Hallux: The Types, Causes, Problems, Solutions & Truth Revealed

To many, it’s simply known as the big toe, but in the anatomy of the human body, it’s called the hallux. Hallux is the common origin of most foot pain for many of us. 

Most big toe pain is easily associated with bunions, but bunions are just one problem that causes pain in the toe. There are various foot pain issues, including those that cause big toe pain.

Big Toe Anatomy

The big toe consists of two joints. One of the joints joins the bones of the big toe to one of the middle bones of the foot known as the first metatarsal. 

Most hallux problems occur at this joint, where the big toe meets the foot because the joint there is subjected to a lot of pressure as a result of walking movement. Plus, the joint is responsible for a lot of flexing every time you push off to take a step.

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Furthermore, being that the big toe joint is located on the outside of the foot, it is also subjected to pressure from the sides of the shoes. It’s a known fact that the type of footwear is a common cause of bunions, and it can also directly influence the painful symptoms associated with hallux.

big toe anatomy

Types of Hallux

Being that hallux is a progressive condition, the toe’s motion decreases with time. Thus, in its earlier stage, when the motion of the joint of the big toe is only fairly limited, the condition is called hallux limitus.

But as the condition advances, the toe’s range of motion gradually declines until it reaches the stage of hallux rigidus, where the big toe becomes stiff.

Hallux Limitus

Hallux limitus causes the joint connected to your big toe to be uncomfortable and stiff. You may have pain and trouble walking. Hallux limitus is a condition in which your hallux joint is inflamed, sore, and somewhat stiff. 

Hallux limitus can progress into hallux rigidus over time, and at that stage, the joint can’t move at all, and walking can become impossible. However, you can prevent the immobilization effect of hallux rigidus with some basic treatment and careful management. 

What Causes Hallux Limitus?

The causes of hallux limitus in one or both feet vary, and some are unavoidable. However, other causes can be avoided. Now, let’s look at the most common causes of hallux limitus:

Unusual foot anatomy that forces victims to walk in a way that stresses their big toe joints.

Arthritis and conditions like rheumatoid arthritis or osteoarthritis may change how you walk, putting stress on your big toe joint. 

‌Injuries like stubbed, sprained, or broken toe, may also damage the joint and cause hallux limitus to appear over time. 

‌Activities that put a lot of pressure on your toes, like running or high-impact sports, can result in damage to your big toe joint. 

Unsuitable and Poorly fitting footwear like high heels or shoes that are too small or with pointed toes can all put extra pressure on your toes, resulting in damage to the toe joints. 

Hallux Rigidus (Stiff Big Toe)

What Is Hallux Rigidus?  

Hallux rigidus of course is a disorder of the big toe joint. This joint is located at the base of the big toe, and hallux rigidus causes pain and stiffness in the joint.

With time, this disorder makes it increasingly harder to bend the toe.  As already stated, Hallux refers to the big toe, while rigidus means rigidity; meaning that the big toe is rigid and cannot move. Hallux rigidus is actually a form of worsening case of arthritis.

Hallux rigidus can be a troubling condition and can even disable you, bringing your movement to a halt.

After all, we use the big toe whenever we walk, bend down, jump up, or stand. Many patients confuse hallux rigidus can easily be confused with a bunion since both conditions affect the same joint. However, they are very different toe conditions and require different treatment procedures.

hallux valgus

Causes Of Hallux Rigidus

Common causes are faulty biomechanics and structural anomalies of the foot that can lead to osteoarthritis in the joint of the big toe. This type of arthritis is the type that results from wear and tear. It often develops in people who have defects that affect the functionality of their feet and big toe.

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For example, Individuals with fallen arches or excessive rolling in of the ankles are vulnerable to developing hallux rigidus. In some people, hallux rigidus is hereditary, where they inherit a foot type that is prone to developing hallux limitus, which progresses to hallux rigidus with time.

In other cases, rigidus is associated with overuse of the foot, especially among people in sport or jobs that put lots of stress on the big toe, such as workers who often squat while working.

Hallux rigidus can also result from an injury to your toe or by inflammatory diseases, such as rheumatoid arthritis or gout.

Symptoms Of Hallux Rigidus

symptoms include:

  • Pain and stiffness in the big toe. This pain or stiffness can be aggravated by cold weather
  • Difficulty with activities that involves the use of the foot such as running, squatting, etc…
  • Swelling and inflammation of the joint around the big toe

Over time, additional symptoms may develop:

  • Pain of the big toe even during rest
  • Problem with wearing shoes because bone overgrowths has developed
  • Poor posture that causes dull pain in the hip, knee or lower back due to alteration in your walking gait.
  • Limping which causes a postural defect that can affect your whole being.

The pain and inflammation associated with Hallux rigidus symptoms can often be relieved with conservative treatment options that might include:

  • Use of ice on the joint of the big toe
  • Application of heat to the affected joint
  • The topical use of medications to reduce pain and swelling
  • Use of prescription orthotics that support the joint
  • Joint injections

You can use these options to provide adequate relief for pain and stiffness, but if they fail, then surgery might be considered to repair the joint, and remove painful bone spurs.

Hallux Valgus (Bunions)

What is hallux valgus?

Hallux valgus is the misalignment of the big toes. With the hallux valgus deformity, the metatarsophalangeal joint is put under undue stress, resulting in painful arthritis of the big toe.

The bunion at the big toe joint can become inflamed and painful with time.

What causes Hallux valgus pain?

