Hallux Limitus and Hallux Rigidus are terms that refer to different stages of the same foot problem.
Hallux – refers to the big toe.
Limitus – refers to decreased motion of the joint. There is less than normal motion available. This is the early stage.
Hallux Limitus and Hallux Rigidus involves the 1st metatarso-phalangeal joint. This joint is located at the base of the big toe. Hallux Rigidus/Limitus causes pain and stiffness in the big toe, and with time it becomes increasingly harder to bend the toe. This is a progressive condition during which the toe’s motion decreases as time goes on. In the early stages, motion of the big toe is only limited, and at this point, the disorder is called Hallux Limitus. As the problem advances, the big toe’s motion gradually decreases until it becomes rigid or frozen. At this point, the disorder is referred to as Hallux Rigidus. As motion becomes progressively limited, pain increases, especially when the big toe is extended, or pushed up. This condition is frequently seen in younger adults and can occur secondary to athletic sports or injury. Often times a relatively minor injury to the area in high school can precipitate an early painful and limited joint. Essentially this condition is a type of osteoarthritis which may be post-traumatic arthritis to this specific joint. There is an early type of Hallux Limitus, which does not shoe any x-ray signs, but there is limitation of motion dorsally especially when the foot is on weight bearing load. This is referred to as Functional Hallux Limitus.
Early Symptoms and Diagnostic Signs (Hallux Limitus):
- Pain and stiffness in the big toe when it is pushed upwards, as occurs when we walk, run, squat, and stand on our toes.
- Swelling and inflammation of the joint, especially on the top of the joint.
- Discomfort in the joint that occurs when the weather is damp and cold.
- A feeling of “tightness” in and around the joint.
Later Symptoms and Diagnostic Signs (Hallux Rigidus):
- Pain in the joint that is almost constant. May even be felt when resting and the shoe has been removed.
- Crepitus, or a “grinding” feeling in the joint when the big toe is moved up and down.
- A bump, or “hardness” can be felt on the top of the joint. Eventually, this bump which is actually a bone spur, becomes large enough to be seen with the naked eye.
- Difficulty wearing shoes, especially high heels, due to the bone spur and stiffness of the big toe joint.
- Walking becomes so painful that we try to walk without bending the big toe.
- Limping and Pain in other parts of the foot, as we try to throw our weight off of the big toe on to the adjacent foot structures.
- Pain in the knee, hip, and lower back due to changes in the way we walk.
- Weight gain due to lack of walking and exercise, because of this pains.
What causes the cartilage to deteriorate?
Repetitive Injuries to the joint occur when the big toe is repeatedly jammed backwards, with force, against the joint cartilage. This retrograde pressure on the cartilage causes the cartilage to prematurely wear down and tear. Some of the most common causes of this type of injury include:
- Frequent wearing of high heel shoes.
- Wearing shoes that are too short.
- Squatting for long periods of time.
- Stubbing the big toe.
- Improper running technique. Running on your toes, so that your heel does not touch the ground.
- Dropping a heavy object on your big toe joint.
- Age-related changes of the big toe joint, or osteoarthritis. Osteoarthritis, or degenerative joint disease, is the most common form of arthritis that affects human beings. It is due to the normal wear and tear that our joints undergo during our lifetime. This disease produces a gradual deterioration of the joint cartilage throughout our entire body, including the big toe joint. The saying is true: “If you live long enough, you will develop osteoarthritis.” As we age, and osteoarthritis sets in, we begin to notice stiffness, swelling, and a little pain in all of our joints. One of the most common sites that this occurs in is the big toe joint. As osteoarthritis progresses, and the cartilage in the big toe joint deteriorates more, we begin to notice more and more of the symptoms of Hallux Limitus at first, and Hallux Rigidus later on. As mentioned earlier, this problem often manifests in younger patients due to athletic injury or even something as simple as dropping something on the affected area.
- Hereditary Defects are those defects that we are born with, which predisposes us to Hallux Limitus/Rigidus. Pronation occurs when the foot rolls outward at the ankle, causing one to walk more on the inner border of the foot than is normal. As we walk, pronation causes us to place excessive weight and pressure on the big toe and big toe joint. When the big toe joint needs to work harder to help push us forward every time we take a step, due to the extra weight placed on it, the joint cartilage becomes overly compressed. Eventually, this causes the cartilage to prematurely wear down, resulting in the symptoms of Hallux Limitus.
- Feet with high arches are usually more rigid than normal, and will not allow the high arch to come into contact with the ground when we step down. Therefore, as we step forward, all of our weight is thrown on to the balls of the feet, rather than some of the weight being carried by the arch. This will force the bones and joints in the balls of the feet to bear excessive weight, especially the big toe joint. The results of this repetitive and excessive weight on the big toe and big toe joint result in compression, deterioration, and eventually tearing of the joint cartilage. As this continues, the signs and symptoms of Hallux Limitus appear.
- An elevated first metatarsal causes the big toe to excessively flex (push downward) with every step we take. When the big toe is in a flexed position and strikes the ground, it is jammed back into the big toe joint cartilage with excessive force, or retrograde pressure. Over time, this results in a thinning and wearing down of the joint cartilage. As this continues, the individual begins to experience the symptoms of Hallux Limitus.
- An abnormally long first metatarsal increases stress on the big toe joint each time the big toe pushes us forward. This stress is further increased if the shoe is too short or the heel is too high, as this forces the big toe back into the joint cartilage with excessive force. The joint cartilage becomes pinched between the big toe and the metatarsal, causing premature wearing and deterioration of the cartilage. This results in the uncomfortable symptoms of Hallux Limitus. (In most instances you can determine if your first metatarsal is too long by the fact that the big toe appears too long, in relation to your other toes). This also applies if the 2nd metatarsal is very short creating an abnormal parabola thereby increasing stress on the 1st metatarsal joint.
Post-operative Care and Risks: