Hallux is the medical term for your big toe. Your big toe is one of the most important parts of your body, as it provides propulsive force during gait. Your big toe should possesses between 50 and 90 degrees of extension—also known as dorsiflexion—if it is healthy and injury-free, and you should be able to move your big toe through a full and pain-free flexion range of motion, too. 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 may, over time, cause pain and fatigue.
1. Hallux Limitus - is the term podiatrists, chiropodists and other healthcare professionals use to describe loss of motion in your big toe joint. The metatarsophalangeal, or MTP, joint of your big toe is the structure affected by this health problem. Your first MTP joint is the location where your big toe connects to your first metatarsal bone—a long, thin bone that spans your mid-foot and forefoot.
2. Hallux Rigidus - is considered by many podiatrists to be the end stage of hallux limitus, or a state in which your ability to create motion in your big toe is lost or severely restricted. Hallux rigidus may lead to long-term damage of your first MTP joint, and it usually involves erosion of your joint cartilage and the development of osteoarthritis, or degenerative joint disease. Hallux rigidus is a condition characterized by near-ankylosis, or a state in which your big toe becomes stiff and immobile due to the partial fusion of your involved bones.
Causes and Symptoms:
Hallux limitus and rigidus are often considered idiopathic, or caused by unknown factors, but certain known factors may contribute to this health problem, too. Possible causes of hallux limitus and rigidus include:
- Faulty foot biomechanics
- Rheumatoid arthritis, gout, or other inflammatory diseases
One of the most significant factors contributing to this health problem, however, may be the prolonged use of inappropriate footwear, especially footwear that constricts your toes.
You may experience the following signs and symptoms if you have hallux limitus or rigidus:
- Pain and stiffness when moving your big toe
- Pain in your affected area when walking, running, or squatting
- Pain and stiffness brought on by cold, damp weather
- Swelling and inflammation in or near your first MTP joint
- Pain in your other lower extremity joints as well as your low back
Non-surgical treatment options exist for this health problem and may help reduce your symptoms. Possible conservative care treatment options for your hallux limitus and rigidus include:
- Chiropractic mobilization manipulations.
- Physical therapy (PT): Low-level laser, ultrasound or other physiotherapy modalities may help relieve your symptoms.
- Daily stretches, such as the toe extensor stretch and bunion stretch.
- Customized orthotics to assist with ambulation (gait) and abnormal postural imbalances.
- Shoe therapy: Minimalist shoes with wide a toe box allow your toes to splay properly.
- Topical pain relievers: Natural pain relievers may help reduce swelling, pain, and inflammation.
- Correct Toes: This toe-spacing appliance helps realign your big toe with your first metatarsal.
The extent to which non-surgical treatment (e.g., using Correct Toes and wearing wide-toe-box shoes) can alleviate hallux limitus and hallux rigidus depends on your ability to manually move your big toe in two directions: away from your second toe (abduction) and upward (dorsiflexion). If these movements are significantly restricted, conservative approaches may not help with your condition. However, if some movement remains, the above-mentioned strategies can be useful.
If you are experiencing hallux limitus or hallux rigidus, Dr. Pisarek can examine your foot to determine which factors are contributing to your challenge, and then use a number of chiropractic techniques, modalities and/or orthotics to lessen pain and improve the function of your foot.
If your condition does not improve, then Dr. Pisarek will refer you to a podiatrist, chiropodist or medical health provider for further evaluation if prescribed medication, over-the-counter (OTC) medications or surgical intervention will be appropriate in a patient's particular case management for bunions.