The first metatarsophalangeal joint (MPJ) is compromised of two bones that make up our big toe joint. The MPJ is one of the major weight bearing joints in our foot. When the range of motion in the first MPJ is limited, the condition is medically known as hallux limitus. Hallux limitus is a form of degenerative joint disease or arthritis which can happen as a result of acute trauma, wear and tear of cartilage from repetitive micro trauma or biomechanical deformities.
Symptoms experienced with hallux limitus are swelling and pain of the big toe joint especially while pushing off. When the arthritis has advanced, it can produce bony growth at the top of the MPJ which can cause irritation in shoe gear from friction. Patients will often develop calluses to the lesser joints of the forefoot because they try to avoid the big toe joint while walking due to pain.
Diagnosis is usually a combination of physical examination and radiographic findings. There is pain on dorsiflexion (extension) of the first MPJ due to arthritic changes and lack of cartilage. On xrays, joint narrowing is usually noted of the first MPJ which clinically coincides with pain on range of motion of the joint. Dorsal exostosis of the first metatarsal bone may also be noted in advanced arthritis.
Conservative treatment options for hallux limitus can range from injections for pain control, padding/strapping and orthotics with supportive shoe gear. Orthotics are helpful in offloading the affected joint and allowing a more neutralized gait pattern.
Surgical options range from joint salvaging procedures such as shaving the arthritic bone (known as a cheilectomy) or placing a spacer implant in the joint to allow for motion. Another surgical option which involves more joint work is known as a fusion which involves screws and plates to surgically fuse the joint so that motion no longer causes pain. Surgical decisions are made based on clinical and radiographic findings along with patient lifestyle.
If you feel like your big toe joint is painful and hurts every time you take a step, call and come in today for a consultation. Don't wait for the pain to become unbearable and your treatment options to become limited. Our podiatrists are surgically trained to have you get back on your feet!