Hallux Limitus

What is hallux limitus?

Hallux limitus is a condition in which the joint where your big toe meets your foot is painful and stiff. Hallux refers to your big toe. Limitus means limitation.

In the early stage of hallux limitus, you have limited flexibility in your big toe joint (called the first metatarsophalangeal joint). As your condition worsens, your toe joint becomes rigid (doesn’t move) and walking becomes very painful. At this stage, your toe joint condition is called hallux rigidus.

What is functional hallux limitus?

Functional hallux limitus is stiffness and limited range of motion in your big toe joint only when weight pressure is applied to your foot, like when you’re walking or stepping.

It can be tricky to discover if your provider isn’t familiar with this condition. This is because during a non-weight bearing examination, the motion in your big toe joint will be normal.

Who gets hallux limitus?

Hallux limitus affects an estimated 1 in 40 adults over the age of 50. It’s thought to begin in young adulthood. X-ray evidence shows joint changes in 10% of people between 20 and 34 years of age.

What are the symptoms of hallux limitus?

Hallux limitus symptoms, which can occur in one or both feet, are mild or even unnoticed in the beginning and gradually get worse.

Common signs and symptoms include:

• Pain (especially on top of your toe joint), discomfort and stiffness in your big toe joint. Pain worsens when walking or during activities that put pressure on your joint.
• Difficulty bending your big toe.
• Numbness or tingling on the top of your big toe or in your foot from pressure on your nerve.
• Development of a callus under your big toe due to increased pressure.
• Development of a bony lump on the top of your big toe joint.
• Development of bone spurs, which is new bone growth off a joint, as your big toe tries to heal itself after an injury.

What causes hallux limitus?

Causes of hallux limitus include:

• Having a long or raised first metatarsal bone. Also, having other unusual foot anatomy that causes increased pressure on your big toe joint.
• Injuries to your big toe, like spraining, stubbing or breaking your big toe. These injuries can cause bone spurs to form.
• Having osteoarthritis, rheumatoid arthritis or gout that affects hip, knee and foot joints and ultimately how you walk.
• Overuse of toes due to high-impact activities that involve repeated pressure on your toes, such as squatting, running, jumping, soccer, basketball, tennis, gymnastics, dancing or ballet.
• Wearing poorly fitted footwear or high heels, which can add stress on your big toe joint.
• Having a family history of hallux limitus.

How is hallux limitus diagnosed?

Your healthcare provider will ask you about your symptoms, ask if you’ve had any injuries to your foot or big toe, perform a physical exam of your foot or feet, check your toes flexibility and watch how you walk.

Your provider will order X-rays to evaluate the bones in your foot, confirm any bone spurs and loss of cartilage in your toe’s joints.

How is functional hallux limitus diagnosed?

There’s a simple test to identify functional hallux limitus. While sitting with your foot free of shoe and sock and off the ground, your provider will place their index finger under your big toe and push your big toe up (toward your leg). Your toe should move back very easily. They’ll repeat the process, but this time your provider will place the palm of one hand under your foot and their thumb firmly pressed against your big toe joint. Then, your provider will again try to push your big toe up. If your toe doesn’t move much, you may have functional hallux limitus.

This test — with a hand under the sole of your foot and thumb pressing against your big toe joint — mimics weight-bearing as if you are walking. Having limited toe extension with this test indicates that motion with your full weight on your foot will be even more limited.

How is hallux limitus treated?

Your provider will first recommend conservative treatment options to reduce your pain and discomfort.

