Advancement in Treating Hallux Limitus/Rigidus & Arthritis of the Great Toe Joint

There has been a great deal of advancement in the treatment of great toe arthritis also known as hallux limitus or hallux ridigus.  The terms commonly used are referring to the latin for limited to no motion which is the main complaint that patients will have when they present to our office.  There is no clear understanding of the cause of hallux limitus/rigidus, but the main understanding is it may be due to trauma or chronic mechanical overload of the joint with abnormal weight bearing. The limited motion in the great toe joint is due to bone spurring and arthritis of the joint which causes jamming and pain.

 

Hallux Limitus Presenting Symptoms:

• Limited motion of the great toe joint.
• Stiffness of the great toe joint
• Pain in the great toe joint.
• Swelling of the great toe joint.
• Cracking or grinding in the great toe joint.

 

What is commonly noted is that the patient will present initially with mild complaints and can often be treated with shoe modifications and orthotics or custom insoles. Patients will often state that this improves their pain because they are not placing as much weight through the great toe region.  However, over time, a certain number of patients will get increasing pain as the arthritis gets worse resulting in arthritis. The diagnosis is made with examination and x-rays of the foot to see the level of arthritis and joint damage to the great toe.  It is rare but in some cases of local cartilage damage of possible cartilage lesions of the great toe, an MRI may be performed.

In most cases, surgical treatment of bone spurs and great toe arthritis is necessary.  As the arthritis gets worse, the surgery is more difficult and requires more invasive options.

 

 

Advancements in surgical options for hallux limitus/rigidus are growing and getting better and better.  We feel at this point that we have excellent options to offer patients and have come up with multiple treatment options to fit our patient’s needs.

 

 

 

 

Advanced Hallux Limitus/Rigidus Surgical Treatment are:

• Cheilectomy of bone spur removal
• Osteotomy for realignment and joint decompression
• Midfoot fusion for 1st metatarsal repositioning
• Hemi base implant joint resurfacing
• Hemi head implant joint resurfacing
• Great toe fusion

 

 

 

 

 

Each choice has given positive and negative aspects.  In general, early cases of spurring with limited joint damage do well with cheilectomy.  As the problem proceeds, we tend to have less cartilage to work with which then requires implant or great toe fusion options to be used.  If the 1st metatarsal bone is very loose and seems to be drifting upwards resulting in jamming of the great toe joint, then a fusion of the metatarsal at the base is a good option to realign the first metatarsal and prevent the jamming at the great toe joint.

 

 

The doctors at University Foot and Ankle Institute have written three published articles regarding arthritis of the great toe, hallux limitus and hallux rigidus.  These can be read by clicking on the links below.

docs/whensesamoidpaincomplicateshalluxlimituscases.pdf

docs/keyinsightsontreatinghalluxlimitus.pdf

http://www.podiatrytoday.com/emerging-advances-treating-great-toe-arthritis

University Foot and Ankle Institute of California has extensive experience in the treatment of hallux limitus/rigidus and great toe arthritis.  We are well versed in all treatment options for great toe arthritis including spur removal, osteotomy, fusion and implant options.  For more information or to schedule an appointment with one of our doctors, please call 877-677-0011 or visit our hallux limitus/rigidus information page.