From the Guidelines
Hallux limitus should be treated with conservative measures, including wearing shoes with a stiff sole and roomy toe box, using anti-inflammatory medications, and applying ice to reduce inflammation, as these methods have been shown to be effective in managing symptoms and improving quality of life 1.
Treatment Options
The treatment of hallux limitus typically begins with conservative measures, such as:
- Wearing shoes with a stiff sole and roomy toe box to reduce pressure on the joint
- Using over-the-counter anti-inflammatory medications like ibuprofen (400-800mg three times daily with food) for pain
- Applying ice for 15-20 minutes several times daily to reduce inflammation
- Custom orthotic inserts with a Morton's extension can help redistribute pressure away from the painful joint
- Physical therapy exercises to maintain joint mobility are beneficial, such as gently pulling the toe upward and holding for 30 seconds, repeated 5-10 times daily
Surgical Options
In severe cases that don't respond to conservative treatment, surgical options like cheilectomy (removal of bone spurs) or joint fusion may be necessary, as indicated by the conditional recommendation in favour of metatarsal-phalangeal joint arthroplasty in combination with a non-removable offloading device when non-surgical offloading interventions have failed 1.
Importance of Early Intervention
Early intervention is important to prevent progression to hallux rigidus, a more severe form with complete joint immobility, and to improve quality of life, as supported by the finding that MTH resection may cause moderate increases in quality of life after healing 1.
Considerations for Treatment
The treatment of hallux limitus should take into account the individual's specific condition, including the presence of any underlying structural issues or abnormal mechanics in the foot, as well as the potential risks and benefits of each treatment option, as emphasized by the consideration of equity and acceptability in the recommendation for MTH resection 1.
From the Research
Definition and Symptoms of Hallux Limitus
- Hallux limitus is a condition that affects motion at the first metatarsophalangeal joint, leading to abnormal forefoot plantar pressures, pain, and difficulty with ambulation 2.
- The symptoms of hallux limitus include pain, particularly under the great toe, and difficulty walking or performing daily activities 2, 3.
Conservative Management of Hallux Limitus
- Conservative care alone can be successful in treating hallux limitus, with 55% of patients responding to treatment in one study 4.
- Orthoses are a common conservative treatment for hallux limitus, with 47% of patients in one study being successfully treated with orthoses 4.
- Other conservative treatments for hallux limitus include corticosteroid injections, shoe modifications, and physical therapy 4, 2, 3.
- A novel forefoot orthosis has been shown to improve foot function, reduce pain, and restore physiologic stance in patients with symptomatic hallux limitus 3.
Surgical Management of Hallux Limitus
- Surgical procedures may be necessary for patients who do not respond to conservative care, with 38% of patients in one study undergoing surgery 4.
- The choice of surgical procedure should be based on the etiology of the deformity and the degree of articular degeneration 5.
- Cheilectomy with osteotomies designed to create an internal rocker bar mechanism is one surgical option for treating hallux limitus in young patients 5.
Comparison of Hallux Limitus and Hallux Rigidus
- Hallux rigidus is a more advanced stage of hallux limitus, characterized by a complete loss of motion in the first metatarsophalangeal joint.
- Nonoperative treatment options for hallux rigidus include manipulation, intra-articular injections, shoe modifications, orthotics, physical therapy, and experimental therapies 6.