A medical name for the big toe is the Hallux, and limitus simply means limitation of motion, so Hallux limitus is the name used to describe a degenerative arthritic process that causes reduced motion in the big toe joint. You may have noticed over time that the joint is becoming stiffer, and a lump appears on the top. The lump is due to extra bone forming on top of the joint. When you walk, the heel lifts off the ground, so the big toe must bend. Normal motion is about 70° – 90°. Arthritis begins to occur because the joint is either malpositioned, such as with bunions or the shape of the bone, which causes the joint to jam. These types of factors can be hereditary. However, a joint injury, such as stubbing your big toe, may also cause this problem. The higher the heel you wear, the greater the motion required at this joint. Some people alter how they walk to compensate for the joint stiffness, which can cause problems elsewhere.

ally because of long-term mechanical irritation. They can occur in many locations in the body, but when they occur in the ball of the foot, they are called Morton’s Neuroma. The most common location is between the third and fourth toes and, less commonly, between the 2^nd and 3^rd toes. Squeezing across the ball of the foot will aggravate the nerve. Symptoms can range from intermittent pain, cramping, or burning in the ball of your foot to numbness affecting the toes. Relief may be obtained temporarily by removing shoes and massaging the foot. On some occasions, there can be inflammation of the joints in the ball of the foot, which is hard to differentiate from neuroma pain.

Nonsurgical treatment can include

• exercises to mobilize the joint
• Footwear – reducing heel height, rocker-soled shoes or carbon foot plates
• orthoses if there are faulty foot mechanics
• Anti-inflammatory drugs
• Cortisone injection into the joint can be beneficial to manage pain, not good long-term

These treatments do not fix the arthritis or the deformity but aim to reduce pain. It may also slow the progression of the arthritis. When conservative care does not provide satisfactory relief, or when the condition interferes with your activities or choice of shoes or is beginning to cause other problems, surgery is the next thing to consider.

Surgical for hallux limitus does not restore the joint back to normal function. The aim is to reduce pain and improve your function. The type of surgery used varies and depends on your age, activity level, the amount of arthritis in the joint, and any underlying structural deformities.

Surgery for hallux limitus can be classified as either joint preservation or joint destructive procedures. Performing joint preservation procedures where you maintain some movement in the joint is ideal. Examples of these types of procedures are in the early stages, where the arthritis is not too bad. Surgery may be as simply removing the bone spurs, but this may go on to develop more arthritis in the future and require further surgery. 

Another option is an interposition arthroplasty, in which part of the joint is removed, and the joint capsule is interposed into the joint space to form a spacer and allow the joint to move still. Joint replacements are also available that can relieve joint pain and maintain mobility, but they do not restore the full function of the joint. For severe arthritis, removing the bone spurs and fusing the joint is the surgery of choice.

We will advise you on the best way to manage your problem depending on the stage you are at, using both conservative and, if necessary, surgical methods. Hallux Limitus is an osteoarthritic process, so it cannot be cured but can be managed to reduce or stop pain. It will cause the joint to stiffen progressively over the years, so you need to consider a short—, medium—, and long-term treatment plan for hallux limitus.