Arthritic Big Toe Joint (Hallux Limitus/Rigidus)

Hallux Limitus is the loss of motion to the big toe joint.  The big toe joint is the main propeller of the foot, therefore normal motion is crucial to this joint.  As the body moves forward, the big toe joint flexes upward and pushes off the ground.  Normal range of motion should consist of upward motion (dorsiflexion) of 50 to 90 degrees.  If there is imbalance and an abnormal walking pattern, this may lead to painful jamming of the joint.

As the joint jams, this will lead to arthritis, the degeneration and eroding of the cartilage of the joint.  Constant pressure to the joint causes the stimulation of extra bone growth (bone spur/ exostosis) around the joint, in particular the top side of the joint.  The arthritis and the extra bone growth in turn leads to more jamming.  The vicious cycle will keep continuing until proper treatment is rendered.  Often, the joint becomes permanently ruined and is not salvageable.

Patients usually describe the pain as being deep achy to sharp pain with flexion of the joint.  There can be additional pain to the top of the big toe joint if a bone spur is present.  Patients may notice redness and swelling to the big toe joint as well. 

The cause of the hallux limitus condition may be genetic or may be due to trauma or overuse.  Genetically, the first metatarsal bone may be out of position – either too long or elevated.  In cases of trauma, any fracture that extends to the joint may potentially lead to arthritis of the joint.  Finally, in an overuse situation, a genetic predisposition coupled with prolonged activity and improper shoegear may cause the condition to flare up.   

As far as treatments are concerned, conservative  treatment is usually geared at cortisone injections and custom orthoses.  These treatments may relieve the pain but usually in the long run, the patient may need surgical intervention.  If surgery is indicated, there are a number of surgical options available for you depending on the severity of the condition as well as the patient’s activity level. 

One such procedure (cheilectomy) involves shaving off of any extra bone and cleaning up the joint of any scar tissue.  Recovery time is rapid and the patient should be able to resume normal activities by the two week mark.  The patient may be able to start walking on their operated foot the next day with the use of a surgical shoe.  This procedure though, is usually reserved for mild to moderate cases of arthritis.

A more aggressive type of procedure involves, in addition to the above described cheilectomy, the cutting of the first metatarsal bone which is usually out of position, placing the bone in the correct position decompressing the joint, and fixating the bone with hardware (usually titanium compression screw).  Thirdly, the joint may be replaced with an implant.  The implant (usually made of titanium) serves to reproduce the smooth motion of an undiseased joint. 

For the three procedures described above, recovery time can extend up to six weeks but like with many surgeries we perform, the patient may start light walking the very next day with the use of a surgical shoe.  Dr. Baik believes that early range of motion to the surgery site actually improves healing time by improving circulation, reducing scar tissue, and preventing muscle atrophy.

For severe cases of arthritis, a fusion may be performed in which the motion of the joint is eliminated all together with the use of titanium compression screws and a plate.  The patient is placed in a walking boot and allowed to walk lightly starting the day after the surgery.  The recovery time is usually 6 to 8 weeks in the walking boot.

For any type of surgery of the foot and ankle, plastic skin closure is often utilized for optimal aesthetic outcome.  Post-operatively, the patient is seen back at our office every 1-2 weeks to ensure proper healing is taking place. 

We highly recommend early consult of all cases of possible arthritis as this will allow the best options to be available and may prevent extensive surgery. 

http://www.footphysicians.com/footankleinfo/hallux-rigidus.htm