Hallux is the clinical name for the 1st or big toe. Hallux limitus is diminished motion in the first metatarsophalangeal or big toe joint, while Hallux rigidus is a fixed big toe joint. During propulsion, the Hallux must dorsiflex or bend upwards 60 to 90 degrees for stability and normal function. In determining the proper course of treatment one must determine if the joint is deteriorated to a point of bone on bone or if it is a functional restriction due to soft tissue.
Symptom of Hallux Rigidus or Limitus
The intensity of the pain in the big toe joint will vary depending on whether the joint has limited range of motion or whether it is fixed and rigid. When wearing flat shoes the pain will occur when walking and the foot is at push off. As the toe is asked to bend upwards it will reach a point that the toe will not bend any further and pain will begin. For women wearing heel shoes the pain will occur once the heel height reaches the point that the toe can’t bend any further and a space between the bottom of the big toe joint and the shoe occurs. In the event of over pronation and the arch collapses, the pressure on the big toe at push off will be on the side of the big toe joint and pain will occur. Should you have tight calves, and while in motion, the foot will be propelled up to the toes to soon in the foot gait placing stress on the joint and pain will occur.
Cause of Hallux Rigidus or Limitus
The deterioration of the big toe joint can occur either by systemic reasons, abnormal biomechanics, or trauma. Systemically we have Arthritis and Gout, both of which will eat away at the joint creating bone on bone that will eventually self-fuse. Trauma can occur by constant jamming of the big toe joint compressing the cartilage and ligaments in the joint. Example of this would be to short of shoes or too wide of shoes causing your foot to slide forwards to the end of the shoe. Another example of this would be Turf Toe, which is commonly seen in football players. Abnormal biomechanics such as over pronation or tightness in the calf muscles can cause abnormal stress on the joint creating deterioration of the joint. Other stress related issues on the joint would be leg length difference, knee and hip deformities, weakness in the IT band or the glutius medius. All of these create an imbalance on the skeletal structure placing stress usually on one foot instead of both. should the stiffness be due to soft tissue preventing the joint from functioning normally the normal cause is the tighting of the Flexor Hallux Longus.
Treatment of Hallux Rigidus or Limitus
The systemic causes need to be treated by your medical doctor. However, the nonsurgical approach to stabilizing and correcting the other causes will also apply to the systemic problems in relieving you of the pain. For hallux Limitus the basic tools to relieving the pain is to be put on a stretching exercise program, get fitted for an over-the-counter arch support or custom foot orthosis by a Pedorthist and be fitted with a shoe with a high toe spring or add a rocker bottom to a properly fitted shoe. For Hallux Rigidus the management of this non-correcting problem is to be put on a stretching exercise program, molded for custom made foot orthosis by a Pedorthist and add a rocker bottom to a properly fitted shoe. As other causes such as Leg Length Differences are determined, other modalities may have to be added to the basic work as discussed above. Keep in mind that when the joint no longer can function we must create an environment that makes the foot think that it is functioning normally. If not, other parts of the body will compensate and different problems throughout the body may develop.