Dr. Lee Wittenberg is a 3 year surgically trained Podiatrist. Dr. Wittenberg is trained in all elements of foot and ankle surgery, wound care and limb salvage, and general Podiatric medicine. Dr. Lee Wittenberg is Board Certified by the American Board of Lower Extremity Surgery, as well as the American Board of Foot & Ankle... more
There are 2 types of hallux limitus: 1) Structural and 2) Functional.
A structural hallux limitus is due to the development of arthritis (a decrease in the cartilage between 2 bones in a joint), which includes spurring or bone growth around the joint, most obvious at the top of the 1st metatarsophalangeal joint. This may be very painful due to the loss of cartilage or painful due to the loss of function and jamming of the 1st metatarsophalangeal joint which may irritate the joint, the bone, or the joint capsule.
A functional hallux limitus is due to mechanical issues with the foot and ankle, particularly pronation, which leads to an abduction of the forefoot (moving out of the midline of the leg) which effectively tightens or shortens the Flexor Hallucis Longus tendon to the bottom of the big toe. This causes a jamming of the joint or a limitation of motion of the 1st metatarsophalangeal joint. This jamming may also cause pain.
Treatments for functional hallux limitus may be more simple than a Structural version of the problem. Orthotics, possibly with a ‘Kinetic Wedge/Zotch Notch’ modification to drop the 1st Metatarsophalangeal joint down and improve motion of the joint may help very well. Also, if the pain is bad, a cortisone injection or oral anti-inflammatory medication may help a great deal. But something must be done to control the pronation and decrease the tightening of the Flexor Hallucis Longus Tendon.
Treatments for structural hallux limitus are more complicated. An orthotic with a rigid piece of material under the 1st Metatarsophalangeal joint (called a Morton’s Extension) may be used, but that only helps when wearing supportive shoes. Conversely, a very rigid soled shoe that does not allow bending at the 1st Metatarsophalangeal joint may also help. Ultimately, though, surgery may be required to alleviate the pain from a Structural Hallux Rigidus/Limitus pathology. Surgery depends on several things: the amount of degeneration of the cartilage in the joint, your activity level, your circulation and other possible complicating medical issues, your age, and your ability to take time off work for proper healing. The most simple procedure with the shortest healing time is called a Chilectomy where the joint is bascically simply cleaned up and a portion of bone is taken from the top of the 1st metatarsal and possibly the base of the proximal phalanx to try to increase motion. A better, more joint preserving option (if you have enough cartilage left) is a decompressive 1st metatarsal osteotomy, very similar to a bunion procedure, but the joint is decompressed to effectively lengthen the Flexor Hallucis Longus tendon and allow better motion of the joint. Lastly, if you’re not very active, at total 1st metatarsal or hemi 1st metatarsal implant work very well. But, like all artificial joints, these wear out if you are too active.