What Is Hallux Limitus?
It's a joint disorder. Your hallux (the joint connecting your big toe to your foot) is inflamed, sore, and stiff with this condition. The joint at the base of your big toe (on one or both feet) is harder to move, and you may have trouble walking.
"Hallux limitus is often related to early arthritis, and the term just refers to limitations to range of motion of the great toe compared to a normal range. A related condition — hallux rigidis — is a more severe version where range of motion and usually pain are more pronounced," says Meghan Kelly, MD, a foot and ankle surgeon at Mount Sinai in New York City.
Hallux rigidis can make walking extremely painful or impossible. But you can usually prevent hallux limitus from advancing to hallux rigidis with treatment and careful management.
What is functional hallux limitus?
When you have this, you have trouble moving your big toe only when you're putting weight on it. You'll be able to move it otherwise.
Who's more susceptible to hallux limitus?
Most people diagnosed with hallux limitus are over 50. But doctors think it probably starts earlier in life. Foot X-rays have shown that about 1 in 10 young adults have some signs of joint changes that could lead to hallux limitus. Multiple factors could increase your risk.
"We don't know the ultimate cause of hallux limitus, but there are several potential contributing factors," Kelly says. "One of the risks is related to foot and toe anatomy related to the lesser toes. However, I more often see it in the setting of prior injuries to the toe — this could be a history of turf toe or other great toe sprain, toe fractures, or just a prior history of activities that can be stressful on the toes, such as martial arts or dancing."
What Causes Hallux Limitus?
Many things can lead you to develop hallux limitus in one or both feet or increase your risk. Some are unavoidable, but other causes can be avoided. The most common causes include:
Atypical anatomy of your feet. If you have unusual foot anatomy, it may cause you to walk in a way that stresses your hallux joints. This can lead to hallux limitus over time.
Arthritis. If you have a condition such as rheumatoid arthritis or osteoarthritis, it might change how you walk and put stress on your big toe, causing joint strain.
Injuries. If you've ever stubbed, sprained, or broken your big toe, you may have damaged the joint. That can cause hallux limitus to develop over time.
Overuse. Activities that put a lot of pressure on your toes, such as running or high-impact sports, can result in damage to your foot joints.
Ill-fitting footwear. High heels, shoes that are too small, and shoes with pointed toes can put extra pressure on your toes and cause damage to those joints.
What Are the Symptoms of Hallux Limitus?
Hallux limitus can be painful, especially at the top of your toe joint. At first, you might not notice it all the time.
"Hallux limitus, in its early stages, may manifest as intermittent pain that comes and goes," says Jason Piraino, DPM, a foot and ankle surgeon at University of Florida Health in Jacksonville, FL.
The pain tends to get worse with regular walking or pressure on the joint. It also may worsen over time as your condition advances.
"Hallux limitus, depending on its severity, can significantly impact a person's ability to walk, run, and perform any activity that requires ambulation," Piraino says. "The more motion required for an activity in the lower extremities, the greater the impact the disease process will have on it. For instance, basketball demands a substantial amount of force through the lower extremities, involving both running and jumping. In contrast, a sport like swimming may not be as affected."
Other symptoms may include:
- Bunions, bony lumps on the top of your big toe joint
- Numbness or tingling in your foot from pressure on the nerves
- Calluses on the bottom of the joint from pressure
- Bone spurs from the damaged joint trying to repair itself
How Is Hallux Limitus Diagnosed?
If you notice consistent discomfort in your feet, discuss it with your doctor. They'll examine the joint and check if it's hallux limitus or hallux rigidus and what treatment you should consider.
"If you notice increasing pain, swelling, or reduced motion to your big toe joint, you should seek medical attention," Piraino says. "Other signs may include a small bump formation at the top of the joint, or irritation at the top of the joint, which could indicate bone spurring."
Ask your primary care doctor for a referral to see a specialist trained in diagnosing and treating hallux limitus.
"If someone is concerned they may have it, getting evaluated by a foot and ankle specialist can be helpful, as a physical exam and potentially X-rays will help guide treatment," Kelly says.
"Hallux limitus in its early stages can be effectively treated if detected promptly," Piraino says. "This prevents major arthritic changes from progressing to the point where they limit motion and progress to hallux rigidus, which is more likely to necessitate surgical intervention."
