The problem occurs at the 1st metatarsal head and the base of the 1st proximal phalanx. The fibro-elastic tissue that covers the head of the metatarsal and the base of the phalanx is known as the articular cartilage. The cartilage allows for fluid motion at the joint surface and good cartilage allows free and unrestricted motion at the joint.
Early Symptoms/Diagnostic Signs (Hallux Limitus):
· Pain and stiffness in the big toe when it is pushed upwards, as occurs when we walk, run,
squat, and stand on our toes.
· Swelling and inflammation of the joint, especially on the top of the joint.
· Discomfort in the joint that occurs when the weather is damp and cold.
· A feeling of ""tightness"" in and around the joint.
Later Symptoms/Diagnostic Signs (Hallux Rigidus):
· Pain in the joint that is almost constant. May even be felt when resting and the shoe has
· Crepitus, or a ""grinding"" feeling in the joint when the big toe is moved up and down.
· A bump, or ""hardness"" can be felt on the top of the joint. Eventually, this bump which is actually a bone spur, becomes large enough to be seen with the naked eye.
· Difficulty wearing shoes, especially high heels, due to the bone spur and stiffness of the big toe joint.
· Walking becomes so painful that we try to walk without bending the big toe. This can cause:
o Pain in other parts of the foot, as we try to throw our weight off of the big toe on to the adjacent
foot structures. In this way we try to limit bending of the big toe as we walk.
o Pain in the knee, hip, and lower back due to changes in the way we walk.
o Weight gain due to lack of walking and exercise, because of this pains.
Hallux Limitus and Rigidus are due to a premature ""wearing down and tearing"" of the cartilage in the 1st metatarsal-phalangeal joint. As the cartilage begins to wear down, the proximal phalanx of the big toe, and head of the metatarsal begin to rub against each other. Without the protection of the cartilage between these bones, each time the toe is moved, friction and pain occur. Each step that is taken causes more deterioration of the joint cartilage. Continued deterioration of the cartilage results in:
Osteoarthritis, or degenerative joint disease, is a term that is used to describe the progressive deterioration of the cartilage in a joint. Therefore, Hallux Limitus and Hallux Rigidus can be thought of as osteoarthritis of the 1st metatarso-phalangeal joint.
What causes the cartilage to deteriorate?
· Repetitive Injuries to the joint occur when the big toe is repeatedly jammed backwards, with force, against the joint cartilage. This retrograde pressure on the cartilage causes the cartilage to prematurely wear down and tear. Some of the most common causes of this type of injury include:
o Frequent wearing of high heel shoes.
o Wearing shoes that are too short.
o Squatting for long periods of time.
o Stubbing the big toe.
o Improper running technique. Running on your toes, so that your heel does not touch the ground.
o Dropping a heavy object on your big toe joint.
· Age-related changes of the big toe joint, or osteoarthritis. Osteoarthritis, or degenerative joint disease, is the most common form of arthritis that affects human beings. It is due to the normal wear and tear that our joints undergo during our lifetime. This disease produces a gradual deterioration of the joint cartilage throughout our entire body, including the big toe joint. The saying is true: "If you live long enough, you will develop osteoarthritis."
As we age, and osteoarthritis sets in, we begin to notice stiffness, swelling, and a little pain in all of our joints. One of the most common sites that this occurs in is the big toe joint. As osteoarthritis progresses, and the cartilage in the big toe joint deteriorates more, we begin to notice more and more of the symptoms of Hallux Limitus at first, and Hallux Rigidus later on. As mentioned earlier, this problem often manifests in younger patients due to athletic injury or even something as simple as dropping something on the affected area.
