What is Hallux Limitus?
Hallux limitus is a progressive condition characterized by decreased dorsiflexion (upward bending) range of motion at the first metatarsophalangeal joint (big toe joint), caused by bony proliferation, osteophyte formation, and articular cartilage degeneration that results in pain and functional disability. 1
Pathophysiology and Clinical Features
The condition involves progressive restriction of dorsiflexion at the first metatarsophalangeal joint, with eventual development of dorsal exostoses (bone spurs), marginal osteophytes, erosion of articular cartilage, and possible joint ankylosis (fusion) 1
Hallux limitus represents an osteoarthritic degeneration of the articular surfaces of the first metatarsophalangeal joint, which can progress to complete stiffness (hallux rigidus) if left untreated 2, 3
The mechanical limitation of dorsal flexion frequently causes compensatory plantar flexion with hypermobility in the interphalangeal joint of the great toe 3
Biomechanical Associations
Any force or condition that restricts dorsiflexion at the first metatarsophalangeal joint may produce these typical changes over time 1
The condition is commonly associated with pes planus (flat foot) deformity and may occur concomitantly with accessory navicular bones, though a direct causal relationship has not been definitively proven 4
In athletes and active individuals, repetitive stress and biomechanical abnormalities are common contributing factors 1
Clinical Presentation
Patients typically present with pain in and around the first metatarsophalangeal joint, particularly during activities requiring toe dorsiflexion such as walking, running, or climbing stairs 1
The condition can lead to abnormal forefoot plantar pressures, difficulty with ambulation, and interference with work performance and activities of daily living 5
Physical examination reveals limited dorsiflexion range of motion at the first metatarsophalangeal joint, with palpable bony prominences dorsally and pain with joint manipulation 1
Diagnostic Approach
Radiographic imaging (plain X-rays, MRI, or CT) should be obtained to determine the extent of joint damage, bony proliferation, and articular cartilage degeneration 6
Standard radiographs will demonstrate dorsal osteophytes, joint space narrowing, and subchondral sclerosis characteristic of the condition 1, 2