Hallux Limitus/Rigidus (Osteoarthritis)

What causes hallux limitus/rigidus?

Often there is no definite cause. As part of normal life, your joints, including the big toe joint, are exposed to a constant low level of damage. In most cases your body repairs the damage itself and you do not experience any symptoms. However, in some cases, the cartilage becomes progressively thinned and damaged causing the pain and stiffness leading to Hallux rigidus/limitus.

Past injury, such as a sprained or broken toe, and certain foot types may predispose to an early altered wear and repair process. Hallux rigidus can also be secondary to gout or other inflammatory conditions that can cause damage to the joint.

What are the symptoms?

The main presenting complaint is pain and stiffness especially when the toe is bent, although some people may have a stiff big toe without pain. There can be localised swelling in the soft tissues around the joint and it may increase in size. 
This can be a problem in certain occupations or activities where the big toe is required to bend. Having stiff big toe changes the way you load the foot and can also give rise to pain in other areas of the foot and lower limb.

• Occasionally shooting pains, burning or tingling sensations can occur as part of the inflammatory process.
• Footwear can be limited as the bone bump that forms over the toe joint can result in irritation of the overlying skin causing pain and limiting footwear choices. The stiff big toe also limits the heel height you can wear.

What treatments are available?

The following advice is recommended as first line treatment and should help reduce your symptoms.

Footwear

• Wearing shoes with a deep toe box will prevent irritation of the skin overlying the bony bump on the toe. Avoid shoes with stitching around or over the joint as this can cause compression and aggravate the joint. Avoid thin-soled, flexible shoes and wear a low-heeled shoe, (not too flat) with a firm/stiff sole.
•  A rocker soled shoe is likely to help, by reducing the movement of the toe limiting painful movement in the big toe.
  • See Footwear advice link below

Exercises

To help with foot function and reduce load on the front of the foot when we walk we need a good range of motion at the ankle joint. If the calf muscles are tight, it is important to stretch these. 

• • See Calf stretches seated and standing link below.

Exercising the foot muscles can help with improved balance and strength.

• • See Intrinsic foot exercises link below.

Activity Modification

Activity is encouraged although adaption may be needed. High impact exercises may need to temporarily be replaced with lower impact activities such as swimming or cycling. Avoid activities where the toe is bent.

Pain Relief

• Using a heat pack on a painful joint may help the pain and stiffness.
• An ice pack may also help. It is important to wrap with a cloth and do not apply directly to the skin for both heat and cold.
• How long you use heat or ice as a treatment may vary. However, you should generally apply heat or ice for up to 15 minutes. You should also leave a few hours between treatments. You should stop treating if you notice redness, discolouration or blistering of the skin.
  Avoid both if diabetic or in doubt if you have poor circulation or loss of feeling in your feet.
• Over the counter painkillers such as paracetamol or topical anti-inflammatory gels may ease the pain, always follow the instructions on the packet or speak with your local pharmacist if in doubt.

More information on pain relief.

• • See NHS Inform About pain relief link below.

Taping

This is a simple self taping that gently restricts some of the movement in the big toe.

• • See Hallux Rigidus/Limitus taping link below

Insoles/Orthoses

Insoles/Orthotics may be of some benefit by off-loading the big toe joint reducing the flexibility of shoes. If the range of motion at the toe joint is very limited a carbon fibre insole or Morton’s extension rigid insole can be tried. It provides rigid support and strong stability to your foot. (These can be purchased online).

When to seek help

If you try the advice as recommended for 6 weeks and you are still experiencing pain or your symptoms are worsening a referral to the podiatry department may be appropriate. Continue with the above advice until your appointment.

Podiatry referral

Surgery

If following all podiatry interventions you continue to experience significant pain, your podiatrist may recommend referral for an Orthopaedic opinion to discuss surgical options available to you. Surgery should only be considered if ALL non surgical interventions have been unsuccessful.