Hallux Limitus / Osteoarthritis

Anatomy

A joint is defined as the connection of two bones. Articular cartilage covers the ends of the bones that form a joint. In the normal setting, articular cartilage and synovial joint fluid allow our joints to move without pain and in a fluid motion.

Condition

Osteoarthritis, also known as degenerative arthritis, refers to mechanical breakdown of the joint surfaces in one or more joints. In its early stages, there is joint inflammation, yet over time this is a mechanical arthritis. Osteoarthritis is the most common form of arthritis.

Although more common in older individuals, younger individuals are certainly susceptible to developing osteoarthritis as a result of high levels of physical activity. Osteoarthritis is common in athletes and physically active individuals as the joints are subject to mechanical breakdown over time. This condition is generally thought of as a “wear and tear” disease as the joint surfaces continuously wear down over time.

Hallux Limitus/Rigidus

All joints in the foot and ankle are subject to osteoarthritis, yet osteoarthritis is most commonly found in the 1st metatarsal phalangeal joint (big toe joint or 1^st MPJ). Osteoarthritis of this joint is referred to as hallux limitus/rigidus. In hallux limitus/rigidus, there is limited motion of the hallux at the 1^st metatarsal phalangeal joint

Symptoms

1. Joint pain and swelling
2. Limited motion
3. Prominent bone or spurring on top of the 1^st MPJ
4. Joint crepitus also known as grinding of the joint with motion
5. Pain in adjacent joints as they compensate for decreased motion in the affected joint. With hallux limitus/rigidus, pain is typically transferred to the 2nd metatarsal phalangeal joint or to the hallux interphalangeal joint
6. Difficulty walking
7. Callus to the bottom of the 2^nd MPJ or hallux IPJ
8. Pain with shoe gear as a irritation along the bone spur

Diagnosis

Diagnosis is made by a comprehensive foot exam by Dr. Stewart along with x-rays of the foot.

Common causes

1. Elevation of the1st metatarsal due to either a structural bone deformity or to imbalance of tendons and muscles
2. Injury of the big toe or 1st metatarsal phalangeal joint
3. Congenital/inherited predisposition to the deformity
4. Shoes DO NOT cause hallux limitus/rigidus, yet if they do not fit properly shoes will aggravate the boney prominence along the top of the joint
5. Flatfoot deformity

Treatment

Dr. Stewart recommends exhausting all conservative treatment prior to surgical intervention. Unfortunately, osteoarthritis (including hallux limitus/rigidus) is a progressive arthritic condition and therefore pain can be challenging to manage.

Conservative treatment for osteoarthritis includes:

1. Anti-inflammatory medications (NSAIDS) in the early stages
2. Tylenol
3. Shoe gear modification to prevent irritation against boney prominences
4. Steroid injections
5. Custom foot orthotics and bracing
6. Avoidance of flip-flops, flats, and barefoot walking
7. Ice and elevation
8. Supportive shoe gear including a motion control running shoe such as Brooks, Aasics, New Balance, or Saucony; Keen and Merrell style shoes are also recommended
9. Modification of physical activity including avoidance of walking, jogging, running, and the elliptical for exercise; recommended exercises include circuit training, swimming, and bicycling
10. Physical therapy

If conservative treatment is insufficient to treat the symptoms, then surgical intervention is required. Dr. Stewart will determine which procedure is best for you. The surgical procedure is determined by the condition of the joint at the time of surgery. For patients that undergo a joint sparing procedure, they are reminded that osteoarthritis is a progressive condition and they may require additional surgery in the future.

Surgical treatment for osteoarthritis includes:

1. Removal bone spurs
2. Joint implant
3. Joint fusion (arthrodesis)
4. Joint decompression
5. Subchondral bone drilling