Pain in the Hallux or “Big Toe” can be caused by a few reasons. A fracture, Ingrown nail, Gout or a condition called Hallux Limitus. This condition is caused by a reduced range of motion in the big toe joint, which can progress and lead to pain, further reduced range of motion and even bones spurs to form, becoming Hallux Rigidus. 

[Images showing anatomy of the foot from footeducation.com and drtompkins.com]

 

The hallux and the 1st MTPJ (Metatarsal Phalangeal Joint) both play important roles in your ability to walk! The hallux functions as a lever in the foot that pushes of against the ground during the gait cycle. The MTPJ allows the hallux to achieve the necessary amount of movement that it needs to bend the foot and create forward propulsion. 

(This picture from bunionclinics.com shows the clinical presentation of Hallux Limitus and Rigidus) 

There are a number of suspected culprits for this condition. Since the problem lies at an articulation of two bones, arthritic changes are suspected. (Either from Rheumatoid Arthritis, Osteoarthritis, Gout or another Inflammatory condition.) Trauma to the area, Ill fitting shoes and genetics may also play a role in developing hallux limitus. Another condition that mimics this pain is “Turf-toe”, in which the ligaments at the base of the big toe are torn or damaged.

Treatment options tend to vary, depending on the severity of the deformity. While the less severe cases tend to be treated more conservatively in the beginning, the late stages almost always require a surgical intervention.

Conservative / Non-surgical Treatment Modalities

Orthotics may help prevent the first metatarsal from being pushed down so much, and therefore hopefully decrease some of the “jamming” of the MTPJ.

Non-Steroidal Anti-Inflammatory Medications will help reduce some of the pain and swelling around the affected joint.

Transitioning from activities that involve the action that causes pain will also help reduce further damage to the joint and alleviate discomfort.

Surgical Interventions

A Cheilectomy may be performed in order to remove the osteophytes or bone spurs surrounding the MTPJ or even a portion of the metatarsal head to allow for more space to flex the toe.

Joint Resurfacing may also help with reducing pain and swelling in the area.

Arthroplasty may be a good choice if the joint is not completely damaged. This procedure involves inserting a replacement joint for the hallux. There are several different options including a hemiarthroplasty (half) or full implant.

Arthrodesis or Fusion of the joint may be a last resort in your Podiatrist’s arsenal against MTPJ pain.

 

Which procedure is performed and the subsequent, if any, complications are usually unique to your individual case.

Hallux Limitus can be an annoying and even debilitating condition that can be addressed easily and usually with a favorable outcome by your Podiatrist!

 

References:

Cook E, Rosenblum B, Landsman A, Giurini J, Basile P. Meta-analysis of first metatarsophalangeal joint implant arthroplasty. J Foot Ankle Surg. 2009; 48(2):180-90.

Martins, Darryl J., DPM. "Current Insights On First MPJ Implants." PodiatryToday. N.p., Apr. 2011. Web. 25 Aug. 2014.

Hatch, Daniel. "DJD & Hallux Rigidus." - Foot & Ankle. N.p., 26 July 2014. Web. 27 Aug. 2014