Hallux limitus - a guide for patients

You have been diagnosed as having an arthritic big toe joint: hallux (big toe) limitus (limited). Here you will find some information about your condition and proposed treatment.

Background

Osteoarthritis of the big toe joint is the most common arthritic condition to affect the foot. It happens in one out of 40 adults over the age of 50 and is the second most common complaint about the big toe after a bunion deformity (hallux valgus). There are a number of factors that can cause hallux limitus. These include increased length and shape of the first metatarsal, as well as damage to the joint in earlier years.

Hallux limitus affects the cartilage of the big toe joint. Cartilage is the material in the body that allows the joints to have a fluid and unrestricted movement. When the cartilage becomes damaged, the underlying bone is exposed. The bony surfaces then begin to rub. This can produce:

• pain
• new bone formation around the joint (joint enlargement)
• limitation of big toe joint movement
• a change in your walking pattern.

The new bone formation around the joint - mainly on the top of the joint - is produced to reduce the motion at the joint, and thereby pain. However, this new bone can produce problems on its own because of friction from footwear.

Why has this problem happened?

There has been a lot of research into the cause of hallux limitus. So far, only a few causes have been determined. These include:

• Family history of hallux limitus.
• Gender - increased incidence in women.

However, other factors also include:

• Length of the first metatarsal – a longer than normal first metatarsal can produce jamming of the joint during walking. This can increase the amount of pressure and contact between the two cartilage surfaces which, over time, can lead to degeneration of the joint surfaces.
• Trauma – damage to the articular cartilage.
• Functional hallux limitus – this is where the joint does not function properly due to the foot rolling in, such as in a flat foot. If functional hallux limitus is diagnosed and there are limited signs of arthritis on an X-ray this can be treated through orthotic shoe insole therapy.

How is this condition treated?

Treatment is based on the amount of symptoms and the severity of the arthritic process.

In some cases, a steroid injection into the joint, alteration of your footwear and the use of an over-the-counter orthotic or insole can help. These may help to reduce the pain and discomfort by adjusting the position of your foot and the function of the big toe joint. This type of orthotic can be bought from any major pharmacy.

The steroid injection reduces the inflammation associated with the condition; it does not have an effect on the arthritis itself. Alteration of your footwear can help to limit the amount of motion at the joint and reduce the pain.

The best type of shoe is a walking trainer. This type of shoe has a thick and rigid sole and prevents your big toe joint from bending too much. It can be bought from any outdoor shop. Be aware, it is not the cost of the shoe but the properties that are important.