From the Research
The initial treatment for hallux limitans should focus on conservative, non-surgical approaches to reduce pain and inflammation, as supported by the most recent and highest quality study available 1.
Key Components of Initial Treatment
- Activity modification to reduce pain, including avoiding high-impact activities and wearing shoes with a stiff sole and rocker bottom to minimize motion at the first metatarsophalangeal joint
- Over-the-counter NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) to manage pain and inflammation
- Physical therapy focusing on gentle range-of-motion exercises and joint mobilization to maintain joint mobility
- Shoe modifications, including wearing shoes with a wider toe box and low heel
- Custom orthotic devices with a Morton's extension or rigid insert to limit painful motion at the joint
- Applying ice for 15-20 minutes after activities to reduce inflammation
- Corticosteroid injections may provide temporary relief for acute flare-ups but should be limited to 2-3 injections per year to avoid joint damage, as indicated by the review of non-operative management strategies 1
Rationale for Conservative Approach
The conservative measures are recommended as first-line treatment because hallux limitans results from degenerative changes and cartilage damage at the first metatarsophalangeal joint, often due to repetitive trauma or structural abnormalities, and these approaches aim to reduce joint stress and inflammation while maintaining function. Although there is limited high-quality evidence supporting specific non-operative modalities, the available studies suggest that these conservative measures can provide improvement in symptoms and function 1.
Consideration of Surgical Intervention
Surgical intervention may be considered when non-operative management strategies have proven unsuccessful, as demonstrated in case studies such as the one presented in 2, where a cheilectomy procedure resulted in significant improvement in joint motion and reduction in pain. However, the decision to proceed with surgery should be made on a case-by-case basis, taking into account the severity of symptoms, the degree of joint degeneration, and the patient's overall health status.