Painful degenerative arthritis of the great toe (hallux) joint is referred to as a hallux limitus/hallux rigidus. The condition involves a decreased (hallux limitus) or complete lack of ability (hallux rigidus) to bend the hallux. The ability to bend the hallux upward is referred to as dorsiflexion, while the ability to bend the toe downward is referred to as plantarflexion. Both are important, but dorsiflexion plays a much more significant role in our ability to walk or propulse. The condition can affect both of these motions, but the limitation of dorsiflexion is where most of the problems begin.
The great toe should have a full range of dorsiflexion motion of 50 to 90 degrees for normal function. The hallux and its motion is an important part of gait and the propulsion of the body forward when it flexes upward and pushes off the ground. With limited motion, the big toe will not propel the body forward and other joints of the body will need to compensate, putting more strain through the rest of the foot and lower extremity. This can lead to increased fatigue and pain. If left untreated the joint will experience constant repetitive stress and jamming trauma, resulting in excess bone formation on the top and sides of the joint. The resulting bone spur/exostosis can further decrease the ability of the joint to function and can cause pain directly. Eventually the joint cartilage will become eroded leading to arthritis and progressive pain in the joint.
In early stages, conservative care can be successful in reducing pain and slowing the arthritic process. Wider and stiffer shoe gear can reduce the pressure over the arthritic join and decrease the need for the toe to try to bend. Oral and injectable medications can be used to reduce pain and swelling. Custom orthotics can be made by your physician to reduce and redistribute pressure through the foot to reduce the strain and damage being done to the great toe joint. Physical therapy may be helpful to help stimulate synovial fluid in the joint and reduce shearing stress across the joint and cartilage.
In more advanced stages or when conservative treatment fails, surgical options are available. A procedure referred to as a cheilectomy is performed frequently and involves resecting the exostosis or bone spur from the top of the joint, thus allowing the hallux to move much more freely. This can reduce pain and slow the progression of the deformity. A more involved procedure combines cheilectomy with a bone cut in the metatarsal to shorten the bone slightly creating more joint space by decompressing the jamming joint. Joint implants are available to replace the joint if the arthritic process has significantly damaged the cartilage. Joint fusion (Arthrodesis) can also be performed in severe cases. A newer approach involves using a small camera (Arthroscopy) to explore the joint and attempt to repair areas of damaged cartilage. All procedures have their benefits and potential risks. All of our physicians at FHA are well trained in these procedures and can discuss and tailor the treatment plan for your specific case and needs.
Dr. Bryan West
Dr. Neal Mozen
Dr. Thomas Belken
Dr. Latasha Walters
Dr. Laal Zada