What is the pain in your big toe?

Hallux Limitus: The Big Pain in Your Big Toe.

The ankle bone’s connected to the… heel bone. The heel bone’s connected to the… foot bone. The 1st metatarsal bone is connected to the… hallux bone.  This (slightly altered) children’s song, “Dem Dry Bones” had it right- everything is connected.  And it is this connected system that allows the body to work in a miraculous unified way.

However, when one bone is not working quite right, it disrupts the function of its connected bone. This disturbance is commonly seen in the big toe joint. The big toe joint sits between the big toe bone, called the hallux, and the long bone directly beneath it called the 1st metatarsal bone. Improper movement of these two bones leads to irritation of the joint and a big toe that has limited ability to move up or down. This condition is termed hallux limitus or hallux rigidus.

Few are blessed with what podiatrists term an “ideal foot”. Most of us out there have unique foot types that require compensation when we walk. This compensation occurs most often by the arch flattening, which can cause pain in the feet and knees. Flattening of the arch (pronating) is an important part of taking a step because it acts to absorb shock as the foot hits the ground. However, it can cause problems if the arch continues to flatten beyond this phase of walking. As the foot propels off the ground, over-pronating will disrupt the normal relationship between the connecting bones and ligaments.  Over-pronating makes the joints in the foot relatively loose causing the first metatarsal bone to become hypermobile. Over many years, this hypermobile joint will rub against the toe bone. This causes jamming at the top of the joint, leading to pain, inflammation and a rigid big toe. The stiffness in the big toe can make walking and running difficult. The cartilage in the joint will break down leading to osteoarthritis. The body will try to repair itself by increasing bone formation at the site of injury,  leading to the production of spurs.

If caught early, orthotics can re-establish normal function of the joint. A functional orthotic will control the excessive pronation and allow for normal communication between the big toe and the metatarsal bone. If the joint is arthritic and spurs have already formed, the spurs must be surgically removed and the debris cleaned out of the joint. After the procedure, orthotic devices are necessary to prevent recurrence of hallux limitus. If severe arthritis is present, the big toe bone and the 1st metatarsal can be fused together. This will eliminate the pain and allow for more stability. Another option for severe hallux limitus is a joint implant. In this scenario, part of the damaged bone is removed and replaced with a metal, plastic, and/or ceramic implant that acts as a moving joint. This is similar to that of a knee implant but on a much smaller scale.

Hallux limitus can be extremely painful. It goes beyond limiting the range of motion of your big toe. It limits your ability to carry out everyday activities that require walking and running.

So don’t let the pain in your toe joint go unnoticed; the longer you wait the worse it gets.
At Kansas City Foot and Ankle, podiatrist Dr. Mark Green will provide the proper care to your big toe joint and free you from the restraints of hallux limitus.  And…the toe bone’s connected to the…Come on now, you know you want to sing it!