How Is Hallux Limitus Treated?
Treatment depends on the severity of your symptoms.
Ice and NSAIDs, including topical versions, can help ease the pain. Changing your shoes can be helpful as well.
"There are some experimental treatments, such as PRP (platelet-rich plasma), that have been mentioned, but results have been varied. I generally don’t recommend it as a first-line treatment," Kelly says.
Hallux limitus exercises
Try stretching your Achilles tendon and doing exercises that strengthen muscles in your feet. These include toe stretches, calf stretches, and heel raises. They can help better support your big toe. Consider seeing a physical therapist for other exercises that may help, such as manipulation or water therapy.
When to consider surgery for hallux limitus
"If there are minimal to no bone spurs and minimal pain with great toe range of motion, often there are nonsurgical treatments that can improve symptoms," Kelly says.
If those don't help or you have a foot deformity, you may consider surgery. Your options depend on what your doctor sees on an X-ray and physical exam. You may need surgery to:
- Remove bone spurs (cheilectomy)
- Cut or realign your foot bones (osteotomy)
- Fuse bones in your joint together (arthrodesis)
- Replace a damaged joint (arthroplasty)
- Remove damaged bone and add a spacer or soft tissue (interpositional arthroplasty)
How to Prevent Hallux Limitus From Affecting Your Health
It's difficult to completely prevent hallux limitus because it's often related to general wear and tear, or an injury. If you think you're developing it, these steps may help lessen your pain or prevent it from getting worse.
Wear the right shoes. Avoid shoes that pinch your toes. Make sure you don't wear heels higher than an inch. Shoes that are flat and fit well allow your big toe to move naturally and heal from irritation. If it hurts too much to walk, try shoes that keep your foot from bending.
"Shoes that have a stiff sole will limit the motion through that joint when you walk, thus minimizing the stress on the toe," Kelly says. "In addition, minimizing heel height and/or wearing arch supports are helpful as well. If you have a favorite pair of shoes but know that they are too flexible, you can consider a carbon fiber footplate in the shoe. These can be purchased online or in stores and are very thin. This turns any shoe into a stiff-soled shoe."
Avoid overuse. As with any other injury, your foot needs to rest to heal. Rest your feet frequently. Avoid running or doing high-impact sports until your joint feels better.
Use orthotic inserts. There is a wide variety of orthotic inserts or insoles that you can use to help support your feet. Soft gel pads can help ease the pressure on your joint, while orthotics can help correct the way you walk. Your doctor can help you find an orthotic that's most likely to work.
"Prevention involves X-rays to determine the underlying cause of the biomechanical abnormality and treatment of that cause," Piraino says. "Often, the underlying cause can be treated with an orthotic."
Take anti-inflammatory medications, such as aspirin or ibuprofen. Inflammation is one of the reasons hallux limitus is so uncomfortable. Taking over-the-counter anti-inflammatory medications can help reduce your symptoms while you heal.
Ice your joint. If you're experiencing acute pain, you can ice your foot two to three times a day to reduce swelling. Make sure to ice your foot for only 15 minutes at a time to avoid cold burns.
Talk to your doctor about corticosteroid injections. If resting your foot and wearing insoles and better-fitting shoes don't ease your symptoms, talk to your doctor about corticosteroid shots. They ease swelling and help your joint heal.
Takeaways
Hallux limitus is a joint disorder that makes it hard to move your big toe. It can happen for many reasons, including arthritis and injuries. If you catch it early, you can help prevent a more serious condition called hallux rigidus. See your doctor if you think you may have this condition to identify the cause and get treatment.
Hallux Limitus FAQs
Can hallux limitus go away?
Not really, but treatment can slow its advance and ease your symptoms. If your symptoms worsen over time, you might need surgery.
Can wearing hallux limitus shoes help?
Yes. Shoes that are supportive or keep your toes from bending may help.
Can hallux limitus be cured or reversed?
It depends on the cause and treatment. If it's related to an injury, it can heal completely. But if it's related to arthritis, it may worsen and never go away.
How long does it take to recover from treatment of hallux limitus?
Everyone is different, so it's hard to say how long it'll take. It depends on factors like the underlying cause and how much damage there is to your joint. Ask your doctor what to expect in your case.
