Hallux limitus or hallux rigidus (big toe pain)

Aches and pains in the feet happen to almost everyone at some point. Exercise and active jobs can have us on our feet for long periods, and that can cause some soreness at the end of the day. But what about when that pain is concentrated in one or both big toes? And what if it keeps coming back, no matter how much you rest or stretch?

It could be hallux limitus or hallux rigidus, which are two conditions that cause big toe pain. “Hallux” is the Latin word for big toe, “limitus” translates to limitation and “rigidus” means rigid or stiff. These afflict the joint that connects your big toe to your foot – also known as the metatarsophalangeal (MTP) joint – leading to stiffness and pain.

Read on to learn more about hallux limitus, hallux rigidus and your overall toe health.

The metatarsophalangeal joint connects the innermost metatarsal bone of your foot to the first phalanx bone of your big toe. The MTP is an especially hardworking joint – when we’re walking normally, the MTP joint of each foot carries 119% of our bodyweight with every step.

Hallux limitus describes a big toe with a limited range of motion due to changes in the cartilage (the soft connective tissue between bones) of the MTP joint. This makes walking and other activities painful. Hallux limitus can be progressive, meaning your toe may become less flexible over time. However, there are ways to prevent this.

Symptoms of hallux limitus

In the early stages of hallux limitus, you will only experience pain and stiffness while walking or doing other activities that involve being on your feet. As the condition progresses, pain can become more persistent.

Symptoms of hallux limitus include:

Trouble bending your big toe
Pain, mostly located on top of your big toe at the MTP joint
Tingling and numbness on top of your big toe that may extend to the rest of the foot
Big toe swelling and redness
Callousing of the skin under the big toe
Developing a bony lump or bulge of soft tissue on top of the MTP joint
Bone spurs at the MTP joint

Hallux limitus is the result of damaged cartilage

Age, injury, illness and other factors can wear down the cartilage around the MTP joint, which causes additional bone growth in the area. This bone growth, which appears as bone spurs or “osteophytes,” is the body’s attempt to repair the joint. Instead, it impedes movement and causes pain.

The following can affect the cartilage of your MTP joint:

A prior injury or repeated injuries to the big toe – We all stub our toes once in a while, but for some, stubbing the big toe over and over again can affect MTP cartilage. So can spraining or breaking your big toe.
Unusual bone structure in your foot – A longer-than-normal or raised metatarsal bone may result in increased pressure and wear on the MTP joint. This foot structure can be inherited through generations, causing hallux limitus to run in families.
Rheumatoid arthritis or gout – These autoimmune conditions cause inflammation of joints throughout the body, including those in your hips, knees and feet. This can change how you walk.
High-impact activities – Activities that require quick pivoting and fast movement on your feet, like soccer, football, basketball and tennis, put repeated pressure on your big toe joint and can damage its connective tissue. This type of injury is also called “turf toe,” because of its frequency in sports played on turf.
Ill-fitting shoes or high heels – Shoes with pointed toes and very high heels put increased pressure on the big toe joint, leading to hallux limitus. This type of footwear can also cause bunions (hallux valgus).

Treatment options for hallux limitus

With proper treatment, hallux limitus can be resolved, allowing you to resume activities pain free. Treatment options include:

Properly fitting shoes – Shoes that are made specifically for flat feet offer more arch support, which relieves stress on the MTP joint. You can also look for shoes with a larger toe box, and consider adding over-the-counter or custom orthotic inserts.
Physical therapy – A physical therapist can guide you through stretches and exercises that focus on the MTP joint, improving its flexibility and strength.
RICE – While rest, ice, compression and elevation (RICE) won’t resolve the cause of hallux limitus, it can ease the pain associated with the condition.
Frequent breaks during high-impact activities – Taking time to rest your feet while engaging in sports or being active at work gives connective tissue a chance to recover, making sprains less likely.
Corticosteroid injections – These injections reduce inflammation and pain at the big toe joint.

Hallux limitus vs. hallux rigidus, or osteoarthritis of the big toe

If hallux limitus is allowed to progress, it can become hallux rigidus – a form of osteoarthritis in the big toe. With hallux rigidus, the cartilage within the MTP joint breaks down even further, resulting in an extremely limited range of motion. Pain in the big toe becomes chronic, meaning it may be present whether or not you’re moving.

Symptoms of hallux rigidus

Hallux rigidus shares many of the same symptoms as hallux limitus, but with increased severity.

Symptoms include:

Extremely limited range of motion in your big toe, or loss of motion altogether
Big toe swelling and redness, especially along the top of the toe
Bone spurs developing around the MTP joint
A bony lump or soft tissue bulge appearing on top of the MTP joint
Difficulty walking, exercising and performing other daily activities
Pain in other areas of the foot due to altered gait

Causes behind hallux rigidus

There may be one or multiple factors contributing to osteoarthritis of the big toe joint. Some of the most common causes include:

Untreated hallux limitus – Hallux limitus doesn’t always lead to hallux rigidus, but it can be an initial indicator that something is not right in your MTP joint. Left alone, the issues causing hallux limitus (soft tissue deterioration or bone spurs) can get worse, and eventually develop into hallux rigidus.
Previous traumatic injury or repeated injuries to the big toe – Just like in hallux limitus, stubbing, spraining or breaking the big toe can weaken the surrounding cartilage, causing it to deteriorate.
Unique foot structure – The bone structure of your feet can put more pressure on your MTP joint, causing the cartilage to wear down faster or more severely.
Genetics – In the same way that the bone structure of your foot can be inherited from your family, studies show that osteoarthritis can also be passed down from one generation to the next. If someone in your family has hallux rigidus, your chances of developing the condition are higher.

Treatments for hallux rigidus

Treatment for hallux rigidus can be more challenging – your options will depend on your age and the condition of the cartilage around your big toe. It’s still possible to find pain relief and regain some range of motion through physical therapy, special shoes or orthotics.

If your hallux limitus or hallux rigidus hasn’t been improving through more conservative treatments, your doctor may recommend corrective surgery.

Surgeries for hallux limitus and hallux rigidus

Surgery for hallux limitus or hallux ridigus is typically reserved as a last resort – your doctor will try every other treatment first to manage your condition. If you become a candidate for surgery, there are a few different options: cheilectomy, joint fusion (arthrodesis) and joint replacement.

Cheilectomy

Cheilectomy is a procedure in which an orthopedic or podiatric surgeon removes the bone spurs that have developed around the MTP joint. This procedure is often accompanied by a Moberg osteotomy, in which the metatarsal bone is realigned with that of your big toe.

Joint fusion (arthrodesis)

In this procedure, a surgeon will fuse your first metatarsal and phalanx bone together, preventing any movement in the MTP joint. Once the MTP is immobilized, the interphalangeal (IP) joint starts to compensate, allowing you to resume moving and walking normally once healed.

Joint replacement (arthroplasty)

A joint replacement involves the damaged MTP joint being removed and replaced with a prosthesis, or manmade device that will mimic the movements of the joint.

Take time to care for your toes

When we think of the most important part of the body – one that allows us to play our favorite sport, walk the dog or simply balance upright – our first thought likely isn’t the toes. But the truth is, our toes are vital to all these activities and much more.

By taking care of your toes, you’re taking care of your ability to participate in daily life without pain and enjoy the things you love to do. So don’t ignore toe pain when it arises. Instead, find care with one of our foot and toe specialists.