· Hereditary Defects are those defects that we are born with, which predisposes us to Hallux Limitus/Rigidus:
o Pronation occurs when the foot rolls outward at the ankle, causing one to walk more on the inner border of the foot than is normal. As we walk, pronation causes us to place excessive weight and pressure on the big toe and big toe joint. When the big toe joint needs to work harder to help ""push"" us forward every time we take a step, due to the extra weight placed on it, the joint cartilage becomes overly compressed. Eventually, this causes the cartilage to prematurely wear down, resulting in the symptoms of Hallux Limitus.
o Feet with high arches are usually more rigid than normal, and will not allow the high arch to come into contact with the ground when we step down. Therefore, as we step forward, all of our weight is thrown on to the balls of the feet, rather than some of the weight being carried by the arch. This will force the bones and joints in the balls of the feet to bear excessive weight, especially the big toe joint. The results of this repetitive and excessive weight on the big toe and big toe joint result in compression, deterioration, and eventually tearing of the joint cartilage. As this continues, the signs and symptoms of Hallux Limitus appear.
o An elevated first metatarsal causes the big toe to excessively flex (push downward) with every step we take. When the big toe is in a flexed position and strikes the ground, it is jammed back into the big toe joint cartilage with excessive force, or retrograde pressure. Over time, this results in a thinning and wearing down of the joint cartilage. As this continues, the individual begins to experience the symptoms of Hallux Limitus.
o An abnormally long first metatarsal increases stress on the big toe joint each time the big toe ""pushes"" us forward. This stress is further increased if the shoe is too short or the heel is too high, as this forces the big toe back into the joint cartilage with excessive force. The joint cartilage becomes pinched between the big toe and the metatarsal, causing premature wearing and deterioration of the cartilage. This results in the uncomfortable symptoms of Hallux Limitus. (In most instances you can determine if your first metatarsal is too long by the fact that the big toe appears too long, in relation to your other toes). This also applies if the 2nd metatarsal is very short creating an abnormal parabola thereby increasing stress on the 1st metatarsal joint.
Self-Treatment or Prevention: The old adage, ""An ounce of prevention is worth a pound of cure,"" is most apropos when trying to prevent the devastating effects of Hallux Limitus and Rigidus. If this disease is not prevented or treated in its earliest stages, it may produce such debilitating pain and deformities that surgery will be required to allow the foot to function normally again.
Long Term Treatment must be directed towards:
· Stabilizing the foot. When the foot is maintained in its normal, or neutral position, it
cannot pronate and roll out. When pronation is controlled, the big toe no longer bears
excessive weight. This reduces forceful and destructive compression of the cartilage in
the big toe joint. Thus, the big toe joint remains healthy.
· Supporting high arches in order to relieve excess pressure on the balls of the feet,
especially the big toe joint. When the big toe no longer must bear excessive amounts of
weight as it ""pushes"" us forward, the big toe joint cartilage is protected from
excessive compression and force. The result is a healthy joint cartilage, free of deterioration
· Stabilizing the big toe, and preventing it from ""over-flexing,"" as it pushes us forward.
This will help to reduce the excessive jamming back of the big toe into the joint
cartilage. Without this jamming effect, the cartilage remains healthy and intact.
· Providing shock absorption for the foot. The arches of our feet are our body's main
shock absorbers. As we take each step, the arch of the foot helps to absorb and disperse
the tremendous force that occurs when our foot strikes the ground. This force can equal 3 to
7 times our body weight, depending on whether we are walking or running. When the arch
is higher than normal, shock absorption by the arch is reduced. When this occurs, the big
toe, ball, and heel of the foot, must absorb this shock. The effect on the big toe is to
over-flex, or to be jammed back into the joint cartilage with excessive force, which may
cause the cartilage to wear down prematurely and unevenly.
Custom-Made Orthotics are considered to be the "Gold-Standard" of medical treatment, especially in the prevention and early stages of Hallux Limitus/Rigidus. Our custom-made orthotics for this condition are constructed of thin, comfortable, shock absorbent "space age" materials, which gently and effectively:
· Stabilize the foot
by using uniquely placed medial wedges, deep heel cups, and "posts"
(stabilizers). When the foot is stabilized, it is brought back to a neutral or normal alignment.
When the foot is in its normal alignment, pronation is reduced or completely corrected, and, the
big toe is no longer forced to bear excessive body weight. This prevents abnormal wear and tear
on the big toe cartilage, and helps to stop or prevent Hallux Limitus/Rigidus from occurring.
· Provide the specific amount of arch support
that your foot requires. Our custom-made orthotics
support not only the arch as a whole, but each individual bone and joint that forms the arch.
When the arch is properly supported, it is allowed to function in providing optimal shock
absorption for the foot, especially to the big toe joint. This will reduce the wear and tear on
the joint cartilage.
