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What to Do About Big Toe Joint Pain/Hallux Limitus

December 9, 2018

 

Hallux limitus, sometimes called hallux rigidus if it’s more severe, is decreased motion in the big toe joint.  It’s caused by a variety of biomechanical and hereditary factors, but basically represents a spectrum of arthritic changes in the joint that prevent motion and cause pain.  Early changes in the joint may manifest themselves as a large bony spur on top of the first metatarsal head.  This is caused by repetitive trauma over the years and jamming of the toe into the metatarsal bone causes reactive bone formation.  Once the spur gets big enough, it can decrease the motion in the joint and cause pain whenever the bone from the toe rubs against the bone from the spur.  The spur may even get large enough that shoes rub against it, causing irritation.

 

In more advanced cases, the cartilage on either side of the joint begins to get thin and can eventually wear away.  When this happens the joint becomes painful with almost any movement, and overtime the motion becomes very limited throughout the joint in all directions.  This represents hallux rigidus.

 

So what can you do about this?  There is no way, unfortunately, to get back lost cartilage.  There are ways to remove bone spurs in the early stages surgically that can help get back more motion if there isn’t much cartilage damage, but unless some lifestyle or shoe gear changes are made, then the spurs will often return.  Once there is significant arthritis, the only choices are shoe gear/lifestyle modifications or surgery.  Surgery would typically consist of either a joint resurfacing procedure with a metal implant on one side of the joint, or fusion of the joint which will stop motion permanently.  

 

As far as lifestyle changes go, I don’t think that you need to stop running.  I don’t like this solution because running and exercise is so important to a runner’s well being mentally and physically.  Instead,  I mean adjusting other activities that are causing excessive toe bending.  This means avoiding going around the house barefoot and instead finding a stiff soled sandal for around the house that doesn’t bend.  It also means avoiding yoga poses or exercises such as planks or push ups that result in extreme toe bending.  It doesn’t mean that you can’t do the exercises altogether, but you do need to either place something under your ankle to put all the pressure there, or wear stiff shoes that don’t allow the toe to bend while doing the exercise.

 

Running shoes become a bit trickier.  The key to a good running shoe for this problem is to have a good stiff sole.  This protects the toe from bending too much and lets the shoe act as a lever to propel you forward, instead of the toe.  One way you can check to see if a shoe is going to work well for you is to grasp it in two hands and try to bend it at the place that your toe would normally bend.  If it’s flimsy then the shoe probably won’t help you much.  I’ve found that shoes with a “rocker sole,” such as the Hoka line of shoes, also work great for arthritis here.  They have a slight bend in the toe area, but use the overall shape of the bottom of the shoe to “rock” you towards the toe and push off, instead of relying on the toe joint bending to do the same thing.

 

If you’ve found a stiff shoe that you like, the next challenge is finding one that also doesn’t have seams over the toe joint that press on it.  Mesh in this area is key in order to avoid friction.  If you can’t find that perfect combo of stiff with mesh, add a silicone pad or wear a silicone bunion sleeve on your toe to decrease pressure on that area.

 

Finally, If you’d prefer more freedom in your shoe choices, there are some inserts that can convert almost any shoe into a stiff one.  The devices are called gait plates, turf toe plates, or spring plates, and are generally very thin inserts made of carbon fiber, graphite, or steel that slip under your regular insert and fit into almost any shoe.  They are a life saver for many runners who want to avoid surgery while doing what they want and can substantially decrease symptoms in many people.  I don’t like to plug any one device because I don’t have affiliations, but I want to point you in the right direction and I’ve had positive results with these two devices.  The first is a spring plate (https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert) without arch support that would be better for sneakers without much built in arch, and the other is called a turf toe insert (https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded) with a built in arch if you’re looking for some arch support as well.

 

I really hope that this information helped.  If you have any other devices that have helped you, or have any general questions, please comment below.

 

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