Causes and Treatment of Hallux Limitus (Toe Arthritis):

Hallux Limitus is defined as a restriction in dorsiflexion of the hallux at the first metatarsophalangeal joint secondary to exostoses or osteoarthritis of the joint. Often the term ‘hallux rigidus’ is used to describe the final progression of hallux limitus as ankylosis of the joint occurs.

The primary role of the hallux is to enable dorsiflexion of the first metatarsal during the propulsive phase of gait. Limitation of this range of motion results in problems with gait.

Causes

• Trauma-secondary to chondral damage
• Excessive pronation of the foot may increase the stresses on the joint and promote development of exostoses
• Repetitive weight-bearing dorsiflexion of the first metatarsophalangeal joint
• Autoimmune arthropathy (e.g. rheumatoid arthritis)
• Aberration of the first metatarsal or proximal phalanx
• Hypermobile first ray
• Muscle imbalance

Clinical Features

• The main presenting symptom is usually that of pain around the first metatarsophalangeal joint. The pain is often described as a deep aching sensation that is aggravated by walking, especially in high heels, or activities involving forefoot weight-bearing.
• Dorsal joint hypertrophy can be a source of irritation from footwear and may lead to pain secondary to skin or soft tissue irritation.
• In patients with longstanding hallux limitus, a distinct shoe wear pattern is seen: the sole demonstrates wear beneath the second metatarsophalangeal joint and the first interphalangeal joint.
• Examination reveals tenderness of the first metatarsophalanageal joint, especially over the dorsal aspect, often with palpable dorsal exostoses.
• There is a painful limitation of joint motion, the degree of limitation reflecting the severity of the arthrosis.

Investigations

• Plain X-rays display the classic characteristics of degenerative osteoarthritis and the degree of degeneration observed will reflect the duration and severity of the condition.
• Features include joint space narrowing, sclerosis of the subchondral bone plate, osteophytic proliferation, flattening of the joint, sesamoid displacement and free bony fragments.

Treatment

• Conservative management consists of an initial reduction in activity, NSAIDs, a cortisone injection if required, physiotherapy, and correction of biomechanical factors with orthoses and/or footwear.
• Conservative treatment often fails when hallux dorsiflexion is less than 50 degree. In extreme cases, cheilectomy is required.
• Occasionally, arthroplasty of the first metatarsophalangeal joint is indicated.

Hallux Limitus is basically restricted movement of the big toe combined. The big toe combined generally will go through a 55-65 level variety of flexibility. With Hallux Limitus this movement may be decreased to 25 or 30 levels. Hallux Rigidus is a firm movement or finish lack of any movement of this combined. As like a bunion problems this is a cuboid architectural problems. If you are suffering from Toe Arthritis then call at Active Physical Therapy: 301-916-8540

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