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Hallux limitus is a foot condition affecting your big toe joint that can cause joint pain whenever you walk. If left alone, the big toe pain will get worse and become more difficult to treat.

Hallux Limitus

Hallux limitus is a type of degenerative arthritis in your big toe – specifically in the first metatarsophalangeal joint, or MTP joint. Trauma or simple overuse can wear out the cartilage in that joint, reducing its flexibility and causing stiffness and joint pain where your big toe meets the rest of your foot, which can lead to other complications as well.

“Hallux” is Latin for your big toe, while “limitus” is Latin for “limited.” Quite literally, your big toe joint has become limited in function.

When hallux limitus has progressed to the point where your big toe no longer moves much at all, it is called hallux rigidus, Latin for “rigid”, meaning stiff big toe.

The condition is not uncommon: An estimated 2.5 percent of all people over the age of 50 develop hallux rigidus.

The good news is that it is a very manageable condition. If you take the right steps, you can avoid surgery, such as a joint fusion, and alleviate the symptoms.

Symptoms

Hallux limitus and rigidus are progressively degenerative conditions – they slowly get worse over time. This can make it difficult to pinpoint when you started feeling symptoms, as they will hardly be noticeable at first.

Symptoms to expect from hallux limitus are:

  • Stiffness and big toe joint pain when you walk or stand, or when you bend it
  • Slight limitations in your toe’s range of motion
  • Swelling and inflammation around the joint, which is located at the base of the toe
  • Increasing difficulties in certain activities that make you bend your toes, like running, walking, or squatting
  • Calluses that develop under your big toe from the increased pressure caused by the stiffness

Many people who suffer from hallux limitus report pain in the big toe and stiffness in the joint getting worse when the weather is cold and damp.

As the condition progresses and gets worse, it becomes hallux rigidus. The symptoms will get worse and worse:

  • The stiffness and pain will continue even when you are not bending your toe
  • The loss of range of motion has become more pronounced
  • You can develop numbness or a tingling sensation if your nerve gets impacted
  • You can develop a bone spur in the joint, deforming your foot with a bony bump on your foot, which makes wearing shoes difficult, particularly tight shoes and high heels
  • You can develop a limp from how difficult walking becomes
  • The pain in your big toe forces you to change your walking gait, which can cause poor foot alignment and lead to pain in other parts of your body, most often your knees, hips, or lower back

Because this is a degenerative medical condition, it is very important to get it diagnosed early on. By treating it before hallux limitus gets too bad you can reduce the pain that you experience and increase the odds that a conservative, nonsurgical course of treatment is successful. Doctors use a variety of methods for diagnosing hallux limitus, including:

  • Gait analysis
  • Physical examinations
  • X-rays and other imaging tests

Unfortunately, some doctors fail to diagnose hallux limitus before it has progressed too far. This is often because you do not experience the symptoms of the condition when you are sitting down, and most medical examinations are done with you sitting on the table rather than standing up.

What Causes Hallux Limitus?

Most instances of hallux limitus seem to be the result of a natural susceptibility to the condition, plus overuse. This is why many people who get hallux limitus are over the age of 50.

Certain types of alignment and foot issues make it more likely that you will develop hallux limitus. Some of these conditions are:

  • Fallen arches
  • Excessive inward foot pronation
  • Arthritis
  • Gout

Additionally, people who have a family history of developing hallux limitus are also at an increased risk of getting it when they get older.

Overuse, though, is a common element for many people who suffer from hallux limitus. Many people who develop the condition were physically active, whether they played sports or had a physically demanding job. This is particularly true if you wore poorly fitting footwear that did not have enough room in the toe box for your feet. Wearing high heels increases the pressure even more and can exacerbate the problems. Atypical foot anatomy can lead to this issue, as it can make it very difficult to find comfortable shoes.

However, some cases of hallux limitus are caused by physical trauma or toe injuries, even if it was just a stubbed toe. If you have broken your big toe, especially if you broke it multiple times, the odds of developing hallux limitus increase.

