Foot aches and pains happen to almost everyone at some point. Exercise and active jobs can have us on our feet for long periods and that can cause some soreness at the end of the day. But what happens when that pain is concentrated in one or both big toes? And what if it keeps coming back, no matter how much you rest or stretch?
It could be hallux limitus or hallux rigidus, which are two conditions that cause pain in the big toe. “Hallux” is the Latin word for big toe, “limitus” translates to limitation, and “rigidus” means rigid or rigid. These affect the joint that connects the big toe to the foot, also known as the metatarsophalangeal (MTP) joint, causing stiffness and pain.
Read on to learn more about hallux limitus, hallux rigidus, and the overall health of your fingers.
The metatarsophalangeal joint connects the innermost metatarsal bone of the foot to the bone of the first phalanx of the big toe. The MTP is a particularly hard-working joint: when we walk normally, the MTP joint in each foot supports 119% of our body weight with each step.
Hallux limitus describes a big toe with a limited range of motion due to changes in the cartilage (the soft connective tissue between bones) of the MTP joint. This makes walking and other activities painful. Hallux limitus can be progressive, meaning the toe may become less flexible over time. However, there are ways to avoid it.
Symptoms of hallux limitus
In the early stages of hallux limitus, you will only experience pain and stiffness when walking or doing other activities that involve standing. As the condition progresses, the pain may become more persistent.
Symptoms of hallux limitus include:
- Problems bending the big toe
- Pain, mainly located on the top of the big toe at the MTP joint
- Tingling and numbness on the top of the big toe that may spread to the rest of the foot
- Swelling and redness of the big toe
- Skin calluses under the big toe.
- Develop a bony lump or soft tissue lump at the top of the MTP joint
- Bone spurs at the MTP joint
Hallux limitus is the result of damaged cartilage
Age, injuries, illnesses, and other factors can wear down the cartilage around the MTP joint, causing additional bone growth in the area. This bone growth, which appears as bone spurs or “osteophytes,” is the body’s attempt to repair the joint. Instead, it prevents movement and causes pain.
The following can affect the cartilage in your MTP joint:
- A previous injury or repeated injuries to the big toe. – We all stub our toes from time to time, but for some, stubbing the big toe over and over again can affect the MTP cartilage. It can also be a sprain or fracture of the big toe.
- Unusual bone structure in your foot – A longer than normal or elevated metatarsal bone can cause increased pressure and wear on the MTP joint. This foot structure can be inherited from generation to generation, making hallux limitus hereditary.
- Rheumatoid arthritis or gout – These autoimmune diseases cause inflammation of joints throughout the body, including those in the hips, knees, and feet. This can change the way you walk.
- High impact activities – Activities that require turning and quick movements of the feet, such as soccer, football, basketball, and tennis, put repeated pressure on the big toe joint and can damage its connective tissue. This type of injury is also called “turf toe” due to its frequency in sports played on grass.
- Ill-fitting shoes or high heels. – Shoes with pointed toes and very high heels put greater pressure on the big toe joint, causing hallux limitus. This type of footwear can also cause bunions (hallux valgus).
Treatment options for hallux limitus
With proper treatment, hallux limitus can resolve, allowing you to resume your activities without pain. Treatment options include:
- Shoes that fit well – Shoes made specifically for flat feet offer more arch support, which relieves stress on the MTP joint. You can also look for shoes with a larger toe box and consider adding custom or over-the-counter orthotic inserts.
- Physiotherapy – A physical therapist can guide you through stretches and exercises that focus on the MTP joint, improving its flexibility and strength.
- RICE – While rest, ice, compression and elevation (RICE) will not resolve the cause of hallux limitus, it can relieve the pain associated with the condition.
- Frequent breaks during high-impact activities. – Taking time to rest your feet while playing sports or being active at work gives the connective tissue a chance to recover, making sprains less likely.
- Corticosteroid injections – These injections reduce inflammation and pain in the big toe joint.
Hallux limitus versus hallux rigidus or osteoarthritis of the big toe
If hallux limitus is allowed to progress, it can develop into hallux rigidus, a form of osteoarthritis in the big toe. In hallux rigidus, the cartilage within the MTP joint breaks down further, resulting in an extremely limited range of motion. Big toe pain becomes chronic, meaning it can be present regardless of whether you are moving or not.
Symptoms of rigid hallux
Hallux rigidus shares many of the same symptoms as hallux limitus, but with greater severity.
Symptoms include:
- Extremely limited range of motion in the big toe or complete loss of motion
- Swelling and redness of the big toe, especially on the top of the toe.
- Bone spurs that develop around the MTP joint
- A bony lump or soft tissue lump that appears on top of the MTP joint
- Difficulty walking, exercising, and doing other daily activities.
- Pain in other areas of the foot due to impaired gait
Causes behind hallux rigidus
There may be one or more factors that contribute to osteoarthritis of the big toe joint. Some of the most common causes include:
- Untreated hallux limitus – Hallux limitus does not always lead to hallux rigidus, but it can be an early indicator that something is wrong with the MTP joint. If left alone, the problems causing hallux limitus (soft tissue deterioration or bone spurs) can worsen and eventually develop into hallux rigidus.
- Previous traumatic injury or repeated injuries to the big toe. – As with hallux limitus, hitting, spraining or breaking your big toe can weaken the surrounding cartilage and cause it to deteriorate.
- Unique foot structure – The bone structure of the feet can put more pressure on the MTP joint, causing the cartilage to wear down faster or more severely.
- Genetics – Just as the bone structure of the foot can be inherited in the family, studies show that osteoarthritis can also be transmitted from one generation to the next. If someone in your family has hallux rigidus, your chances of developing the condition are higher.
Treatments for hallux rigidus
Treatment for hallux rigidus can be more challenging: Your options will depend on your age and the condition of the cartilage around your big toe. It is still possible to find pain relief and regain some range of motion through physical therapy, special shoes, or orthotics.
If your hallux limitus or hallux rigidus has not improved with more conservative treatments, your doctor may recommend corrective surgery.
Surgeries for hallux limitus and hallux rigidus
Surgery for hallux limitus or hallux ridigus is usually reserved as a last resort; Your doctor will first try any other treatments to manage your condition. If you are a candidate for surgery, there are a few different options: cheilectomy, joint fusion (arthrodesis), and joint replacement.
cheilectomy
Cheilectomy is a procedure in which an orthopedic or podiatric surgeon removes bone spurs that have developed around the MTP joint. This procedure is usually accompanied by a Moberg osteotomy, in which the metatarsal bone is realigned with that of the big toe.
Joint fusion (arthrodesis)
In this procedure, a surgeon will fuse the first metatarsal bone and the phalanx, preventing any movement at the MTP joint. Once the MTP is immobilized, the interphalangeal (IP) joint begins to compensate, allowing you to move and walk normally again once it has healed.
Joint replacement (arthroplasty)
A joint replacement involves removing the damaged MTP joint and replacing it with a prosthesis or artificial device that will mimic the movements of the joint.
Take the time to care for your toes.
When we think about the most important part of the body (the one that allows us to play our favorite sport, walk the dog or simply maintain balance), the first thing we think of is probably not our toes. But the truth is that our toes are vital for all of these activities and much more.
By taking care of your toes, you are taking care of your ability to participate in daily life without pain and enjoy the things you love to do. So don’t ignore toe pain when it arises. Instead, seek care with one of our foot and toe specialists.
