A big toe (called a hallux) should have 70° -90° of “up” motion (called dorsiflexion) and 20° -25° of down motion (plantarflexion.) It should move freely without any restrictions, clicks, catches or feeling like there is grinding. Foot biomechanics requires that the metatarsal move down in order for the big to move up. In essence the toe ends up on top of the first metatarsal when you raise your big toe.
Hallux limitus is defined as a deformity of the first metatarsophalangeal joint (1st MPJ) or bunion joint, that restricts the range of motion and often causes pain in the joint. With Hallux limitus, there can be a little as no motion in the joint. Often there is significant arthritis associated with the 1st MP joint, which is clearly visible on x-ray.
Different grades of the deformity exist from mild to severe, with the amount of joint motion typically decreasing over time. Patients usually exhibit pronated or flat feet during gait and stance.
Often there is a build up of bone spurs around the head of the metatarsal that you can feel with your finger and rubs in your shoe. This spur can be seen on an x-ray. If an x-ray is taken with the heel off the ground and the ball of the foot on the ground, the base of the toe bone can be seen to impact the first metatarsal instead of sliding over it.
A joint that has less “up motion” that needed is said to have hallux limitus (pronounced “limit-us”). With hallux limitus patients experience pain when running, walking uphill and eventually just walking. The bone in the big toe is jammed against the metatarsal head, which causes inflammation and pain.
Hallux limitus makes patients shift the weight to the side of the foot and it is not uncommon to see calluses under the lesser metatarsals, especially under the second metatarsal (behind the second toe.)
There are several causes of Hallux Limitus. One cause is a gradual deterioration of the joint due to age. There could be a history of trauma to the foot or joint, which may have begun the deterioration of the joint years before.
Causes that can make the problem worse when running and doing other high impact activity include;
Increase in training levels.
Increased hill training.
Lack of shock absorbency in the trainers worn.
Worn running shoes.
hallux limitus treatment in the acute phase
Golden rule- Don’t ignore the problem, it won’t go away! If you have been afflicted by this injury it is virtually certain that you will have another attack sooner rather than later.
The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family).
The is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and to prevent re-injury is follow our checklist below. Overall costs for the average athlete will run into pennies per mile/hour of sport.
1. Check your footwear
Are your running shoes worn and in need of replacing? If so change them. Hallux limitus is often caused by high impact forces so a good shock absorbing shoe is a must. Also a quality running shoe will have a stiffer/ thicker sole which will reduce the bending force at the big toe joint. For more advice on running trainers our running shoe advice page is worth reading. Read more->
Below are a selection of trainers that are ideal for athletes.
Trainers for a neutral or under pronating foot type
Trainers for over pronators
2. Rectify poor biomechanics with orthotics if necessary
The way your foot strikes the ground and the forces that are placed on it can have a direct effect on hallux limitus. With this condition it is in the athletes best interests to get a bespoke orthotic made that will limit the amount of upward movement of the toe with a special ‘rocker bar’.
Think you require bespoke orthotics for your hallux limitus symptoms? Visit our sports podiatry clinic pages for a clinic near you.
3. Strengthen weak foot and ankle muscles
Wobbleboard exercise is a great way to strengthen foot & ankle muscles and help reduce the symptoms of hallux limitus.
4. Improve shock absorbency
Hallux limitus can be made markedly worse by high impact forces being directed through the forefoot, particularly in running activities. Purchasing some shock absorbing insoles is a cheap and effective way of vastly improving shock absorbency and reducing unwanted ground reaction force. These little pads slip into the shoe and are not noticed by the athlete when partaking in sport.
Hallux limitus injury prevention checklist summary
- Rectify Biomechanics if necessary
- Check Running shoes
- foot and ankle strengthening
- Improve shock absorbency
Returning to Activity
With hallux limitus, the goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your hallux limitus recovers, not by how many days or weeks it has been since your injury occurred.
After suffering from hallux limitus, you may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
You have full range of motion in the injured foot compared to the uninjured foot.
You have full strength of the injured foot compared to the uninjured foot.
You can jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
Hallux limitus explained with surgical procedures discussed