Recommendations include:

• Wear properly fitted shoes. Shoes that have a wide width across the top of the shoe allow room for your big toe to move and not pinch your toes. Avoid wearing shoes with high heels higher than 1 inch. Shoes that are flat and have a rigid sole or rocker sole (to help reduce the bending of your big toe) are good choices.
• Avoid overuse of your feet. Take frequent breaks and get off your feet and avoid high-impact activities (running, gymnastics, jumping), especially after a foot injury, until your big toe joint heals.
• Use orthotics to help support your feet. Over-the-counter orthotics (shoe inserts) or custom-made orthotics can help support your feet and correct an imbalance in your walk. Ask your provider for a prescription for custom-made orthotics.
• Get physical therapy. Physical therapy methods include traction, manipulation, water therapy (hydrotherapy) and ultrasound.
• Take over-the-counter (OTC) anti-inflammatory drugs. Examples include ibuprofen (Advil®, Motrin®), aspirin (Bayer®) or naproxen (Aleve®).
• Apply ice packs. Apply ice packs to your big toe joint once or twice a day for up to 20 minutes each time.
• Corticosteroid injections. If other conservative treatments don’t relieve your pain, your provider may recommend corticosteroid injections.

How is functional hallux limitus treated?

Functional hallux limitus is treated with:

• Rest, ice and elevation.
• Custom-made orthotics or a carbon fiber insole.
• Physical therapy.

Your provider will discuss the best treatment options for you.

When is surgery considered?

Surgery is usually considered when hallux limitus progresses to hallux rigidus or when conservative treatments haven’t relieved your pain. However, if you have a foot deformity that’s making your hallux limitus worse or if you have severe symptoms, you and your surgeon will decide if surgery is an option.

Surgery options include:

• Cheilectomy (bone spur removal). This procedure involves shaving down bone spurs and shaving some bone on the top of your metatarsal head. Metatarsals are the long bones in your foot that attach to the bones in your toes. Shaving bone gives your big toe the space it needs to move properly and improves the ability to bend the toe while reducing pain.
• Osteotomy. In this procedure, the metatarsal bone of your foot is cut and realigned to correct a foot deformity.
• Fusion (arthrodesis). In this surgery, damaged cartilage (the end surfaces) of the two bones that make up your toe joint is removed and the bones are joined (fused) together. Fusing two bones prevents your big toe joint from moving. The metal pins, screws or plate permanently join these bones.
• Joint replacement (arthroplasty). During this surgery, damaged end surfaces on the bones in the metatarsophalangeal joint are removed and a ceramic or titanium implant is put in place. The implant allows movement in the big toe joint.
• Joint resurfacing (interpositional arthroplasty). In this procedure, some of the damaged bone is removed and a spacer is placed between the bones of the big toe joint to reduce bone contact. The spacer can be soft tissue taken from another area of your body or cadaver tissue, or it can be synthetic cartilage made out of polyvinyl.

Your healthcare provider may consider other specific surgical procedures. You and your provider will discuss if surgery is appropriate for your big toe and, if so, which procedure may give you the best outcome.

What outcome can I expect if I have hallux limitus?

You can improve your chance of preventing further damage to your big toe if you see your healthcare provider as soon as you notice pain and discomfort in your big toe or your feet. Identifying hallux limitus early allows for treatment to begin early.

Can hallux limitus be reversed or cured?

It depends on the cause and the treatment selected. Hallux limitus due to an injury can heal. On the other hand, hallux limitus due to arthritis may not go away and may progress to hallux rigidus.

Nonsurgical treatment can relieve your symptoms, but the pain might come back or get worse. Surgery may provide a permanent solution to pain and stiffness if you have hallux rigidus.

How long does it take to recover from hallux limitus?

The cause of hallux limitus and treatment determine the length of your recovery.

If a high-impact activity or an injury is the cause, rest your foot often and avoid that activity until your joint or foot has recovered. Your provider will recommend how often to rest your foot and how long you should avoid certain activities.

If you had surgery, healing can take weeks and your return to usual activities can take a few months. Your provider will tell you specifically how long your recovery may take depending on the type of surgery you had and the condition of your big toe joint.

A note from Cleveland Clinic

Hallux limitus is a condition that makes it difficult to bend your toe, which makes walking painful. It can worsen over time to the point that the joint in your big toe can no longer move. When this happens, the condition is called hallux rigidus. To slow the progression, make sure you have proper-fitting footwear, use orthotics as directed by your provider, take anti-inflammatory drugs and rest your feet. If you’re still in pain and walking is difficult, talk to your provider about corticosteroid shots and surgical options.