Understanding Hallux Limitus / Rigidus: A Conservative Approach For Each Stage of Joint Destruction
pattern can be seen with instrumented gait analysis. The first metatarsal head has a ginglymus shape
Vallotton postulated that this occurs when over- similar to the knee, and in order for dorsiflexion
pronation of the hindfoot leads to excess medial motion to be unhindered, the metatarsal head
loading that puts tension on the flexor hallucis must be free to plantarflex as the hallux rises. Early
longus (FHL) tendon. The FHL tendon passes in the development of the condition the joint is
through a groove in the posterior aspect of the asymptomatic and presents with normal range of
talus sometimes referred to as the retrotalar pulley. motion (ROM). As the disease progresses motion
Tension on the tendon during pronation causes it decreases, and pain develops with each step.
to become functionally shortened, restricting the
amount of dorsiflexion available at the first MTPJ [1] . Structural hallux limitus is differentiated from the
Another theory focuses on dorsiflexion of the medial functional form by the onset of joint stiffness and
column. In cases where the patient has a flexible a progressive loss of dorsiflexion ROM from bony
medial column that allows for excess dorsiflexion and joint capsule adaptations at the first MTPJ. The
of the first ray during mid-stance and propulsion, degree of adaptation will worsen over time, to the
jamming of the first MTPJ occurs as the hallux tries point where no motion is available to the joint and
to dorsiflex on an elevating first metatarsal head. As hallux rigidus occurs [2] . This often occurs bilaterally,
the base of the phalanx rides up on the metatarsal and is more commonly seen in females [3] . Other
head, binding or tightening of the joint occurs. etiologies include trauma, extrinsic biomechanical
"Hallux limitus/rigidus is the second
most common condition affecting the
big toe after hallux valgus."
Figure 1: Here one can see an orthotic with a first ray cutout that clinicians
can use to help treat Stage 0 and 1 functional hallux limitus.
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Pedorthic Footcare Association | www.pedorthics.org