By Gabrielle Lee-Kim, DPM, AACFAS
“My big toe hurts when I walk/run.” There are many reasons that cause this symptom. One of the reasons is hallux limitus/rigidus.
When the big toe (hallux) joint does not bend about 65 degrees when it moves up, it is called hallux limitus (limited motion). The causes can be bony spur on top of the big toe joint that limits the motion, wear and tear (arthritis) that narrows the joint space, and abnormal foot type with trauma or tight ligaments/ tendons around the joint. When the conditions worsen, the limitus progresses to the rigidus (virtually no motion at the joint).
People experience tremendous pain and stiffness with range of motion at the joint which affects overall quality of life. If the joint is still being used even with the pain, it can get swollen and cause inflammation. When that happens, the pain exists even without motion at the joint.
Treatment options consist of conservative v. surgical intervention. For pain and swelling, RICE therapy (Rest, Ice, Compression, Elevation) can be started initially. Non-Steroidal anti-inflammatory drugs (NSAIDS) can also be used as needed. Physical therapy to work on the joint motion and decrease scar tissue at the joint can be considered. Corticosteroid injections can reduce scar tissues and improve symptoms. For long-term, Custom foot orthosis with morton’s extension modification (to restrict excess motion at the joint) can be beneficial.
However, if all conservative treatments fail, surgical interventions are indicated. Mild to moderate hallux limitus can be managed with cheilectomy procedures. For severe hallux rigidus, joint replacements with implants or joint fusion is considered.
The goal with both conservative and surgical interventions is to have patients pain-free when they walk and get back on their feet so they can do daily activities without restrictions. It is recommended to see a podiatrist if you experience any discomfort at the big toe joint when the symptoms are mild in order to prevent extreme pain that limits the ability to perform daily activities.
