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Foot Conditions

Hallux Limitus:

Hallux is the medical term for your big toe. Your big toe is one of the most important parts of your body, as it helps with your gait. When the toe is healthy and free of injury, you should be able to move your big toe through a full and pain-free flexion range of motion. A dysfunctional big toe will cause other parts of your body, especially the joints and tissues of your lower extremity, to compensate when you walk or run, which places increased strain on these structures and can, over time, cause pain and fatigue.

Hallux limitus is the loss of motion in your big toe joint. The metatarsophalangeal, MPJ, is the structure affected by this health problem. Your first MPJ is where your big toe connects to your first metatarsal bone— or at the base where your foot and toes meet.

Symptoms of Hallux limitus come on slowly; pain is sometimes felt only when someone is in motion or when moving the big toe joint. Hallux Limitus is usually caused by unknown factors, but certain known factors like Trauma, genetics, Rheumatoid arthritis, gout, or other inflammatory diseases and overuse may contribute to this health problem, too. One significant factor that contributes to this health problem can be the prolonged use of inappropriate footwear, especially the type of footwear that constricts your toes.

The following signs and symptoms can be associated with hallux limitus: Pain and stiffness of the great toe, pain in the area when walking, squatting, or running, pain and stiffness due to cold weather, limping, pain in the lower extremity joints and lower back. These symptoms represent the early stages of this condition, and can worsen until you no longer can move the joint; a condition known as hallux rigidus.If you are experiencing any of the symptoms listed above, you may want to seek medical attention from podiatrist as soon as possible for a diagnosis

Non-Surgical Treatment
The doctor will begin by examining the range of motion within the joint. Imaging tests such as x-rays are used to determine whether arthritis is present, to see how much the joint has narrowed, and to evaluate the foot’s overall health. For mild to moderate cases the following Non-surgical treatment options may help reduce your symptoms:

Anti-inflammatory medication - Help in reducing inflammation, swelling, and pain. Short doses over a period of weeks are administered in an effort to decrease the inflammation. This is used only as a temporary measure and not a long term solution.

Corticosteroid injections - Administered into the joint to reduce inflammation and swelling around the joints. They may be of use for only a short and moderate time period. Multiple injections can be performed but there is a limit as to how much cortisone can be injected in the same area in a one-year period.

Physical therapy - Physical therapy may help relieve your symptoms and can help in reducing the inflammation in the joint. This can be combined with anti-inflammatory medication or cortisone injections.

Shoe modification - Shoe modifications, custom orthotics or inserts and many times an extra-depth shoe with a stiff sole can help with the discomfort.

Modification of activities - avoiding of certain activities can help in reducing the symptoms. Daily stretches, such as the toe extensor stretch and bunion stretch.

PRP/SCT injection - Platelet Rich Plasma or Stem Cell Therapy can be useful for hallux rigidus cases that did not respond well to conservative therapy. PRP can fool the body into responding to chronic injury site by causing a large inflammatory response. This could lead to a healing response from patient’s own body.

Surgical Treatment
For severe cases, surgical intervention may be necessary. Some treatment options include:

Joint remodeling (chilectomy) - where all the bony overgrowth is removed which should allow for better motion without pain.

Osteotomy (surgical cutting and realigning of bone) - A wedge of bone will be removed from the top of the first metatarsal to allow the big toe to bend upwards over the metatarsal.

Joint destructive procedure or Implant - If the cartilage is destroyed, a joint destructive bunionectomy is performed or a joint implant is inserted.  

First metatarsal phalangeal joint fusion - If the joint cannot be salvaged, the joint may have to be surgically fused.

Talk to your podiatrist to see what is best recommended for you.