Hallux Limitus

What is Hallux Limitus?

Hallux Limitus is simply limited motion of the big toe joint. The big toe joint typically will go through a 55-65 degree range of motion. With Hallux Limitus this motion may be reduced to 25 or 30 degrees. Hallux Rigidus is a rigid motion or complete absence of any motion of this joint. As like a buniondeformity this is a bone structural deformity.


What are the symptoms of Hallux Limitus?

Symptoms of Hallux Limitus or Rigidus besides limited motion may be pain with all motion or at the end range of motion. Pain may occur only with heavy activity, or even at rest. You may see an enlarged big toe joint, more on the top of the foot rather than the side as seen with bunions. There may also be a noted redness or swelling associated with this bump. Some of the symptoms seen with Hallux Limitus or Rigidus may be seen in other medical conditions like gout, or other arthritis entities. There may be a callousunderneath the second metatarsalphalangeal joint or on the big toe itself from friction and extra pressure caused by the toe deformity.


What are the causes of Hallux Limitus?

Causes of Hallux Limitus or Rigidus is most likely due to the foot structure you were born with. If your foot type excessively pronates then this condition is more likely to develop. The first metatarsal may be longer in relation to other metatarsals or may be elevated causing a jamming of the big toe joint. Trauma or other surgery of your foot may predispose you to having the condition if your foot structure is altered.


How do I prevent Hallux Limitus?

Prevention of Hallux Limitus or Hallux Rigidus is difficult since it is due to the structure of the foot you were born with. Many times surgery is recommended for the condition. Proper shoe wear and controlling the structure of your foot at all times may be the easiest treatment. A shoe with a wider toe box to accommodate the foot structure as well as avoiding high heeled shoes is necessary. If the area is irritated with redness, swelling, and pain some ice and anti-inflammatory medications may be helpful. The best prevention may be to get advice from your podiatrist.


How to treat Hallux Limitus?

Podiatric Care may include using other anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce this swelling or if a bursitis is present. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and determine how much damage has been done to the bone. The podiatrist may see you to take care of any cornsor callouses that develop due to the bone deformities. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure especially if you have excessive pronation. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.

Surgery to correct Hallux Limitus and Hallux Rigidus is very common and may be the best prevention. Your surgeon may even use the term bunionectomy for this correction as similar procedures may be used for both conditions. As your big toe joint worsens over time, there is increased damage being done to joints of the foot. With a longstanding deformity of the joint surface the cartilage may be worn down producing degenerative arthritisthat is not reversible. As jamming of this joint progresses, there maybe extra build up of bone on the top and sides of this joint. There are many ways to correct the deformity of this joint depending on the stage of deformity and the foot structure. This can range from simply removing the excessive bone around the joint known as a Cheilectomy. There may be bone cuts made to decompress the joint to stop the jamming similar to what is done with bunioncorrections. The surgeon may place fixation in your foot as it heals which may include a screw, pin, or wires. The joint may need complete removal if it is destroyed. Sometimes the bones are actually fused together to become one bone to relieve the pain and misalignment. Other times a first metatarsal joint implant is placed in the joint to simulate the joint and allow for some flexibility. Typically only one foot is done at a time so that you have one good foot while the foot having surgery can recover.

Post-operative Care and Risks of a surgical correction of Hallux Limitus/Rigidus depends on the exact surgery performed. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and occasional ice placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. For many procedures you will be required to keep all weight off of your foot for several weeks, typically 5-8 weeks depending on procedure. Your surgeon may allow you to place some weight on the heel. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing time is typically 6-8 weeks for all bone cuts. This is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If your bone heals real slow it may be a delayed union, or if not at all a non-union. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know.