Hallux Limitus Signs and Symptoms

a woman's bare feet

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Hallux limitus literally means stiff big toe joint. It is a condition that is characterized by a decreased range of motion and pain at the big toe joint (first metatarsophalangeal joint). Over time, the limited range of motion can result in arthritis of the big toe joint. The decreased range of motion that causes hallux limitus is a common occurrence — but it is not often recognized until the big toe becomes painful.

Signs and Symptoms

  • Pain at the big toe joint, made worse by athletic activity or walking
  • A bony enlargement or bump at the top of the big toe (metatarsophalangeal) joint
  • Decreased range of motion of the big toe joint — seen as an inability to flex the big toe about 65 degrees upward while standing
  • Bone spurs and joint space narrowing at the big toe joint, seen on X-ray
  • A callus on the side of the big toe
  • Limping

With each step, a certain amount of flexibility of the big toe joint is required. This allows the foot to properly absorb and transfer body weight as the feet hit the ground. When foot flexibility is compromised, other joints of the body can feel the effects. Successful treatment of hallux limitus and hallux rigidus can reduce back pain symptoms.

Causes

Hallux limitus is most often caused by wear and tear, or in some cases is associated with abnormal foot anatomy. An elevated first metatarsal bone, such as is seen in flat feet, will hinder proper range of motion of the great toe. An abnormal length of either the second metatarsal bone or first metatarsal bone can also cause hallux limitus.

The classic example of an abnormal metatarsal length is Morton's toe. A Morton's toe is another name for a second toe that is longer than the big toe. This type of foot is more prone to the discomfort of hallux limitus.

Other Causes

The reduced range of motion associated with hallux limitus can progress to a more severe loss of range of motion, known as hallux rigidus. Hallux rigidus is the result of either chronic or acute joint damage that leads to the metatarsophalangeal joint becoming stiff.

Treatment

Once a diagnosis of hallux limitus or hallux rigidus has been made, possible treatment options include:

  1. Rest, Ice, Compression, and Elevation (RICE) of the affected limb
  2. Stretching of the big toe
  3. Orthotics or arch supports with special modifications to take the stress off the big toe. These can be prescribed by a foor and ankle specialist.
  4. Special shoe styles such as stiff-soled shoes or styles with rocker soles which are seen with certain toning shoes. These styles help to decrease motion at the big toe joint.
  5. Over-the-counter pads which are added to the inside of the shoe
  6. Surgery, if conservative measures fail to improve symptoms. Surgery involves procedures to either restore range of motion to some degree or fuse the joint completely to prevent any motion.
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Article Sources
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  2. American Academy of Orthopaedic Surgeons. Stiff big toe (hallus rigidus). Updated October 2017.

  3. American College of Foot and Ankle Surgeons. Hallux rigidus.

  4. Cusack J, Shtofmakher G, Kilfoil RL, Vu S. Improved step length symmetry and decreased low back pain with the use of a rocking-soled shoe in a patient with unilateral hallux rigidus. BMJ Case Rep. 2014;2014. doi:10.1136/bcr-2014-206408