Definition

Hallux limitus literally means stiff big toe joint. It is a condition that is characterized by decreased range of motion and pain at the big toe joint, medically referred to as the first metatarsophalangeal joint). Over time, the limited range of motion can result in arthritis of the big toe joint and a complete loss of range of motion, known as hallux rigidus.

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. Podiatrists are experts in their ability to clinically diagnose a hallux limitus and suggest the best treatment options preventing complications which can only be resolved through surgery. 

Cause

Hallux limitus is most often caused by 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 the 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 of hallux limitus can include acute trauma to the big toe joint, rheumatoid arthritis, gout, turf toe (repetitive sport injury).

This condition can cause the following 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 (see links to photos below)
• Bone spurs and joint space narrowing at the big toe joint, seen on X-ray
• A callus on the side of the big toe
• Out-toeing (walking like a duck)

Treatment and Prevention

Although many people may suffer from hallux limitus but are unaware of it, the biomechanical problems as a result of this problem may be felt throughout the body. In fact with each step we take, a certain amount of flexibility of the big toe joint is required. This allows the foot to properly absorb and transfer our body weight as our feet hit the ground. When foot flexibility is compromised, as seen with hallux limitus, other joints of the body can feel the effects. One study linked hallux limitus to back pain and showed that successful treatment of hallux limitus reduced back pain symptoms in a majority of study participants. 

Function of the big toe joint can be achieved through custom made orthotics as prescribed by a podiatrist. These should contain special modifications to take the stress off the big toe. Special shoe styles such as stiff- soled shoes or styles with rocker soles are also useful and help decrease motion at the big toe joint. Surgery is only recommended when the condition is causing mobility problems and recurring pain.