Arthritic Big Toe Joint / Hallux Limitus
Hallux (big toe) limitus (limited) is a wear and tear arthritic condition of the big toe joint. It is the second most common condition affecting the foot and ankle and can produce pain and limit a persons’ activity.
Many factors have been implicated in the development of hallux limitus but the most common cause is trauma to the joint. Trauma often damages the articular cartilage, the shiny and smooth material that is on the end of bones and allows the bones to move in an unrestricted manner. This damage produces cracks within the cartilage and allows the fluid of the joint (synovial fluid) to seep under the cartilage and cause it to lift away.
If this process continues eventually all the articular cartilage can wear away to expose the underlying bone and further increase pain levels.
Hallux limitus is characterised by pain, stiffness and new bone formation which increases the size of the joint and can cause footwear irritation and constriction.
X-ray showing end stage arthritis of a big toe joint. In comparison to the joint next to it there is no joint space and large amounts of new bone formation around the margins of the joint.
Non-surgical management of this condition can include: orthotics (insoles) to address any malalignment of the foot, steroid and synthetic joint fluid injections.
Surgical management of hallux limitus includes a number of different treatments. The treatments are tailored to the patient as well as the severity of the arthritic changes. Investigations include x-ray and MRI as this is sensitive in detecting cysts or defects that may not be apparent on x-ray.
- Removal of the bony outgrowth and tidying up of the joint: Cheilectomy
- Osteotomies to address any length or positional abnormalities
- Implants: total implant or a Cartiva implant (see below)
- Fusion: this procedure is used for severe arthritic changes or in patients who are very active.
- Arthoplasty: This procedure is reserved for more sedentary patients
- Arthroscopic debridement / drilling: this is used in cases where there is an isolated defect within the cartilage and bone that produces pain
As mentioned procedures are tailored to the patients activity levels, social and work circumstances and the severity of the condition.
Hallux limitus with large osteophyte (new bone formation) on the top of the joint that develops with the condition.
Same foot from the side
Fusion of the big toe joint with two cross screws
Innovations in Hallux limitus surgery
In recent years, there have been several developments in the surgical management of hallux limitus and depending on the severity of the condition the condition may be amenable to a Cartiva implant thereby, possibly, reducing the need for a fusion. The link below outlines the Cartiva implant: