Your big toe, Hallux or great toe is a very important structure of the proper function of the lower extremity. Most of the people they don’t pay any attention to their toe unless it’s too ugly or hairy or too long and of course when it’s injured.
Hallux Limitus is described as a restriction IN the range of motion (ROM) of the big toe motion. Such motions are Plantar Flexion that means moving toe towards the floor and Dorsi Flexion meaning movement of the toe upwards.
Hallux Limitus can be extremely painfull or can be present with no pain at all. Even if there is no pain this condition should be concerned because its very important for the biomechanics of the Toe/ Ankle/Knee/ Hip and low back. Can create some compensations of the body that can be surely unpleasant for the patient.
Hallux Limitus can be caused from various circumstances. In athletes, trauma is the most common reason. The degree of trauma can vary from minor repetitive stress to severe trauma. Over pronation is a common cause of repetitive stress that is not felt until is too late.
Improper body mechanics and dysfunctional movement patterns, can lead to compensations which may cause over pronation of the foot during gait. Wearing short shoe or constrictive can also cause Hallux Limitus. In general, if the big toe is forced to hyperextension can result to the Hallux Rigidus condition. If the hyperextension is a minor one, then you can realize there is problem until the condition sets –in.
Under normal conditions, with each step, your foot must expand to absorb and distribute with loading of your bodyweight. Your arch or more specifically, your longitudinal arch takes the brunt of these forces. Your foot and arch then lengthens at which time, your big toe has to extend to tighten up the tendons and ligaments and plantar fascia of your foot to both support these forces and utilize potential energy so you have a little ‘’spring’’ in your step… literally. This is often referred to as the ‘’windlass’’ effect.
When working correctly, your foot should roll onto your big toe after the ‘’windlass’’ effect and you should push off of this very rigid yet ‘’springy’’ ‘’strut’’. If you have Hallux Limitus, this does not occur, the big toe does not extend enough and you will end up pushing off of your 2nd or third toe while walking, running, jumping etc.
This is not only an inefficient way to go about moving around in life, it can cause you to compensate in your ankle, knee, hip and even low back to keep things moving smoothly. Over time, this may result in injuries to these structures (due to overload) and, through a series of complex compensatory patterns, transfer the foreces into your upper back, neck and jaw leading to a myriad of problems.
One such a problem is the problem that is still within the foot structure is the development of a bunion or Hallux Valgus. As the foot/leg complex tries desperately to roll off of the big toes (which won’t let this happen because it can’t extend correctly), the rest of your foot will roll in putting forces on the metatarsal joint of the big toes which causes it to be pushed laterally. Over time, the joint (as seen in the picture) will become deformed and the big toe will angle awkwardly towards your other toes.
No matter what the cause of Hallux Limitus is , repetitive hyperextension and/or compression to the joints of the big toe will eventually cause inflammation resulting in early breakdown of the cartilage protecting the ends of the two bones. Without treatment the degenerative process will continue, forming cartilaginous spurs. With progression these cartilage structures can calcify into bony spurs. The end-stage of this disorder is a condition known as Hallux Rigidus, where the joint literallu fuse and no motion is left within it. Even with this as a possibility, much of the dysfunction that results from hallux limitus is not due to the injury to the joints of the big toe, but the compensation that takes place elsewhere in the body.
Hallux Limitus is easily detected by a well-trained doctor and can usually be treated conservatively with self-mobilization, pronation, controlled shoes, possibly orthotics, manipulation and Kinesiotape and Granston Technique. The first noticeable change with Hallux Limitus is loss of ability to dorsiflex (or extend) your big toe. Normal ROM is about 65 degrees. If you notice limitations or pain in the big toe joint with dorsiflexion, or your shoes are wearing unevenly, or have asymmetrical calluses on your feet, it may be time to visit your clinician.