Hallux limitus

Hallux limitus is a type of arthritis which affects the joint of the big toe, usually the bunion joint. It is also known as ‘Hallux Rigidus’. Fluid builds up in this joint which causes pain, inflammation and stiffness and difficulty in walking.

This restriction of movement is why it is known as ‘hallux limitus’or ‘limited movement’.

Like any other form of arthritis hallux limitus cannot be cured. The symptoms will become progressively worse but treatment is available to slow down the rate of progression.

Hallux limitus is discussed in the following way:

  • Who is most likely to develop hallux limitus?
  • How does hallux limitus occur?
  • Causes of hallux limitus
  • Symptoms of hallux limitus
  • Diagnosis of hallux limitus
  • Tests for hallux limitus
  • Treatment for hallux limitus
  • Managing hallux limitus

Who is most likely to develop hallux limitus?

Women are more prone to this condition which is often due to the fact that they wear tight, narrow shoes with a high heel. These shoes constrict the joints and throw the body off balance which puts pressure on the spine and joints in the lower half of the body.

What has been found is that hallux limitus develops in people wearing the wrong sized shoe, namely shoes that are too small. These shoes pinch the toes and increase the risk of damage to the joints, leading to conditions such as this.

How does hallux limitus occur?

Basically, it occurs when arthritis develops in the big toe which distorts the shape of the toe and restricts movement.

A joint consists of two bones which are connected by tendons and ligaments and covered a soft white material called cartilage. These help to strengthen the joint. They are located within an outer shell or ‘joint capsule’ and surrounded by an oily liquid produced by this capsule called ‘synovial fluid’.

If the cartilage is damaged then it gradually wears down which means that the bones are able to grind against each other. This friction causes extra bone or ‘spurs’to grow which distort the shape and affect the movement.

This then restricts the movement of these bones and the joint as a whole. The joint is pushed out of its normal alignment which impacts upon the biomechanics of the rest of the body.

This in turn causes pain, swelling and stiffness.

Causes of hallux limitus

The most likely cause is an injury to the big toe which causes this condition to develop over a long period of time. This is usually accompanied by some mild symptoms which tend to worsen over time. This often results in the sufferer developing a misshapen joint around the big toe and difficulty in walking.

Excessive compression of the toes such as those experienced by wearing too tight shoes is another cause.

This condition can develop following a ‘one-off’injury or a series of repeated injuries which gradually wear down the cartilage in the joint leading to this form of arthritis.

Most people tend to develop some form of arthritis at a later stage in life, for example osteoarthritis. But there are people who have inherited a gene for certain forms of arthritis such as rheumatoid arthritis or gout which occur for autoimmune reasons.

Hallux limitus can be caused by an infection or another form of arthritis such as osteoarthritis.

Symptoms of hallux limitus

There are a range of symptoms with hallux limitus which include:

  • Pain in the joint
  • Swelling
  • Redness around the joint
  • Increased size of the joint
  • Stiffness
  • Tendons and/or soft tissues are inflamed
  • Joint becomes misshapen
  • Difficult to walk or put any pressure on the joint

These are the most common symptoms of this condition. You may experience some or most of them and the intensity of these vary between individuals.

Note: arthritis is a progressive condition which means that it will worsen over time. With this condition the joint of the big toe will become enlarged and the stiffness will increase but the amount of pain will remain the same.

In other words it will not become more painful over time which is a common feature of many types of arthritis.

Diagnosis of hallux limitus

If you notice any of these symptoms and are finding it increasingly difficult to walk then see your GP. He or she will ask you about these symptoms before carrying out an examination of your affected joint.

He/she will also ask you a series of questions about your medical history and if anyone in your family has arthritis.

Tests for hallux limitus

X-rays and/or MRI scans will be performed to assess the extent of the damage. This also enables your GP to determine what type of arthritis you have as these symptoms may indicate another type such as rheumatoid arthritis.

The results of these tests will be used to devise a treatment plan for you.

Treatment for hallux limitus

There is no cure for this and any other form of arthritis. Once damage has occurred in a joint (or joints) then the best option is to slow down the rate of progression.

But there are many effective forms of treatment which can do just that. They ease the symptoms and slow this progression which means that you can live a normal life.

This is treated either non-surgically with medication such as anti-inflammatory drugs or cortisone injections. Another option is the drug called ‘Ostenil’: this is a liquid which contains ‘hyaluronic acid’ that restores the consistency of synovial fluid in the affected joint.

This helps to ease pain and stiffness in an arthritic joint.

Surgery is only performed if these fail. This takes two forms: preserving the joint, e.g. Cheilectomy and destruction/removal of the joint, e.g. Keller’s arthroplasty or joint implant.

These and other procedures are discussed in more detail in our surgery for arthritis section.

Other options include visiting a podiatrist who will advise you about suitable shoes to wear, foot exercises and foot splints or orthotics.

For more information about any of these visit our treatment for arthritis section.

Managing hallux limitus

As well as the treatment options mentioned above there are a few things you can do to relieve the symptoms. These include:

  • Avoid wearing high heels
  • Wear shoes which are a good fit and the right size
  • Take exercise
  • Balance exercise with rest periods. Literally, ‘take the weight off your feet’ as and where necessary.

Consider dietary supplements such as Glucosamine which can help to ease any symptoms and minimise cartilage damage.

Remain active as much as possible and do exercises to keep the feet especially the affected joint flexible and mobile.

If your job requires you to stand for long periods of time then arrange to take frequent breaks or ask your employer if you can change duties on a temporary basis.

Find out more about these self help measures in our living with arthritis section.

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