Hallux Limitus/ Rigidus is a condition where the big toe joint degenerates and becomes stiff and arthritic. The hallux (big toe) needs to flex upward and downward at the first metatarsal phalangeal joint (big toe joint) to function normal. Due to certain conditions such as trauma/ injury, genetic predisposition to faulty structure, generalized (whole body) arthritic conditions or prior surgery, the big toe joint may start a process known as degenerative joint disease. This progressive condition leads to wearing out of the articular cartilage (the pearl white shinny tissue seen where two bones form a joint), and the big toe joint starts to become stiff and painful to move. Once the body recognizes that this process is occurring extra bone is laid down around the joint (bone spur) to begin a process of fusing the joint solid thus no motion, no pain. While this process is occurring pieces of the extra bone can break off into smaller fragments and cause pain to the joint.
Hallux limitus is more common in men than women but plenty of active women are diagnosed with the condition. It consists of four stages. Most people are unaware of any symptoms in stage one other than possible progressive joint stiffness. Many present for treatment in stage two as the joint becomes more painful to move and fracture fragments may start to jam the joint. If left untreated as one progresses toward stage four the joint becomes very stiff and bulbous as the body places bone around the joint in an attempt to fuse it (no motion, no pain). Small amounts of motion though stiff occurs and the poor quality of this motion combined with extensive bone spur development (some pieces may even be fractured) can lead to extreme pain with ambulation.
Treatment is patient specific depending on age, activity level, type of employment, stage of condition, prior treatment, shoe choices, and expectations. Hallux limitus is progressive over time and is not reversible. Non-surgical treatments may alleviate pain and slow progression. Stiff sole shoes with an appropriate orthotic (shoe inlay) may off load the great toe joint and support the transverse and longitudinal arch of the foot. Anti-inflammatory medications and injections into the joint can temporarily ease symptoms. Self-directedor formal physical therapy may help improve function, decrease swelling, and increase local blood flow. As the condition progresses with increased pain and decreased function, surgical options are usually considered. If it is possible, an attempt is made to reconstruct the degenerative joint to reduce the stage of the condition. This preserves ones natural joint and although far from perfect may function pain free for many more years. As one advances to stage three or four, reconstructing ones joint may not be possible and joint destructive procedures such as a joint implants or surgical fusion need to be considered. Joint implants may be limited to a select type of person. Joint fusion (arthrodesis) is a very powerful procedure to eliminate pain and still allow for a high level of activity. Joint fusion requires a committed rehabilitation and understanding that adjacent joints can be affected in the future.
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