her big toe through a full and pain-free range of motion (including both extension and flexion). A dysfunctional big toe will cause other parts of the body, especially the joints and tissues of the lower extremity, to compensate when walking or running, which places increased strain on these structures and may, over time, cause pain and fatigue.

Hallux limitus is the term foot health experts use to describe loss of motion in the big toe joint. The MTP joint of the big toe is the structure affected by this health problem. The first MTP joint is the location where the big toe forms a joint with the first metatarsal bone—a long, thin bone that spans the forefoot and midfoot.

Hallux rigidus is considered by many physicians to be the end stage of hallux limitus, or a state in which the ability to create motion in the big toe is lost or severely restricted. Hallux rigidus may lead to long-term damage of the first MTP joint, and it usually involves erosion of the joint cartilage and the development of osteoarthritis, or degenerative joint disease. Hallux rigidus is a condition characterized by near-ankylosis, or a state in which the big toe becomes stiff and immobile due to the partial fusion of the involved bones.

Signs & Symptoms

Some of the most common signs and symptoms associated with hallux limitus or rigidus include:

• Limping
• Pain and stiffness when moving the big toe
• Pain and stiffness brought on by cold, damp weather
• Swelling and inflammation in or near the first MTP joint
• Pain in other lower extremity joints as well as the low back
• Pain in the affected area when walking, running, or squatting

Possible Causes

Hallux limitus and rigidus are often considered idiopathic, or caused by unknown factors, but certain known factors may contribute to this health problem too. Possible causes of hallux limitus and rigidus include:

• Trauma
• Overuse
• Genetics
• Faulty foot biomechanics
• Rheumatoid arthritis, gout, or other inflammatory diseases

One of the most significant factors contributing to this health problem, however, may be the prolonged use of inappropriate footwear, especially footwear that constricts the toes.

Helpful Strategies

Non-surgical treatment options exist for this health problem and may help reduce symptoms. Possible conservative care treatment options for hallux limitus and rigidus include:

• Shoe Therapy: Minimalist shoes with wide a toe box enable the toes to splay properly.
• Physical Therapy (PT): Ultrasound or other PT modalities may help relieve any symptoms.
• Correct Toes: A toe spacing appliance that helps realign the big toe with the first metatarsal.
• Topical Pain Relievers: Natural pain relievers may help reduce swelling, pain, and inflammation.
• Stretches: Daily stretches, such as the Toe Extensor Stretch and the Big Toe Stretch, are often helpful.

The extent to which non-surgical treatment (e.g., using Correct Toes, wearing wide toe box shoes, applying natural pain creams, etc.) can alleviate hallux limitus and hallux rigidus depends on a person’s ability to manually move his or her big toe in two directions: 1) Away from the second toe (abduction) and 2) upward (dorsiflexion). If these movements are significantly restricted, conservative approaches may not help with these conditions. However, if some movement remains, the above-mentioned strategies can be useful.