The first metatarsophalangeal joint (MPJ) is compromised of two bones that make up our big toe joint. 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 such as an elevated first ray or a long first metatarsal. When hallux limitus advances or goes untreated, it leads to hallux rigidus-a condition where there is no motion of the big toe joint.
Symptoms experienced with hallux limitus and rigidus are swelling and pain of the big toe joint especially while pushing off during the gait cycle. 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.
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 to the bones involved. 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 or bony spurring 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 stable gait.
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. For more advanced cases, a joint fusion procedure is often recommended.
Joint replacement procedures involve placing a spacer or prostheses in the affected joint. This prostheses is able to perform the function of a joint such as extension and flexion about the first MPJ. When the first MPJ becomes arthritic and starts affecting patient's gait and lifestyle, an artificial implant is added to prevent the two ends of the joint rubbing up against one another. Joint implants come in various types- such as metal, silicone or plastic.
The podiatrists at Advanced Podiatry have been trained in various surgical approaches and are experienced in various types of implant placements.
If you are experiencing pain in your big toe or notice a bunion type deformity starting to appear, do not hesitate to contact one of our foot specialists and see if surgery is the right fix for you!