Hallux limitus/rigidus

Findings

Dorsiflexion of the first metatarsophalangeal joint is limited. It may be asymptomatic, but the symptomic patients have pain, especially on tiptoe, and with running and change of direction sports. The pain, which is worse on dorsi- and plantar flexion of the big toe, is localized to the joint area, which is swollen and may be tender to palpation.

Cause

Osteoarthritis of the first metatarsophalangeal joint. There may be a congenital tendency. An overpronated foot may prevent full dorsiflexion of the toe.

Treatment

a)      Avoid high heels, which promulgate extension of the toes.

b)      Correct any overpronation.

c)      Widen the shoes, and use a metatarsal bar of kinetic wedge orthotic.

d)     If painful, use electrotherapeutic modalities, such as ultrasound and shortwave diarthermy.

e)      Cortisone injection of the joint if it is inflamed.

f)       Surgery may be required.

Sports

a)      Runners and joggers will have to shorten the stride length and lift off from the ball of the foot rather than the toe. Running around this problem may be achieved by externally rotating the foot, but this can produce secondary injuries such as overpronation, genu valgum and hallux valgus.

b)      The tennis serve may require “jump” to avoid rolling through this joint.

c)      Dancers with this problem should be filtered out at the career beginning, as this will certainly cause problems requiring surgery.

Steroids are very successful to relieve pain, but alternation of movement patterns that affect the toe, orthotics and adjustment of shoes are vital before surgery is considered.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English