Hallux Limitus vs. Hallux Rigidus: what's the difference?

In this video we explain what Big Toe Arthritis, stages of the disease and advanced treatment options at UFAI.

Depending on what stage of arthritis has affected your big-toe joint, your doctor will refer to earlier onset as Hallux Limitus or more-advanced onset as Hallux Ridgus (once the joint becomes almost unusable)

 

UFAI, the best choice for state-of-the-art Big toe arthritis care.

 

We're at the forefront of big toe arthritis treatment. The leading surgical implant was developed with UFAI and we teach foot surgeons throughout the nation how to perform the procedure

 

We offer a full level of care including conservative treatment, a full spectrum of diagnostic imaging including digital x-rays, MRI and CT scanning services and a dedicated foot and ankle physical therapy and surgical options.

What is Hallux Limitus and Hallux Rigidus?

Hallux Rigidus Surgery Before and After Picture, University Foot and Ankle Institute
The "after" picture taken immediately after surgery. Notice the increased range of motion.

The 1st metatarso-phalangeal joint is seen by looking at the base of your big toe. Hallux Rigidus and Hallux Limitus begins when your range of motion in the big toe is impaired and, left untreated can advance to a point when the joint becomes completely frozen.

 

The result of either of these conditions is pain in the big toe. The condition is often the result of a previous injury to the toe, perhaps one considered “old news” when discomfort begins years later. In fact, Hallux Limitus (a type of osteoarthritis), may not even show up if an x-ray is taken. But as the joint maintains its ability to bear weight, functional flexibility can begin to wane.

 

Early signs of discomfort occur when the fibro-elastic tissue covering the head of the metatarsal and the base of the phalanx begin to wear. This tissue (cartilage) allows for fluid motion at the joint surface, thus free and unrestricted motion at the joint.

 

Symptoms of Hallux Limitus and Hallux Rigidus

Hallux Limitus Symptoms include:

  • Pain and stiffness in the big toe when it is pushed upwards.
  • Swelling and inflammation of the joint, especially on the top of the joint.
  • Discomfort that occurs when the weather is damp or cold. 
  • A feeling of "tightness" in and around the joint.

 

Hallus Rigidus Symptoms include:

  • Constant big toe joint pain, even when at rest. Irritation when the joint is moved up and down.
  • A bump, or "hardness" at the top of the joint. If left untreated this bump (bone spur) becomes more pronounced.
  • Difficulty wearing shoes, especially high heels
  • Eventually, even walking becomes difficult, causing limping, pain in other parts of the foot, discomfort in the knee and hip, and weight gain due to decreased exercise.

 

Behavioral Causes of Hallux Limitus and Hallux Rigidus

Some Behaviors that can cause premature cartilage deterioration:

  • Wearing High-heel shoes

  • Wearing poorly fitting shoes
  • Squatting for long periods of time
  • Stubbing the big toe
  • Poor running techniques

 

Non-behavioral Causes of Big Toe Arthritis

There are things that can cause or contribute to big toe arthritis that you cannot do anything about, including:

 

Age-related changes

Hallux Limitus, Big Toe Arthritis - UFAI

Many times impairment to the joint below the big toe is simply caused by age and normal wear and tear. Fact is, every joint in our body deteriorates to some degree with age.

 

Genetics

Sometimes you really can blame your Mother or Father (though telling them is certainly not going to help)! Some physically inherited factors are known to contribute to, or even cause, big toe arthritis, Examples include:

 

Pronation

When the foot rolls outward at the ankle, a person uses too much of their inner foot when walking, causing excessive weight and pressure on the big toe joint. Eventually, pronation causes the cartilage in the joint to compress.and wear down. 

 

High arches

When a person with high arches steps forward there is too much weight on the bottom of the foot. This forces excessive weight on the toe joint, causing compression, deterioration and tearing in the joint.