· Stabilize the big toe
and limit its movement during the gait cycle. This is accomplished through
the use of a uniquely placed ""stabilizer"" called a Morton's Extension
. It is embedded in our
custom-made orthotics, and placed under the 1st metatarso-phalangeal joint and big toe. It is a
semi-rigid platform, which is covered by a padded material to ensure comfort. This Extension limits
the motion of the big toe joint, thus reducing or eliminating pain. It works in two ways:
o It reduces/or prevents the big toe from bending and pushing us forward as we walk or run.
o Its shape allows for a slight tilting of the forefoot that ""off-loads"" the weight from
the big toe to the remaining structures of the forefoot and toes. When this occurs, the
big toe is allowed to ""rest,"" while the orthotic itself, and the other foot structures take
over the job of the big toe.
Reducing movement of the big toe, as well as the amount of weight it must bear results in
a reduction or complete elimination of:
· Joint cartilage destruction.
· Bone spur formation around the big toe joint.
Walking can become fun again.
The lighter tan material is the Morton's Extension. It extends under the big toe and 1st meatatarso-phalangeal joint.
Custom-made orthotics for Hallux Limitus and Rigidus
are constructed of durable, comfortable, shock absorbent "space age" materials. From the impressions of your feet that you make with our Foam Impression Kit, and the information you provide us with, we design and construct a pair of orthotics that will help to stabilize your feet, gently prevent the big toe from ""pushing"" us forward when we take a step, and help to alleviate your foot pain. These orthotics will fit in any shoe with a heel height up to 1 1/2 inches . For information on how to order these uniquely effective custom-made orthotics, click here
All conservative treatments begin with the shoes that you wear. While shoes may help to reduce the pain of Hallux Limitus and Rigidus, they do not seem to prevent this disease from becoming worse. This is due to the fact that shoes wear down quickly, and whatever soothing effects they may have when they are new, are quickly lost as they wear down. This is one reason why custom-made orthotics are more cost effective than orthopedic shoes…custom-made orthotics last for years without breaking down, while shoes do not.
Make sure that your shoes are:
- Wide enough across the ball of the foot and toe area, so that there is no pressure on the big toe and its joint.
- The shoes must be long enough in order to prevent pressure on the tip of the toe.
- The heel of the shoe should be no higher than 1"".
- The sole of the shoe should be rigid, in order to reduce bending of the big toe when walking.
Immediate Treatment must be directed towards reducing the inflammation, swelling, and pain in the big toe and its joint, the 1st metatarso-phalangeal joint. In the very early stages of Hallux Limitus, the following self-help treatments may be effective:
- Rest the foot by keeping weight off of it. Each time you take a step, the big toe joint is aggravated and abused. It cannot calm down if you do not keep weight off of the foot.
- Shoes can help to protect the big toe joint if they have the following features:
- A rigid sole. This will help to reduce bending of the big toe with each step that is taken.
- A wide and deep toebox keeps pressure off of the big toe and swollen joint.
- A flat shoe reduces compression and injury of the big toe joint cartilage. High heels and short shoes jam the big toe back in the joint with excessive force, causing destruction of the joint cartilage.
- Proper length shoes will also go a long way in reducing jamming of the big toe into the joint cartilage.
- Reduce pressure on the big toe joint. Use a soft gel pad to cushion the ball of the foot and reduce pressure on the big toe joint. Dr. Jill's self-stick pads make for easy application, and are re-usable. Click here for more information.
- Soaking the foot in warm water may help to soothe the inflamed and painful big toe joint. The soaking water must be comfortably warm and not hot, as hot water will usually cause discomfort, skin burns, and increased joint inflammation and swelling. Soaking for 10 to 15 minutes two or three times a day is usually suggested. If soaking increases pain, swelling, or inflammation, stop immediately.
- Gentle massage with a topical pain reliever can help to provide comfort. By combining the pain relieving properties of Tripod Labs Flexstat Topical Pain Reliever with gentle massage, pain, swelling, and inflammation can be reduced or eliminated.
If the pain becomes worse, the foot more swollen or inflamed, or if you think that you have a serious problem, see a doctor immediately.