How to Run with Hallux Limitus

People who have hallux limitus, and especially those who have progressed to hallux rigidus, will have extra difficulties running. For avid runners – especially short-distance runners whose stride requires greater toe flexes to build speed – this discomfort can be one of the worst things about the condition.

However, there are several things that runners can do to mitigate the discomfort and prevent the condition from getting worse due to their activity.

Most obviously, runners who do not want to lose their sporting life to hallux limitus need to revisit their footwear. Getting running shoes with a wider toe box, stiffer sole, and stronger arch support is extremely important. There are even running shoes that are specifically designed for people with arthritis or hallux limitus.

If you still experience discomfort, you may want to replace some of your running routine with conditioning that is lower-impact, such as biking or swimming. This can keep you in good shape while also preventing your toe condition from progressing too quickly.

Finally, you can experiment with different running gaits that reduce the impact on your affected toe. By focusing on attaining smoothness in your stride, shortening your stride length, and aiming to land further to the middle of your foot rather than on your toe, you can reduce or potentially even eliminate the discomfort that you felt before.

Treatment

There are several conservative treatments that you can try to correct hallux limitus. These are less likely to work if the condition has progressed to hallux rigidus, though.

Changing your footwear to shoes that have stiffer soles and enough toe room can make a huge difference. Wearing the correct shoes can reduce motion through the painful joint, relieve pressure, and can prevent the condition from worsening.

You can also get custom orthotics, or inner soles for your shoes. There are numerous options that you can purchase over-the-counter that are designed for hallux limitus. However, customized orthotics that are designed for your particular feet are likely to lead to better results.

Physical therapy can build muscle in the foot and decrease the inflammation that you suffer. This has produced a marked improvement in many patients with hallux limitus.

There are also steroidal injections that can be administered to the joint that could reduce pain and inflammation. Other medications, like nonsteroidal anti-inflammatory drugs, or NSAIDs, can do this as well.

Reducing your activity can be a big part of hallux limitus treatment, though many active people with the condition bristle at the idea. By taking a step back, though, you can keep the problem from getting much worse.

Finally, icing your big toe, taking pain relievers, and elevating your toe are often a component of a conservative treatment regimen.

If none of these treatments has worked, or if your doctor thinks that your hallux rigidus has gotten too bad for them to stand much of a chance of success, surgery is an option to relieve pain and correct the issue. That surgery is often either a:

  1. Cheilectomy, or
  2. Arthrodesis.

In a cheilectomy, the surgeon would shave down the bone in your metatarsal head, including any bone spurs that have developed. This gives your toe the room that it needs to move the way that it should.

In an arthrodesis, the damaged cartilage in your toe is removed and the two bones that make up your toe joint are fused together using pins, screws, or a metal plate.

The risks and the prognosis after surgery for hallux limitus or rigidus will depend on the severity of the condition and what caused it. However, it is not uncommon for patients to take multiple weeks to start ramping up their activity and several months before they are back to their normal routines. During this time, your doctor will likely recommend that you:

  • Stay off your feet as much as possible
  • Ice the affected foot
  • Elevate it
  • Avoid the types of activities that would cause foot or toe pain

The best way to mitigate the risks of the procedure is to go to all follow up appointments and do all of the foot care practices that your doctor recommends.

What is the Best Way to Keep My Foot Elevated After Hallux Limitus Surgery?

Elevating your foot after a hallux limitus or rigidus surgery is crucial. It can reduce swelling and keep the pain down. Generally, your doctor will initially recommend keeping it elevated over your heart’s level for 30 minutes every 2 hours. Most patients do this by lying down and propping up their foot with pillows.

Depending on the surgery, you may be told to do this for up to 14 days following the procedure.

Talk to a Doctor About Hallux Limitus Today

If you suspect that you have a case of hallux limitus, you should see a doctor as soon as you can. It is best to start treating this condition quickly. If you treat it before it gets too bad, the outcome is often much better and you will not suffer as much pain.