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Hallux Limitus is a term used to describe a first metatarsophalangeal joint (MTPJ) that has developed
a painful limitation in motion secondary to an acquired arthritic condition. This limitation in motion
is progressive and may lead to a condition termed Hallux Rigidus, in which there is an absence of motion.
During normal gait the first MTPJ dorsiflexes 50-75 degrees, and requires stability of proximal bones
and joints to function properly. Abnormalities such as pronation, trauma, neuromuscular disease,
arthritic conditions, or variations in bone structure can interfere with normal first MTPJ function
and lead to a decrease in motion.
Appearance
Outwardly the condition may look like a bump on the top of the first metatarsal head with varying
degree of limitation of the first MTPJ motion.
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Symptoms
- Joint pain and stiffness at the first MTPJ
- The joint may feel like it "locks up" at a certain point due to articular cartilage damage
- Pain on the top or bottom of the first metatarsal head
- Difficulty with certain activities like running, squatting, or walking up an incline
- Difficulty wearing shoes due to the excessive pressure on the body prominences
- Swelling and erythema
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Diagnosis
Physical examination and biomechanical assessment: The limitation in motion may not be appreciated
in a non-weighbearing patient, proper loading of the first ray may reveal a functional limitation in
motion. The patient may complain of pain beneath the second metatarsal or even the lateral aspect of the
foot due to transfer of pressure from the first MTPJ as it's function declines.
X-rays will be used to help determine the severity of the condition, structural or positional
deformity, as well as the proper course of treatment.
Ultrasound may also be used to evaluate the dynamic functioning of the first MTPJ.
Conservative Treatment
Initial treatment involves management of symptoms and biomechanical control.
- Non-steroidal anti-inflammatories or steroid injections
- Sodium hyaluronate (Synvisc, Supartz) injections may provide relief in mild to moderate
cases
- Changes in shoe gear
- Functional orthotics: Orthotics are and important part of treatment, especially when biomechanical
abnormalities are present
- Surgical treatment
Surgical Treatment
Surgical treatment can be divided into joint preserving and joint destructive type procedures. The
degree of motion limitation, condition of the joint, patient age, and symptoms help determine which type
of procedure would be best for each patient. Joint preserving procedures include simple remodeling of
the joint with resection of prominent osteophytes, osteotomy, and osteochondral replacement grafts.
Joint destructive procedures include joint implants and arthrodesis.
other online resources
You can also download our Podiatry-at-a-Glance newsletters:
A Guide to Hallux Limitus/Rigidus
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