HALLUX LIMITIS/RIGIDUS

 Oh, my aching big toe! You never think about your toes or even think they are important until they hurt. Arthritis of the big toe joint is progressive Hallux Limitis and in the end stages is known as Hallux Rigidus. In English, this means your big toe joint doesn’t move as much any more, and then progressively doesn’t move at all. This is the disorder that stopped the Dallas Cowboy’s Deion Sanders career and slows down many patients, young and old. If you have limitation of bending in your big toe joint, it crunches when moving, and hurts or aches most of the time, you may be developing hallux limitis.

What causes Hallux Limitis/Rigidus? Commonly, the development of hallux limitis is due to faulty, inherited biomechanics of your foot. (Blame Mom and Dad) The stress on the big toe joint is abnormal and over time, the cartilage starts to wear away. You start to develop a bump on the top of the joint, which rubs in your shoes, and in the late stages, the joint range of motion deteriorates to nothing. This is often accelerated by trauma from a sudden jamming of your toe, a direct blow or “turf toe” from athletics. It can also be accelerated by an occupation or activity that required constant stooping or squatting, which puts a lot of abnormal stress on the joint. Less commonly, hallux limitis is caused by an inflammatory arthritis like gout or rheumatoid arthritis.

What are the symptoms of Hallux Limitis/Rigidus? Early symptoms include pain and stiffness which gets worse with activity or cold weather, swelling around the joint, and pain in certain shoes or with certain activities. Later your symptoms progress to pain all the time, pain in all your shoes, and compensatory pain in your back, hips and knees due to walking funny.

Diagnosis of Hallux Limitis/Rigidus is done by x-ray findings coupled with physical exam. A creaking joint is not necessarily always hallux limitis/rigidus, so a complete podiatric exam including x-rays should be done to evaluate your condition. Many people actually have bunions, gout or systemic arthritis, and even an infected joint which can elicit the same symptoms, but is may be treated completely differently.

Treatment includes shoe gear modification, an orthotic device to control the abnormal biomechanics, padding, injection therapy to decrease inflammation, and at the later stages, surgery.
When is surgery needed for hallux limitis? If you have pain every day, in every pair of shoes you own (including your athletic shoes) and you have treated your condition with conservative therapy without any relief; it’s time to discuss surgery. Surgery should never be contemplated without pain and activity limitations. There are many advances in foot surgery and varied procedures depending on your foot type, the stage of your deformity, your activity level, your medical history, and your age.

Surgery usually falls into three major categories: “clean up” procedure (Cheilectomy) which removes all the spurring and increases the range of motion and tries to salvage your joint; “Fusion” which removes the remaining injured cartilage and fuses the big toe joint so it doesn’t move, so it doesn’t hurt any more; or a joint replacement. There have been many advances in joint replacement surgery which make the new prosthetic joints much more functional and durable.

Make an appointment to discuss surgery with your podiatrist if you have progressing symptoms and conservative therapy is not helping. Call or contact us on the website for an appointment today to get your questions answers. Don’t live with the pain of hallux limitis due to fear of the unknown. Many patients wait too long to seek medical attention and need a joint replacement when they could have saved their joint if they sought medical attention sooner!