Hallux Limitus/Rigidus

This may develop due to big toe joint overuse in workers who squat & stoop, or athletes who put too much pressure on the joints.

Hallux Limitus/Rigidus

What is Hallux Limitus/Rigidus?

Hallux limitus refers to a condition where your big toe joint (first MTP joint) loses its range of motion. This condition can be troubling and painful as we use our big toe joint whenever we walk, stoop down, climb up or even stand. Since hallux limitus is a progressive condition, the toe’s motion decreases as time goes on and reaches the end stage of condition known as hallux rigidus where you completely lose range of motion at the big toe joint.

When Hallux Rigidus advances to a point where your big toe cartilage erodes, everything you do with your feet becomes increasingly tricky and painful. You cannot engage in walking, sports, and even household or social activities.

Hallux Rigidus (also known as big toe joint arthritis) is caused by an acute traumatic or repetitive microtrauma event, which in turn leads to an arthritic process around the big toe joint. It causes pain and stiffness in the joint where your foot joins the big toe known as the first metatarsophalangeal joint.

Your big toes hold up to 50 – 60% of your body weight when you are walking, or up to 100% of your body weight when doing vigorous exercise. This pressure is what causes your joint to wear down, leading to painful big toe arthritis – Hallux Rigidus.

Causes

Faulty biomechanics and structural abnormalities: Abnormal pronation may put excessive pressure on the big toe that then needs to work harder to push off and move the body forward, then joint cartilage becomes overly compressed and damaged.

Previous injury to the big toe joint: Stubbing the big toe or dropping a heavy object on the big toe joint.

Frequent wearing of high heel shoes or tight shoes:

Overuse: In activities or jobs that increase the stress on the big toe joint such as workers who have to stoop or squat.

Inflammatory arthritis: Rheumatoid or gouty arthritis or Osteoarthritis.

Treatment

Conservative

Self-care at home: aim to reduce the inflammation, swelling and pain in the big toe and the joint.

Rest: rest the foot by putting weight off the joint.

Shoes: wear shoes with a rigid sole (to reduce the big toe joint from bending), a wide and deep toe box, and no raised heel (to reduce compression of the cartilage in the big toe joint).

Soaking the foot: warm water can help soothe the inflamed and painful joint.

Gentle massage: massage with topical anti-inflammatory gel.

Professional treatments:

Medication: Anti-inflammatory and/or pain medication.

Orthotics: to compensate for abnormal pronation or sometimes limit the motion at the big toe joint.

Injections: Ultrasound guided steroid injection.

Surgical

Depending on the stage of your hallux limitus/rigidus and your symptoms the type of surgery performed varies.

Cheilectomy: Usually recommended for mild to moderate deformity and aims to increase range of motion by removing bone spurs and portion of bone to allow more room for the toe to bend and alleviate pain.

Arthrodesis: It is recommended for moderate to severe hallux limitus/rigidus where joint damage is severe. In this procedure the damaged cartilage is removed from both sides of the joint and two bones are fused together with screws and/or a plate. It mainly aims to eliminate the arthritis and pain.

Hallux Rigidus (stage 4) - 1st MPJ Arthrodesis

Hallux Rigidus (stage 4) x-ray - 1st MPJ Arthrodesis

Hallux Rigidus (stage 3) + 2nd toe dislocation - 1st MPJ Arthrodesis + Modified Weil Osteotomy

Appointment Information

Cost & Item Codes – Our fees are quoted on a case-by-case basis after your initial consultation with the surgical podiatrist as each patient presents differently and each surgery varies from patient to patient. Please book an initial consultation to discuss this further.

Scans – We recommend you have weight bearing x-rays prior to your appointment.

Telehealth – We may be able to offer an initial telehealth appointment if you live a distance away. Phone one of our friendly staff to see if this is possible for you. We may ask you to email some photos prior to your appointment. (1. from patient looking down at the front of their foot/feet 2. if someone can take a photo at floor level from behind of foot/feet)

Surgery Information

Do I need surgery? – Although your doctor may recommend an operation to improve the function of your foot, reduce pain, and restore your range of movement, it is your decision if you go ahead with the operation or not.

When you consult a foot surgical podiatrist, they will take into consideration the deformity on your feet, your age, and the level of your activity before deciding on surgery.

As with many arthritic conditions it is progressive, and stiffness will increase.

Duration – Surgery can typically take between 45 minutes to 1 hour to complete, and patients can usually return home the same day.

Anaesthesia – Surgery can be performed under general anaesthesia, local anaesthesia, or regional anaesthesia, depending on the doctor’s and the patient’s preferences.

Medications – Your doctor will discuss all medications with you on your initial consultation.

Smoking – If you are a smoker, you need to stop the habit of smoking 4 weeks before your operation for normal healing and reduce postoperative complications. Nicotine is known to stop bones from healing.

Recovery Process

The following should be adhered to in order to hasten your recovery from foot surgery.

In general, the following timeline can be expected:

Immediately after surgery: Go home and rest. Elevate your foot as often and as much as possible to reduce swelling. Take pain medication as instructed and avoid smoking. Wear post-operative shoe all the time, even at bed for the first 2 weeks. Place a plastic bag over your foot when showering.

Some blood ooze can be expected in the bandage, but if worried, contact the number given.

The first few days: Patients will need to spend most of the time with the operated foot raised to reduce swelling as much as possible. You should restrict your walking in the postop shoe to minimal activities such as going to the bathroom only.

1-2 weeks: In the first 2 weeks, keep the foot dry until stitches are removed.

Cheilectomy

Rest – 1-2 weeks (minimal weight bearing for essential things only like bathroom breaks 5-10 minutes maximum per hour)

Walk – 4 weeks (movement limited outside of house)

Driving – 4 weeks (for any hospital procedures under general anaesthesia, you cannot drive until after 24 hours when you are off narcotics. Therefore, you will need someone to drive you home from hospital)

Return to sedentary work – 2-4 weeks (If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet)

Return to active work – 6-8 weeks (If you have a physical job or are standing a lot and unable to elevate your foot/feet)

Low impact exercise – 8 weeks (slow walking, cycling, golf using a caddie)

High impact exercise – 12 weeks (fast walking, running, jumping, playing sport)

Arthrodesis

Rest – 1-2 weeks (minimal weight bearing for essential things only like bathroom breaks 5-10 minutes maximum per hour)

Walk – 6 weeks (movement limited outside of house)

Return to sedentary work – 2-4 weeks (If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet)

Return to active work – 6-8 weeks (If you have a physical job or are standing a lot and unable to elevate your foot/feet)

Low impact exercise – 8 weeks (slow walking, cycling, golf using a caddie)

High impact exercise – 12 weeks (fast walking, running, jumping, playing sport)

Some possible complications following surgery include – pain, infection, bleeding, scarring, DVT. Patients should contact their doctor if they experience any signs of complications, such as fever, redness, or increased pain in the affected foot.

Cheilectomy: Arthritis progression, Nerve damage.

Arthrodesis: Delayed union or non-union, Nerve damage.

Book Appointment

Surgery

Surgery is advised if non-surgical treatment fails.

Please call 1300 522 096

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