CEU
DEFINITION & ETIOLOGY
Despite being perceived as two separate entities, hallux
limitus and hallux rigidus actually signify different phases of
the same pathological process. Hallux limitus can clinically
be defined as a biomechanical or structural decrease in
the available dorsiflexion of the first metatarsophalangeal
joint (MTPJ). When there is a long-standing
biomechanical limitation of hallux dorsiflexion, the first
metatarsophalangeal joint responds by slowly developing
a progressive osteoarthritis of the joint, manifested as a
loss of dorsal articular cartilage and a hypertrophy of the
dorsal aspect of the first metatarsal head. If this condition
continues for several years, a condition known as hallux
rigidus will result. The pathologic process that occurs with
hallux limitus is responsible for a reduction in motion and
eventually pain experienced during the propulsive phase of
gait.
There are two phases of hallux limitus that can be
clinically differentiated. The earliest stage of first MTPJ
osteoarthritis is referred to as functional hallux limitus
and is characterized by a lack of dorsiflexion during gait.
When the joint is examined, unloaded range of motion
ROM appears normal, but a distinct dorsiflexion restriction
Contributing Authors:
• Samantha Miner, DPM is currently a Resident Physician in Podiatric
Medicine and Surgery at Mount Auburn Hospital, a Harvard-affiliated
teaching hospital.
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• Gregory A. Foote, DPM is affiliated with Shands Jacksonville Medical
Center in Jacksonville.
• David Cheskis, DPM is affiliated with NYU Langone Hospital Systems,
Brooklyn, NY
Current Pedorthics | March/April 2019
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