 

Elevated big toe

When the big toe is elevated there is excessive downward pressure with every step. The big toe remains in a flexed position, causing the big toe joint cartilage to experience excessive force. Over time, this results in a thinning and wearing down of the joint cartilage.

 

Abnormally long big toe

This increases stress on the big toe joint, especially if you are wearing shoes that are too tight or high heels. The joint cartilage becomes pinched between the big toe and the metatarsal, causing premature wearing and deterioration of the cartilage.

 

Tips to Prevent or Minimize the Effects of Arthritis in the Big Toe 

 To defer further damage to the big toe joint, try these suggestions, sooner rather than later:

 

Hallux Limitus Treatment Options, University Foot and Ankle Institute
UFAI's Dr. Bob Baravarian discussing Hallux Limitus in Podiatry Today.

Wear shoes that fit correctly

Sometimes appearance or style fails to take your feet into account. Consider width, length, heel height (no greater than 1 inch), and rigid soles.

 

Stabilize your foot

This prevents pronation. When pronation is controlled, the big toe no longer bears excessive weight. We suggest medial wedges, deep-heel cups and posts (stabilizers).

 

Support higher arches

This relieves excess pressure on the big toe joint, avoiding compression and force.

 

Stabilize you big toe

This will help to reduce the excessive jamming back of the big toe into the joint cartilage.


Wear Custom Ortothics if you suffer from, or are predisposed to foot pain

Orthotics provide shock and arch support and can help with a range of foot problems. It is essential that whomever makes your ortotics utilize the latest equipment to ensure comfortable and effective protection.  We design and construct our custom orthotics to stabilize the foot, each tailored to our patients individual condition.

 

In the case of our Hallux Limitus and Rigidus patients, our orthotics will gently prevent the big toe from "pushing" forward and help alleviate the associated pain from this condition. Our orthotics fit in any shoe with a heel height up to one and a half inches. It is essential to reduce the wear and tear on your toes before the condition starts or to prevent further damage.

 

Choose UFAI for the Treatment Big Toe Arthritis

University Foot and Ankle Institute is at the forefront of big toe arthritis treatment. We offer a full level of care including conservative treatment, a full spectrum of diagnostic imaging including digital x-rays, MRI and CT scanning services and a dedicated foot and ankle physical therapy and surgical options.

 

By offering a full spectrum of work up, conservative, surgical and recovery options, we are truly taking care of you in a state of the art manner without the need to go from place to place. We treat patients like family while providing world-class care.

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Frequently Asked Questions about Hallux Limitus and Hallus Rigidus

 

Q: I think my child has hallux limitus. He is only 12 years old; can you diagnose hallux limitus on a patient that young?

A: Yes, we can diagnose and begin treating hallux limitus at any age.

 

 

Q. Do stem cell injections help with Hallux Limitus? What is the success rate?

A. Stem cell therapy works well in the early stages of hallux limuts with pain relief in 70-80% of patients. Unfortunately the spurs in the joint can continue to cause damage.

 

 

Q. I have heard that arthroplasties of the big toe don't last long and that the Cartiva implant is a great option for hallux rigidus. Can you tell me how long the Cartiva implants last?

A. The Cartiva Implant has the potential to last for 20 years. It is too new to know for sure, but conversion to fusion is very easy so that is always an option, if needed, as time goes by.

 

 

Q. I am a hiker (and former runner). I developed hallux rigidus 8 years ago in both big toes and had cheilectomy surgery. I got some relief from the surgeries, but am now back to pre-surgical pain. Are there any new procedures that can help with range of motion and pain, other than fusing the joint?

A. Yes, there is a new gel implant called Cartiva and is part of our Gel-Toe Protocol for Toe Arthritis. The Cartiva implant has been shown to reduce pain, improve range of motion and quality of life to our patients. It is a great option for both joints that have been previously operated on and those that have not. University Foot and Ankle Institute was a leader in the development of this new implant. You can view us discussing this procedure on ABC news by clicking here.

 

Have a Hallux Limitus question we should add to our FAQ's? Please let us know by clicking here.

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