Hallux limitus/rigidus
Hallux Rigidus/Limitus involves the 1st metatarso-phalangeal joint. This joint is located at the base of the big toe. Hallux Rigidus/Limitus causes pain and stiffness in the big toe, and with time it becomes increasingly harder to bend the toe. This is a progressive condition during which the toe’s motion decreases as time goes on. In the early stages, motion of the big toe is only limited, and at this point, the disorder is called Hallux Limitus. As the problem advances, the big toe’s motion gradually decreases until it becomes rigid or frozen. At this point, the disorder is referred to as Hallux Rigidus. As motion becomes progressively limited, pain increases, especially when the big toe is extended, or pushed up.
Early Symptoms of Hallux limitus
Pain and stiffness in the big toe when it is pushed upwards, as occurs when we walk, run, squat, and stand on our toes.
- Swelling and inflammation of the joint, especially on the top of the joint.
- Discomfort in the joint that occurs when the weather is damp and cold.
- A feeling of “”tightness”" in and around the joint.
Later Symptoms/Diagnositic Signs (Hallux Rigidus):
- Pain in the joint that is almost constant. May even be felt when resting and the shoe has been removed.
- Crepitus, or a “”grinding”" feeling in the joint when the big toe is moved up and down.
- A bump, or “”hardness”" can be felt on the top of the joint. Eventually, this bump which is actually a bone spur, becomes large enough to be seen with the naked eye.
- Difficulty wearing shoes, especially high heels, due to the bone spur and stiffness of the big toe joint.Walking becomes so painful that we try to walk without bending the big toe. This can cause:
- Limping
- Pain in other parts of the foot, as we try to throw our weight off of the big toe on to the adjacent foot structures. In this way we try to limit bending of the big toe as we walk.
- Pain in the knee, hip, and lower back due to changes in the way we walk.
- Weight gain due to lack of walking and exercise, because of this pains.
Causes of Hallux rigidus and Hallux Limitus:
Hallux Limitus and Rigidus are due to a premature “”wearing down and tearing”" of the cartilage in the 1st mettarso-phalangeal joint. As the cartilage begins to wear down, the proximal phalanx of the big toe, and head of the metatarsal begin to rub against each other. Without the protection of the cartilage between these bones, each time the toe is moved, friction and pain occur. Each step that is taken causes more deterioration of the joint cartilage. Continued deterioration of the cartilage results in:
- Under the weakened cartilage, the bone tries to regenerate and replace worn down areas. This leads to an over-growth of bone called bone spurs. These spurs can be felt, and sometimes seen, all around the big toe joint, especially on the top of the joint.
- A narrowing of the 1st metatarso-phalangeal joint, which is evident when radiographs of the foot are taken.
- Increased stiffness, swelling, inflammation, and pain in the big toe. Eventually, when the cartilage has been worn down completely, there is no movement at this joint….the big toe is said to be “”rigid.”"
Custom Treatment of Hallux rigidus and Hallux Limitus:
Self-Treatment or Prevention: The old adage, ”"An ounce of prevention is worth a pound of cure,”" is most apropos when trying to prevent the devastating effects of Hallux Limitus and Rigidus. If this disease is not prevented or treated in its earliest stages, it may produce such debilitating pain and deformities that surgery will be required to allow the foot to function normally again.
Long Term Treatment must be directed towards:
- Stabilizing the foot. When the foot is maintained in its normal, or neutral position, it cannot pronate and roll out. When pronation is controlled, the big toe no longer bears excessive weight. This reduces forceful and destructive compression of the cartilage in the big toe joint. Thus, the big toe joint remains healthy.
- Supporting high arches in order to relieve excess pressure on the balls of the feet, especially the big toe joint. When the big toe no longer must bear excessive amounts of weight as it “”pushes”" us forward, the big toe joint cartilage is protected from excessive compression and force. The result is a healthy joint cartilage, free of deterioration and tearing.
- Stabilizing the big toe, and preventing it from “”over-flexing,”" as it pushes us forward. This will help to reduce the excessive jamming back of the big toe into the joint cartilage. Without this jamming effect, the cartilage remains healthy and intact.
- Providing shock absorption for the foot. The arches of our feet are our body’s main shock absorbers. As we take each step, the arch of the foot helps to absorb and disperse the tremendous force that occurs when our foot strikes the ground. This force can equal 3 to 7 times our body weight, depending on whether we are walking or running. When the arch is higher than normal, shock absorption by the arch is reduced. When this occurs, the big toe, ball, and heel of the foot, must absorb this shock. The effect on the big toe is to over-flex, or to be jammed back into the joint cartilage with excessive force, which may cause the cartilage to wear down prematurely and unevenly.
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