Stiff Big Toe? Hallux Limitus/Rigidus

What is Hallux Limitus/Rigidus?

Hallux (big toe) limitus is a condition of the joint at the base of the big toe called the first metatarsophalangeal joint (1st MTP joint). It causes pain and stiffness, most notably a reduction in dorsiflexion (bending toe upwards) range of motion and is often due to osteoarthritis at the joint. ‘Hallux rigidus’ refers to the final stage of hallux limitus as ankylosis (fusion of the bones) of the joint occurs.

The predominant role of the hallux  or big toe through our walking cycle is to enable dorsiflexion during the push off phase (as the toe is leaving the ground). Around 60 degrees of dorsiflexion of the 1st MTP joint is required for normal walking function, any less than this can lead to issues with walking and potentially cause problems further up the kinetic chain i.e. in the knees/hips/back.

Causes of Hallux Limitus

  • Trauma causing cartilage damage
  • Excessive pronation (foot rolling inwards)
  • Constant weight bearing through the 1st MTP in a dorsiflexed position e.g. On your toes in a deep squat position
  • Rheumatoid arthritis, psoriatic arthritis, gout

Signs and Symptoms

Early

  • Pain and stiffness in the big toe during walking, standing, running, jumping
  • Pain and stiffness that is worse in cold weather
  • Swelling and inflammation around the joint

Late stage

  • Pain at rest
  • Difficulty wearing shoes
  • Pain at other joints knees/hips/back due to altered gait cycle
  • Distinct shoe wear pattern – sole wear between the first and second toe joint

Diagnosis

A diagnosis can usually be made during a clinical examination by your doctor or Physiotherapist. In some cases, they may request an X-ray to assess the degree of degeneration at the joint.

Treatment

Rest- Conservative management consists of an initial offload period whereby you must rest from any aggravating activities.

Medication- Oral non steroidal anti-inflammatory drugs (NSAIDS) eg. Ibuprofen can help to reduce pain and inflammation

Physiotherapy- Your Physio will assess you and provide hands on treatment and exercises to help with mobility, strength and pain.

If you are suffering from toe pain come and see our experienced Physiotherapists here at Bend + Mend in Sydney’s CBD. We will assess your pain and give you a comprehensive management programme to ensure optimal treatment and recovery.

Nicklaus Vincent

About Nicklaus Vincent

Nick graduated from the University of Sydney with a Bachelor of Exercise and Sports Science and a Master of Physiotherapy. Since graduating Nick has worked in a private practice setting in Sydney’s CBD helping patients recover from a variety of acute and chronic conditions. He has a keen interest in extreme sports and all water-based sports, having previously competed at a national level in swimming. Nick is a strong advocate for strength training and pain science and regularly uses dry needling in his hands-on approach to treatment. Nick has worked with grass roots to elite level water polo and enjoys working with patients from all walks of life.

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