Hallux Limitus/Rigidus

Hallux Limitus/Rigidus is a condition of degenerative arthritis that affects the great toe joint. There may or may not have been any injury. It is associated with some foot types more than others and may also occur because of injuries. These injuries may have been low grade but recurring athletic injuries from years ago.

Symptoms — Bony spurs form around the great toe joint. Most people with the condition experience deep joint aching when the toe is brought to the end range of motion. When walking, the pain is at its worst right when you step off the big toe joint. As the joint enlarges there may also be shoe irritation on the bump.

X-ray findings—Except in the very earliest cases, x-rays will provide the diagnosis. As the cartilage becomes worn, the joint will appear narrower. Bone spurs will be seen to form around the joint.

Treatment—The body likes full motion or no motion at joints. Restricted motion can be very painful. Treatment is directed at limiting the pain by either limiting motion or by restoring motion at the grettoe joint. The latter can only be done surgically. The treatment chosen will be dependent on how early the disease is caught and treated.

Early stage treatment

Orthotics are devices that can be placed in your shoes to change the way you walk. They work by decreasing the amount of motion necessary for the joint to function. They work only in the earliest stages of the disease.

Rigid, rocker soled shoes also work by reducing the amount of motion needed by the joint. Most oxford style shoes can be converted to a rigid rocker sole. This is best done by a certified orthotist and may require a prescription. These can be very effective but obviously you are limited to the shoes that have been altered.

Surgery to clean up the joint (Cheilectomy) can also be effective in the earlier stages. The boney spurs that form around the joint are removed. Small holes may be made in areas of damaged cartilage to stimulate the body to form a new joint covering made of fibrocartilage — a cross between scar tissue and cartilage. The advantage of this procedure is that it has a relatively short postoperative recovery compared to other procedures. Orthotics are frequently used after this type of surgery to reduce the likelihood of the problem coming back. If you wait too long and the joint damage is extensive, this type of procedure will no longer be adequate.

Later stage treatment

Joint replacement—Joint replacements have come a long way in their development. They allow the restoration of motion and eliminate the pain. The newer joint resurfacing implants require minimal removal of bone from the joint.

Joint resection—If the joint damage is too extensive, part of the joint may be removed and soft tissue placed in the joint space. The primary advantage is the restoration of motion.

Joint fusion—In patients with very severe degenerative changes of the joint, the great toe joint can be fused restricting motion entirely. This creates a very stable foot. Because those who have this procedure done have usually lost most of their joint motion already, they do not miss the lack of motion. It converts a very painfully stiff joint to a comortable one. Indeed, about 70% of those who were running before can return to athletic, running type activities after this procedure.