hallux limitus


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Related to hallux limitus: functional hallux limitus

hallux limitus

Limitation of range of motion of the first metatarsophalangeal joint, usually with arthritic degeneration of the joint and pain. See: hallux rigidus
See also: hallux

hallux limitus

first-ray pathology characterized by restricted dorsiflexion (reduced sagittal-plane motion; i.e. <60° available dorsiflexion) at first metatarsophalangeal joint, during the propulsive phase of gait (Table 1 and Table 2 and Box 1, Figure 1; see synovitis)
  • acute hallux limitus acute-onset first metatarsophalangeal joint inflammation due to stubbing the great toe; see toe, turf

  • functional hallux limitus reduced range of dorsiflexion motion at the first metatarsophalangeal joint (see functional hallux limitus)

Table 1: Factors that predispose to hallux limitus/rigidus
LocationFeatureCharacteristics
Intrinsic factorsFoot shapeRectus foot
Long first toe
Long first metatarsal
Biomechanical factors within the foot that cause excess STJ and MTPJ pronation, so that foot is pronated from midstance to toe offAnkle equinus
Pes planovalgus
Forefoot varus
Metatarsus primus elevatus
Hypermobile first ray
Flexor plate immobility
Plantar soft-tissue contracture
Functional hallux limitus
Structural anomalies that predispose to excess STJ and MTPJ pronationExternal tibial torsion
Tibial varum
Knee position variants
Femoral retroversion
Longer limb
Wide-based gait
TraumaOsteochondritis
Osteoarthrosis
Soft-tissue tears
Turf toe
Extrinsic factorsInflammatory joint diseaseRheumatoid arthritis
Gout/crystal arthropathy
Psoriatic arthropathy
Generalized osteoarthritis
Sesamoid degeneration
Occupational hazard - repeated forced dorsiflexion of the first MTPJ/stubbing the first toeCarpet laying
En pointe ballet dancing
Football
Netball
Tennis
High-heeled shoes

STJ, supratalar joint; MTPJ, metatarsophalangeal joint.

Table 2: Classification of stage of hallux limitus/rigidus
StageCharacteristics
Stage 1
Functional HL
∼60° available dorsiflexion at 1 MTPJ
Functional (weight-bearing) limitation of dorsiflexion at 1 MTPJ, with:
• 1 MTPJ painful under load
• Hypermobility of first ray
• No real joint deterioration, but some osteophytosis
• Non-weight-bearing 1 MTPJ dorsiflexion near normal
Stage 2
Mild structural HL
35-55° available dorsiflexion at 1 MTPJ
Structural limitation of dorsiflexion at 1 MTPJ
• 1 MTPJ painful after exercise/movement
• Broadening and flattening of 1 MTPJ surfaces
• Narrowing of 1 MTPJ space
• Moderate osteophytosis of 1 MTPJ area
• Local bone sclerosis
• Elevation of the first ray
• Sesamoid hypertrophy
• Reduced 1 MTPJ dorsiflexion (weight- and non-weight-bearing)
• Reduced heel lift
• 1 MTPJ crepitus
Stage 3
Moderate structural HL
15-30° available dorsiflexion at 1 MTPJ
Structural loss of dorsiflexion at 1 MTPJ
• Pain within 1 MTPJ
• Marked 1 MTPJ deterioration
• Loss of 1 MTPJ space
• Extensive osteophytosis
• Bone sclerosis
• Cystic degeneration of subchondral bone
• Joint 'mice'
• Hypertrophy of sesamoids
• Elevation of the first ray
• Loss of height of MLA
• Decreased calcaneal angle
• 1 MTPJ crepitus
• Marked reduction of heel lift
Stage 4
Severe HR
<15° available dorsiflexion at 1 MTPJ
1 MTPJ immobility
• 1 MTPJ ankylosis and loss of joint space
• Marked osteophytosis and increased bulk of 1 MTPJ
• Loss of heel lift and/or hyperextension of IPJ of hallux

1 MTPJ, first metatarsophalangeal joint; MLA, medial longitudinal arch; IPJ, interphalangeal joint.

Box 1: Gait and postural effects of hallux limitus/rigidus
  • Loss of heel leverage due to reduced dorsiflexion at the first MTPJ affects transfer of weight from rearfoot to forefoot

  • Obligatory pronation of the foot about the oblique axis of the MTJ and abduction of the forefoot occur in order to achieve a degree of toe off

  • Obligatory lower limb pronation including:

    • Internal rotation of tibia

    • Internal rotation, increased transverse-plane motion and medial knee strain

    • Internal rotation of the lower limb at the hip and lateral hip pain

  • Increased lumbar lordosis, forward tilt of the pelvis and lower-back pain

  • Thoracic kyphosis, forward tilt of the cervical spine with compensatory 'hunched' back/'bad' posture/'round' shoulders

  • Hyperflexion of the cervical spine, neck tension and tension headache

  • Gait effects include:

  • Foot pronation throughout ground contact and at toe off

  • Short stride length

  • Early knee flexion

  • Reduced heel lift

  • Decreased thigh extension

  • Diminished arm swing (to match reduced stride length)

  • Apropulsive gait

Figure 1: Hallux limitus. GRF, ground reaction force. This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall, Copyright Elsevier, (2006).