Stiff Big Toe

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.

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 bony prominences
  • Swelling and erythema

Treatment
Initial treatment involves the 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 an important part of treatment, especially when biomechanical abnormalities are present
  • Surgical treatment