The bunion becomes inflamed and pushes against the inside of the shoe in response to pressure. Pain now develops in the arch of the foot, because the big toe is not fully functional and the small toes are overstrained. Finally, Arthritic pain in the joint of the bigfoot occurs due to wear of the joint.

Prevention

You can prevent the hereditary factors that expose you to this condition, but other things like wearing shoes that fit properly and avoiding high heels or pointed shoes can be important factors in preventing bunion condition.

Hallux Varus

Hallux varus can result from a number of causes but usually from a poor capsular repair or tissue handling during surgery, and patients not complying with recommendations from specialists.

Hallux Varus is a clinical condition that causes deviation of the great toe at the metatarsophalangeal (MTP) joint. This condition has multiple causes with various symptoms and varying severity.

Mild hallux varus can be managed with stretching exercises and splints, but a more serious condition that can affect daily activities may require surgery.

How do You Cure Hallux?

Operative Treatment

If non-operative treatment fails, surgery could be considered. Before an operation is chosen, the severity of the hallux valgus has to be determined. In order to do that, weight-bearing plain film radiography is used.

There are about a hundred and thirty-one different surgical techniques. Many surgeons combine one or two techniques depending on the severity of the condition and the history of the patient.

hallux surgery 2

How to Prevent Hallux From Affecting Your Health

If you think that you’re developing hallux, you can do a couple of things to reduce your pain and heal your joint. 

  • Wear shoes that fit and allow your big toe to move. Avoid wearing shoes that pinch your toes, and make sure that you don’t use heels higher than an inch. Shoes that are flat and fit well allow your big toe to move naturally and heal.
  • Just as with any other injury, your foot needs to rest to heal. Make sure to rest your feet frequently and avoid high impact activities like running until your joint has recovered.
  • Use orthotic inserts or insoles to help support your feet. Soft gel pads can help reduce the pressure on your big toe joint, while orthotics can help correct the way you walk. 
  • Take anti-inflammatory medications like ibuprofen or aspirin to help reduce the symptoms while you wait for the condition to heal. 
  • Ice the joint two to three times a day to reduce swelling and pain. Make sure to only ice your foot for fifteen minutes at a time to avoid cold burns.
  • Talk to your doctor about corticosteroid injections, and if using the options mentioned above doesn’t help your symptoms, you can talk to your doctor about corticosteroid shots to reduce swelling and help the joint heal.
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Diagnosis

The earlier this condition is diagnosed, the easier it is to treat and fix it. Thus, it’s best to see a foot and ankle surgeon as soon as you notice the first symptoms. Waiting until bone spurs develop will worsen your condition and make it more difficult to manage.

In diagnosing the condition, the surgeon will examine your feet and move the toe to determine its range of motion. Sometimes, the use of X-rays helps determine how much arthritis is present already and to check if any bone spurs or other abnormalities have formed.

Nonsurgical Treatment

In many cases, early detection and treatment may prevent the need for surgery in the future. Therefore, treatment for mild or moderate cases of hallux may include:

  • Shoe modifications to put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.
  • Use of Orthotic devices that may improve foot function.
  • Medications like Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used to reduce pain and inflammation.
  • Similarly, Injection therapy with corticosteroids may reduce inflammation and pain.
  • Physical therapy like Ultrasound therapy may be undertaken to provide temporary relief.

When Is Surgery Needed?

In some cases, surgery is the only way to eliminate or reduce the pain. Several types of surgery are available and your doctor will know the procedure or combination of procedures for your particular case.

Your health care provider will take into consideration the extent of the deformity of your toe based on the x-ray findings, your age, your physical activity level, and other significant factors.

Your recovery from the surgery (recovery period) will vary depending on the procedure or procedures used.

Hallux Amputation

Many surgeons have documented the success of more distal amputations emphasizing the techniques of limb preservation. The primary function of the lower extremity is locomotion and the podiatrist’s goal is to preserve this function.

The primary objective of amputation surgery when necessary is the maintenance of a functional stump at a level capable of healing. Partial amputations may allow for the preservation of a functional foot with a major advantage being the ability to bear weight and walk.

One of the major objectives of amputation surgery is to maintain a functional limb, which is capable of adequate wound healing, thus preventing the need for additional amputation at a more proximal level.

hallux amputation

General Principles

Most surgeons rely on certain basic principles in amputation surgery in order to obtain a successful result.

These may be categorized in the following anatomic groups: skin, muscle function, nerve endings, blood vessels, bony prominences, and diseased tissues.

These principles are equally applicable to hallux amputation. Great care must be taken by the surgeon to minimize trauma to the skin, by avoiding unnecessary or excessive handling of the tissues.

In order to preserve the deep circulation and viability of the tissues, anatomic dissection with the separation of tissue layers is avoided.

During surgery, consideration must be given to each tissue encountered and the role it would play in providing function following hallux amputation. It is essential that all diseased tissue is excised and that no dead space remains prior to final skin closure.

It is important to determine whether the wound should be open, or closed by secondary healing, delayed primary closure at a later date, or closed primarily at the time of surgery. When in doubt, the surgeon should leave the wound open.

Closing thoughts

Relative contraindications for tendon transfer reconstruction for hallux surgery include, but are not limited to, degenerative arthrosis, inflammatory arthritides, active infection, peripheral neuropathy, and vascular compromise.

In addition, excessive resection of the medial eminence and fixed deformity of the metatarsophalangeal (MTP) joint might occur.

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