The great toe joint or big toe joint bears a tremendous amount of stress with very step you take. The force can be two times your body weight. We take our big toe joint for granted and unless a problem develops we don’t think about it. The big toe joint is medically called the first metatarsophalangeal joint.

A common medical problem in this area is called Hallux Limitus or Hallux Rigidus. Hallux means great toe and limitus refers to a limitation of joint motion. Rigidus means no motion occurs. Hallux limitus is one of the most common conditions that a podiatric surgeon sees in the office. This is often confused with a bunion but it is actually a different condition (see bunions on this site). Hallux limitus involves restriction of movement of the great toe joint to varying degrees.

This disorder can be very disabling for some people because we use this joint so much in our daily lives. This condition often involves pain and stiffness in this joint. You may also have redness, swelling and a large bump on the top of the joint. Usually the bump or bumps are due to abnormal bone that has developed in the area of stress. These are also known as bone spurs and are called ‘osteophytes’ by surgeons. They can block normal motion from occurring and cause pain.

The pain can be a deep ache or occasionally very sharp and disabling. Most patients that encounter this condition are over 40 years of age and men have a slightly higher incidence than women.

This is a progressive condition and the joint motion often decreases over time. It is essentially a form of degenerative arthritis of the big toe joint. It is not related to gout and is a separate condition. It can be caused by trauma, overuse and abnormal mechanics of the foot. This can cause other joints to be overworked to compensate for the lack of motion to the great toe joint. It can even cause low back pain as the great toe joint is very important for normal gait patterns. Sometimes the body causes the low back to increase its curvature in walking. When the joint no longer moves at all it is called ‘hallux rigidus’.

Early signs and symptoms include:
1. pain and stiffness in the big toe during use
2. pain and stiffness aggravated by cold damp weather
3. difficulty with running or squatting
4. swelling and inflammation around the joint
5. pain and difficulty with shoes

In more mild cases the surgeon will “clean up the joint” removing bone spurs that may be blocking motion and causing pain. In addition the surgeon will also remove any floating pieces of bone or cartilage in the joint that can cause pain. If more is required the surgeon may make a bone cut called an osteotomy to create more motion in the joint. This is done in a very precise way to ‘decompress the joint’ and is very successful.

The last option, when the joint has less than 50% of cartilage remaining on the surface of the joint and the patient is over 50 years of age, is to insert an implant. The implant is not a ‘total joint replacement’ but rather a ‘hemi’ or half of the joint is resurfaced. These implants have been in use for over 40 years. Another option in severe cases (but much less common) is fusion of the joint.