Hallux Limitus/Rigidus
Hallux Limitus/Rigidus
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Hallux limitus/rigidus is a gradual condition where the movement at the 1st metatarsophalangeal joint decreases with time. In the early stage, the movement at the joint will have only reduced a little, but as the problem advances the movement becomes less and eventually the joint becomes stiff. The protective tissue around the joint called cartilage can become damaged causing extra bone to form around the joint. This extra bone will restrict movement and will cause pain when walking. Hallux limitus/rigidus is when there is change to the bone that prevents normal movement of the hallux.
Patient Signs and Symptoms
Patient Signs and Symptoms
Pain 1st metatarsophalangeal joint
1st metatarsophalangeal joint stiffness
Pain increases with activity
Aggravated by shoe wear
Sharp/ radiating pain
Biomechanical abnormality
Insidious onset and/or acute Trauma
History of Arthritis/underlying medical conditions
Change in lifestyle
Occupational demands that involve 1st metatarsophalangeal dorsiflexion
High heeled shoes
Significant Findings
Significant Findings
Dorsal prominence (Exostosis)
Hallux Equinus flexion of the 1st metatarsophalangeal joint
Hyperextension of the interphalangeal joint
1st metatarsophalangeal joint abnormal range of motion (this should be around 60-70 degrees of dorsiflexion)
Abnormal quality of movement (crepitus)
Associated Findings
Associated Findings
Grade 1: Functional Hallux Limitus. Associated with a hyper mobile first ray foot type. Range of motion non weight bearing is close to normal and symptoms may or may not be present
Grade 2: Mild Hallux Limitus In this stage, 35-55 degrees of dorsiflexion ROM is available at the joint.
Grade 3: Moderate Hallux Limitus 15-30 degrees of dorsiflexion is available and marked joint space changes can be seen.
Grade 4: Severe Hallux Limitus. Motion is less than 15 degrees; joint space has severe osteophytic proliferation.
Callous - Plantar interphalangeal joint/ lesser metatarsal heads
Central metatarsalgia/2nd plantar plate issues
Positive grind test
Imaging
Imaging
Not indicated at initial assessment unless history of trauma or to suspect osteomyelitis, however x-ray has low sensitivity and specificity for detecting acute osteomyelitis.
Diagnosis made by clinical signs as typically indicates accurate diagnosis.
Imaging maybe used at later date, can be discussed at our MSK Podiatry Virtual Escalation clinic as required on presentation.
Preferably weight bearing views in lateral, Dorsal/ Plantar and Oblique.
Common presentation on X-ray are:
Dorsal Osteophytes
Progressive degenerative changes at 1st metatarsophalangeal joint
Joint space narrowing/articular flattening
Subchondral sclerosis and/or subchondral cysts
Common Causes
Common Causes
Traumatic
Traumatic
Osteochondral 1st metatarsophalangeal joint injury
Intra-articular fracture
Sesamoid dysfunction
Mal-union of the 1st metatarsal
Metabolic
Metabolic
Arthritic & inflammatory conditions
Osteochondral defects
Neuromuscular
Neuromuscular
Extrinsic or intrinsic muscle imbalance affecting 1st ray
Functional gait impairment
Anatomic/ Structural
Anatomic/ Structural
Abnormal long interphalangeal
Abnormal long 1st metatarsal
Metatarsal primus elevatus
Biomechanics
Biomechanics
Hypermobile 1st ray
Excessive pronation
Functional Hallux Limitus
Differential Diagnosis
Differential Diagnosis
Hallux Abductovalgus (Bunion Deformity)
Sesamoiditis
Gout
First line treatment options
First line treatment options
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