Hallux Rigidus/Limitus

Medical terminology: degenerative arthritis of the 1st toe

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Hallux rigidus/limitus is a disorder of the big toe joint. Due to joint wear and tear (or trauma) over time, degenerative arthritic changes happen within the joint causes stiffness and pain. This condition usually starts with a small decrease in joint motion (hallux limitus) and as the condition progresses and arthritic changes increase, the joint eventually becomes stiff and completely rigid (hallux rigidus).

This condition usually occurs due to structural abnormalities of the foot (genetics or ill-fitting footwear) or faulty function (bad biomechanics/use of the big toe). These issues cause excessive stress on the joint which damages it and starts the arthritic joint changes which continue to progress with joint use.

Hallux rigidus/limitus can be a debilitating condition because it affects every day activity. Due to the importance of the big toe in the way we move, any motion in the big toe will suddenly become painful and unbearable. Depending on the amount of degenerative arthritic changes, some patient’s may require surgical intervention to fuse or replace the joint completely.

The difference between hallux rigidus and limitus is the amount of motion in the big toe. If the big toe can’t extend more than 15 degrees, then it is considered hallux rigidus. If the big toe extends more than 15 degrees but less than the standard 65 degrees, it is considered hallux limitus.

How can you treat?

• Shoe modifications – shoes with a large toe box to reduce pressure on the enlarge joint as well as a stiff soled shoe to reduce the bending of the stiff toe.‍
• Orthotic w/ rigid morton’s extension – this stiff shaft extends under the big toe to help reduce big toe motion which can irritate a stiff joint.
• Injection therapy – steroid injection can help reduce inflammation and pain in a stiff big toe joint.
• Laser therapy – helps reduce inflammation and improve the body’s self healing abilities.
• Shockwave treatment – can help improve joint mobility by breaking down soft tissue adhesions which may be making the toe "stiff".
• Taping – use sports tape to immobilize/minimize the big toe from bending which help reduce pain with movement.
• Physiotherapy – joint immobilization stretches/exercises may help improve big joint motion which will help reduce joint pain during activity.

Recommendation to prevent the issue:

• Proper fitting footwear – make sure the toe box is deep and wide for your foot. Any squeezing of the toes can affect how the big toe functions.
• Orthotics w/ rigid morton’s extension brace – not only does it have the benefits of the stiff shaft extension under the big toe but helps support and stabilize the overall foot.
• Rigid sole of footwear – the less the affected toe bends, the less chance of re-injury of turf toe.
• Physiotherapy – keeping the big toe joint flexible through stretching can help reduce limited joint motion. Foot exercises can also help strengthen foot/toe muscles that will help reduce joint instability that could lead to joint arthritic changes.