Big Toe Joint Pain – Limited motion

What is Hallux limitus and rigidus?

Normal Motion

Normal Motion

Hallux limitus and rigidus are other names for osteoarthritis or “wear-and-tear” arthritis of the big toe joint. Normally, the range of motion at the big toe joint is greater than 65 degrees. When this is decreased, it is called hallux limitus, meaning that the big toe, or hallux, has limited motion. The body then attempts to compensate for the missing range of motion and the axis of the joint shifts and compensation occurs at the joint. This may progress to the point where the joint has less than 15 degrees or is completely rigid, hence the name hallux rigidus.

How does this develop?

There are many underlying biomechanical and medical reasons why the range of motion at the big toe joint changes. Common reasons include previous trauma to the joint, other arthritic conditions (both rheumatoid and psoriatic), overpronated/flat feet and other alignment issues. The length of the metatarsal, whether long or short, can lead to the development of this condition as well. When the metatarsal is long it causes jamming at the joint and osteophytes or bone spurs to grow at the joint which decreases the range of motion further. Other reasons include weak muscles and hammering of the first toe.

Limited Motion

Limited Motion

Associated Symptoms

• Calluses
• Joint pain
• Bump pain
• Metatarsal bones
• Stress fractures
• Increased bone formation or spurring at thejoint called osteophytes. (see the image above to the right and the x-ray below)

Conservative Treatment
Treatments for hallux limitus should always include a first line attempt to treat conservatively. Injections of anti-inflammatory or steroid agents can relieve the pain and decrease the inflammation at the joint level. Orthotic therapy may realign the foot, adjust or accommodate the mechanics at play. Physical therapy may help increase the range of motion at the joint or decrease pain levels.

Surgical Treatment
Surgical treatment should not be considered unless the above mentioned conservative approaches fail. There are a wide variety of options to address the joint level problems. They range from what are called “joint sparing” and “joint destructive” options. Each treatment depends on the patient and what pathology is present. Among the options to removing the cause of pain are the following: simply shaving of the bump on the top of the bone, inserting a joint implant, or fusing the joint completely. The toughest choice for the patient in my experience is making the decision to fuse or not to fuse the joint. Many fear that the fusion is not ideal. Yet, research has shown that there is less pain and the outcome is more reliable with fusion. (1)(2)

References:
1. Gibson JN, et al. Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial.. Foot Ankle Int. 26(9):680-90. 2005.

2. Erdil M, et al. Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus. J Foot Ankle Surg. Foot Ankle Int. 52(5):588-93. 2013.

Images
www.footankleknee.co.uk – Hallux limitus x-ray
arlette1.blogspot.com – A princess Looks at 40

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