Hallux Limitus/ Rigidus
Hallux Limitus/Rigidus is a gradual condition where the movement at the big toe joint decreases with time. In the early stage, the movement at the joint will have only reduced a little, but as the problem advances the movement becomes less and eventually the big toe joint becomes stiff. The protective tissue around the joint called cartilage can become damaged causing extra bone to form around the joint. This extra bone will restrict movement and will cause pain when walking.
What Is Hallux Limitus/ Rigidus?
Hallux Limitus/ Rigidus is when there is change to the bone that prevents normal movement of the big toe joint.
These changes can be minor with a slight reduction of movement and is known as Hallux Limitus. Hallux Rigidus is when there is a significant reduction in movement and in some cases there can be a complete loss of motion at the big toe joint.
Changes to the big toe joint can affect the ability of your foot to remain stable during walking. This can result in increased pressure through your fore foot and you may develop a bony enlargement on the top of the big toe joint.
Classic signs and symptoms:
-Pain, usually at the top of your big toe joint that worsens with weight bearing activity
-Difficulty bending your big toe
-A bony lump/ soft tissue swelling on the top of you big toe joint that may hurt when it rubs against your shoe
-Numbness or tingling if the bony lump is pressing on your nerves
What causes the problem?
There is no specific cause of Hallux Limitus/Rigidus but there are a number of things that can increase your risk. The most common cause is trauma as this can lead to arthritic changes within the big toe joint. Unusual foot anatomy can also increase your risk. The length of your big toe can affect the function of the joint.
Other contributing factors
- Acute injury e.g. stubbing your toe
- Repetitive trauma with movements that will increase load through the big toe joint i.e. squatting
- Changes in the shape of the bones in your foot that can lead to osteoarthritis in the big toe joint
- Inflammatory diseases e.g rheumatoid arthritis, etc
- Unsupportive/ ill-fitting footwear
- Family history
What can I do to help?
Unfortunately there is no quick or easy fix and your symptoms will not improve overnight. Making simple changes to you lifestyle and footwear choices can help improve your Hallux Limitus/Rigidus pain.
It is important to note that if you have any of the above contributing factors you consider making the necessary changes to your lifestyle to help aid your recovery.
The one person who can help you manage your symptoms is you!
Weight management
Increased weight will place extra stress on the joints and soft tissues in your feet. Losing even a small amount of weight can make a difference.
If you need help with weight-control, you can find information, advice and groups you can join to help you manage your weight better. Follow this link to an NHS BMI Calculator (https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/) to guide you on whether you should consider weight management.
Footwear
It is important to be aware that your big toe joint may not bend enough to accommodate being in certain shoes. High heeled shoes in particular will place further stress on the joint and the soft tissues around it. Wearing a shoe with a stiffer sole and/or a curve at the forefoot area can be more comfortable. The curve at the front of your shoe is called a toe spring and helps to reduce the stress in the joints and soft tissues in your feet when walking.
Pain Management
Pain medication can help reduce your symptoms and allow you to move more comfortably which will aid your recovery. Your community Pharmacist can provide guidance on specific medication or other methods of pain relief (always read the label and manufacturer’s guidelines).
Strengthening and Stretching Exercises
Exercises can help to reduce the tightness in the muscles in the back of your leg and improve flexibility in the foot and ankle. Your podiatrist wil advise you on which exercises are suitable for you.
Strapping / Taping
Strapping/Taping can be a useful short term treatment to reduce painful movement at the big toe joint. Once movement has been controlled you should note improvement in your symptoms. Your podiatrist will advise you on this.
Padding
If the skin on the top of the big toe joint becomes irritated by your footwear, cover the area with a dry dressing (if the skin is broken) or some padding (fleecy web/semi compressed felt) if not. Padding will help reduce the pressure and friction and can be bought from your local pharmacy or online.
Patience
Have patience. Your symptoms should start to improve within three months of following this advice.
What else can be done?
If your pain has not started to improve after a period of three months of following the above advice or if you have any concerns that you are getting worse or notice any changes in the shape of your foot please contact your local MSK Podiatrist via your local health centre.
Frequently Asked Questions
The information below will answer many of the questions you may have in the early part of your treatment. We aim to ensure your specific needs are considered throughout. A shared decision making process is used by our teams. This means you will be informed about the treatment options open to you and the risks and benefits of each option. You will be supported to make a choice about which treatment best meets your needs.
We hope the following questions that have been developed on the back of MSK focus groups will provide you with some answers and key information around your condition.
• What is wrong? Why? What is the cause? Hallux Limitus/Rigidus is a gradual condition where the movement at the big toe joint decreases with time. In the early stage, the movement at the joint will have only reduced a little, but as the problem advances the movement becomes less and eventually the big toe joint becomes stiff.
The exact cause is unknown. Inherited factors (runs in the family) trauma and ill fitting footwear are all known causes.
• What is the possible impact on my health and function? Hallux Limitus/Rigidus can cause pain when walking and you may have difficulty finding comfortable footwear.
If the skin on the top of the big toe joint becomes irritated by your footwear, cover the area with a dry dressing (if the skin is broken) or some padding (fleecy web/semi compressed felt) if not. Padding will help reduce the pressure and friction and can be bought from your local pharmacy or online.
• Will I get better or worse? The good news is that your pain should start to improve once you start following the above advice. The aim is to reduce the pressures around the big toe joint.
If you have any concerns that you are getting worse or notice any changes in the shape of your foot please contact your local MSK Podiatrist.
The one person who can help you get better is you!
• How long will it take to get better? Your symptoms should start to improve within three months of following the above advice.
• What are you (the health professional) able to do about my problem? By using our self-help tool, we would like to help you to better understand your condition and provide you with the tools which should help support your recovery.
• What is the treatment that is most appropriate for me? Treatment protocols for Hallux Limitus/Rigidus always start with basic principles and we would encourage you to consider trying some self-help treatment in the first instance before making a referral to your local Podiatry department.
• What can I do to help myself to alleviate it? We would encourage you to consider trying some self-help treatment in the first instance. If you have any concerns that you are getting worse or notice any changes in the shape of your foot please contact your local MSK Podiatrist via your local health centre.
• Why am I not improving? Where have I gone wrong? Am I doing the right things? There may be a number of reasons why your symptoms may not be improving within the three months of following the self-help advice. When this is the case we would advise you to make contact with one of our MSK Podiatry clinics for further advice/assessment. This can be done by either by completing a self-referral form in person at your local Health Centre.
• How can I maintain my function and do the things I want to and need to do? If you are in pain do not try and do all your normal daily activities such as housework at once. Break the harder jobs down into smaller time frames and do something gentler in between. Extensive walking or standing should be avoided if it may aggravate your pain. It is recommended to modify activities rather than to fully stop all forms of movement or exercise. Work out what you can do relatively pain free and use that as a starting point. Then over time, build up your activity. Track and write down your progress to keep you motivated.
• What activities can I do and how should I adapt them (e.g. sports, work)? Avoid high impact activities like running which will significantly increase the load through the big toe joint. We would encourage you to participate in low impact activities like walking, swimming, cycling etc, until the pain is at a manageable level.