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Other big toe joint problems

For Hallux Abducto Valgus (bunions) – click here

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Structural Hallux Limitus

Often considered osteoarthritis of the big toe joint, this is where the big toe joint (1st Metatarsophalangeal joint) is stiff and does not bend up (dorsiflex) as much as it should. This can be painful, particularly when the joint is forced to bend, stubbed or knocked, or is repeatedly bent from activities such as running (particularly up hill), crouching, or wearing thin sole (flexible) footwear or heels. In some people, despite reduced movement, the joint can still be pain free.

The joint usually has bony changes and little spurs called osteophytes may be visible on x-rays or even as little lumps on the top of the joint which can be painful to press. Changes to the mobility of this joint can completely alter the way you walk and can be the cause of other foot or related pains and problems, so checking this joint is something a podiatrist will do as part of a routine assessment.

Hallux Rigidus

When the joint barely bends at all and is really stiff, we call this hallux rigidus, which is a near fusion of the joint. There are usually a lot of osteoarthritic structural changes associated with this which can be very painful, or again, in some people does not cause any pain at all.

Usually, we find joints get stiffer over time, sometimes they are more painful when they are hallux limitus (above) but the pain improves when the joint fully stiffens up.

Like hallux limitus, we often find altered foot and lower limb mechanics due to reduced movement of the joint. “transfer metatarsalgia” which just means pain in the metatarsals or ball of the foot (usually under the 2nd and 3rd metatarsophalangeal joints) is common when the big toe joint doesn’t bend because people have to shift their bodyweight to avoid the dysfunctional big toe.

Some people walk on the outside of to foot to avoid bending the toe too, so it is worth asking a Podiatrist to have a look at your foot mechanics if you have stiff toes.

Functional Hallux Limitus

Functional Hallux Limitus is when the big toe joint bends freely when you are sitting or lying down (not standing or putting weight through the foot), but it does not bend when you are standing or walking.

This is a a little more complicated, and is likely being caused by other mechanical issues and abnormal loading of the big toe joint which results in the joint “jamming”. A Podiatrist can assess this and try to manage the root cause using foot orthoses or insoles.  

Just like hallux limitus or rigidus above, it can lead to abnormal biomehchanics of the foot and lower limb if not managed.

When you have Functional Hallux Limitus, Hallux Limitus, Hallux Rigidus or Hallux Valgus, you may notice a bit of hard skin under the ball of the foot more in line with the 2nd toe joint. This is usually due to a shift in pressure into this area.

Turf Toe

This is an injury to the big toe joint caused when the joint is forced to bend upwards which can damage the joint and surrounding soft tissues. It is most commonly associated with sports, or pushing off when sprinting, running or jumping.

Extensor tendon or extensor hood injury

The tendon on the top of the big toe joint or the hood/sheath around it can become painful, swollen or injured. This is usually due to trauma or forced downward bending of the toe.

When to see a Podiatrist?

Problems with the big toe joints can impact your walking and running and change the mechanics of your feet, even if the big toes themselves do not hurt, so it is worth getting someone to assess your foot biomechanics and gait.

Furthermore, if you are having pain, an assessment may lead to advice on helping to manage this.

From our experience, footwear is a huge factor here. We often find that if you are suffering with pain when the big toe joint is bent, then stiffer/rocker soled footwear such as running trainers or walking boots may help. However, it is still worth getting an assessment to check the underlying mechanics.

Sometimes exercises and mobility work can be done to try and help and foot orthoses can play a huge role in offering further relief and improve symptoms, however these usually need to be designed specifically for your mechanical needs, which a Podiatrist can do.

Sometimes X-rays and other imaging is advised to further assess the joint and steroid injections and other types of injections such as Ostenil, or even surgery may be considered to help treat problems if they are more severe.

If you book an appointment to see a Podiatrist, it is a good idea to take the shoes that you wear day to day and any sports or exercise specific footwear that you use.

Big toe joint problems