Description

Hallux refers to the Big Toe (1st Toe) or 1st Ray. Limitus refers to limited or reduced range of motion at the base of the joint of the big toe, known as the metatarso-phalangeal joint.

Hallux limitus is a progressive degeneration of the joint, often associated with arthritis, which causes the joint to become very painful and stiff. The articular cartilage that covers the 1st metatarsal head and base of the 1st proximal phalanx becomes damaged. It has a slow onset and is commonly due to poor foot mechanics or injury/trauma to the joint.

Over time, it may progress to Hallux rigidus, in which there is very little, if any, motion in the 1st metatarso-phalangeal joint.

Symptoms

Pain and stiffness in the 1st metatarso-phalangeal joint, difficulty bending the toe upwards (dorsiflexion), often worsened with activities such as walking or running. Inflammation and or swelling of the joint. Bone spurs (osteophytes) and/or narrowing of the joint space, which restricts normal motion of the joint.

Pedorthic Management

• Custom made orthotics – with a 1st ray cut out and/or reverse morton’s extension (sometimes called a 2-5 extension) for limitus, to maintain or improve range of motion in the joint -or- a rigid morton’s extension (an extension under the 1st met and hallux) often made from polypropylene for rigidus, to restrict painful motion at the joint.
• Orthopedic Footwear – properly fitted with a rocker sole will assist forward propulsion during the gait cycle and eliminate pressure at the 1st MPJ Joint. As arthritis is often an issue, proper fit over the metatarsal area is essential, and tight footwear should be avoided.

Other Treatments/Modalities

• Physical therapy
• Cortisone shots
• Rest/ice/compression/elevation (after activity)
• In severe cases surgery may be required