Hallux Limitus-When a Bunion is Not a Bunion

An enlarged  and painful first metatarsal phalangeal joint( big toe joint) is not always a bunion deformity.  Bunions are usually the result of a drifting of the first metatarsal and enlarging of the medial side(inside) of the first metatasal head.  Hallux limitus on the other hand is a stiffening of the first metatarsal phalangeal joint with excessive bone growth surrounding the joint.  This causes an enlarged joint which may rub and be irritated by shoe pressure on top of the joint.

Most people with hallux limitus complain of pain with movement of the joint during walking or exercising.  It is also difficult to bend the joint and therefore squating or raising up on ‘tip-toes’ can be difficult and painful, as well.

Hallux limitus can occur as a result of a number of factors.  There may be trauma , such as having dropped a heavy object  on the joint or jamming the joint causing micro-fractures that mature into an arthritic, stiff and painful joint.  A more common reason for the occurrence of hallux limitus is due to the structural anatomy of the bones.  If the first metatarsal is excessively long or in a fixed elevated position relative to the other lesser metatarsals the joint will jam and become irritated which can lead to stiffness and arthritis.

Treatment for this painful condition is multifaceted.  Conservatively, the goal is to control the jamming of the joint and reduce the inflammation.  This can be done with gait orthotics and NSAIDS in the less severe cases.  This will not alter the underlying arthritic changes in the joint.  In more severe and painful cases of hallux limitus surgical intervention is required.  The goal is to remove the bone spurs and reposition the metatarsal so that there will be less compression and jamming of the joint.  In cases where the joint is rigid and there is severe arthritis and loss of cartilage,  joint replacement surgery may be indicated.

Dr. William A Sachs



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