yogabook / pathology / hallux limitus

Definition

The hallux limitus is a stiffening of the metatarsophalangeal joint of the big toe. While in anatomically zero the metatarsophalangeal joint is dorsiflexed (extended) by up to 20°, requires walking and even more running with a larger stride width significantly more range of motion. The average person has around 55-75° dorsiflexion available, compared to only 20-30° plantar flexion, which is not needed in everyday life. If the metatarsophalangeal joint stiffens due to arthrosis, the range of motion is reduced to the point of complete ankylotic fusion (Hallux rigidus). Very often, this condition is the result of hallux valgus. The terminology is not standardised, some authors only use hallux limitus to refer to stage 1 of the classification below.
The condition can be divided into stages:

1. limited function without correlate on X-ray
2. Increased functional restriction, degenerative joint changes become visible on X-ray
3. Full picture of arthrosis with osteophytes and intermittent or permanent arthritis (activated arthrosis)
4. Ankylosis (stiffening)

The terminology is obviously not standardised; some authors use Hallux limitus to refer only to stage 1 of the classification.

Predisposing

1. Long metatarsal bone 1
2. Previous injuries to the Hallux or MTP 1
3. Disorders of the kinetic chain of the lower extremity
4. Overuse, especially during impact-loaded activities (running, dancing, ballet, racket sports, indoor sports, team sports)
5. Wearing high heels or ill-fitting shoes
6. familial disposition

Cause

1. trauma
2. Congenital deformities
3. Disorders of the kinetic chain with shortened achilles tendon and plantar fascia
4. Diseases of the metatarsophalangeal joint such as Arthrosis, RA, gout

Therapy

1. PT
2. Insoles
3. For activated arthrosis, NSAIDs or intra-articular injections if necessary
4. Surgery depending on progression: joint-preserving, joint-replacing or joint-stiffening
5. Avoid overloading
6. Switch to more supportive shoes if necessary