Hallux Limitus

What is Hallux Limitus?

Hallux limitus is where there is a reduction in the normal movement of the great toe. Normal range of dorsiflexion motion of the first MPJ should be 65 to 75 degrees in order to allow for a normal gait.

Normal Great Toe	Hallux Limitus

Causes of Hallux Limitus

Biomechanical dysfunction and trauma are the main causes of hallux limitus.

Trauma from an injury results in damage to the normal articular cartilage resulting in greater wear and tear.

Biomechanical dysfunction also causes degeneration of the great toe joint and occurs with:

• Non- Supportive footwear
• Flat arched feet A flat arched foot causes dorsiflexion of the 1st metatarsal, this results in the movement of axis of the great toe joint. The movement of the joint axis means that there is greater dorsal jamming of the joint.
  

  Dorsiflexion off the great toe as seen in a flat foot results in jamming at the top of the toe.

• High arched feet

Diagnosis of Hallux Limitus

Those that present with hallux limitus will have a reduced movement of the great toe joint. This reduction can either be functional or structural.

• A functional hallux limitus is where the the limitation of movement is eliminated with correction of the mechanical deformity
• A structural hallux limitus is where the limitation of movement persists, regardless of position of the foot. This type of problem will typically occur when there are bony changes to the joint which occurs in longstanding hallux limitus and traumatic hallux limitus

At the Foot an Ankle Centre we are able to provide additional information about the presence of a function or structural with ultrasound imaging.

Typically someone with hallux limitus will have a dorsal exostosis preset as seen in the following picture

Treatment of Hallux Limitus

Treatment differs depending on whether the deformity is structural or function

• A functional deformity is one that can be reduced this can be treated with
  • Orthotic realignment of the 1st metatarsal
  • More supportive shoes
  • Taping
• A structural deformity is where there has been osseous changes in the great toe joint. Treatment to facilitate movement sometimes results in increased pain. If there is significant osseous damage treatment is aimed to reduce the dorsal jamming of the great toe this can occur with
  • Turf toe taping
  • Rocker soled shoes
  • Stiffer more supportive shoes (Birkenstock or a shoe with a similar stiffer forefoot)
  • Carbon fibre orthotic insert
  • Surgical fusion of the great toe.
  • Metal joint replacements rarely work for this condition
  • The artificial cartiva implant is showing some promise although is not available in Australia yet

The Foot and Ankle Centre’s Northcote Podiatrists can help you with all lower limb complaints, including Hallux Limitus. Make an appointment to get your foot and ankle pain under control.

Podiatrists Specialising in the treatment of Hallux Limitus servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston