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Posted on: June 29 2021

Big toe arthritis

Stiffness (limited upward flexion) of the big toe joint due to osteoarthritis is termed Structural Hallux Limitus. Hallux is the medical term for the big toe. When the big toe possesses no upward flexion , it is termed Hallux Rigidus. To confuse the topic, the big toe joint can also appear to have normal motion, but this motion can be limited when weight is on the foot and during the normal standing and walking. This is termed functional Hallux limitus, because it occurs during the normal functioning of the foot while walking.

Diagnosis

The most common cause of Hallux limitus is an abnormal alignment of the long bone behind the big toe joint called the first metatarsal bone. In this condition, the first metatarsal bone is elevated relative to the other metatarsal bones that lie behind the other toes. When this is the case, the big toe joint cannot move smoothly and jamming occurs at the joint. A variety of symptoms can begin to occur. One common problem that occurs is pain in the bottom of the big toe where a central callus can develop. The pain and callus develop because the big toe does not bend upward enough as the bottom of the toe is jammed into the ground.

Another consequence of the jamming of the big toe joint is the development of bone spurs on the top of the joint. This bump on the top of the big toe joint can become painful as a result of shoe pressure or jamming of the joint with the spurs, during gait as the great toe attempts to flex . With time, the big toe joint becomes stiff and painful to move. As the joint continues to degenerate more bone spurring occurs. If the condition is left untreated complete destruction of the joint can occur.

Diagnosis is made by performing a physical exam of the foot and the use of x-rays/ultrasound. In early stages of the condition x-rays may be normal. In later stages of the condition, narrowing of the joint and/or bone spurs may be evident.

Treatment

A functional hallux limits can simple be treated with padding and/or orthotics. A structural hallux Limits requires mechanical change to offload the joint, then if required followed by options to change the internal biologics (reduce the inflammatory proteins in the joint).

Mechanical treatments include mobilisation of the joint, and orthotics. Other options include rocker shoes and carbon plates. If pain and inflammation are still prevalent, injection therapy such as platelet rich plasma, or prolotherapy can be utilised. For those that prefer to avoid injections -low level laser -photobiomodulation is a gentle painless option.

If the condition progresses to severe spurring and joint damage where all conservative measures fail to give relief, surgery may be indicated. Depending upon the degree of degeneration of the joint, surgery may consist of simply removing the bone spurs around the joint or may require more involved surgery.

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