Dr. Vincent Giacalone
Podiatric Medicine & Surgery
466 Hook Rd., Suite 24D, Emerson, NJ 07630
Each day, with every step you take, your big toe bears a tremendous amount of stress, a force equal to about twice your body weight. Most of us don’t realize how much we use our big toe. We tend to take it for granted, unless a problem develops. One problem that afflicts the big toe is called hallux limitus, a condition where movement of the toe is restricted to varying degrees. This disorder can be very troubling and even disabling, since we use the all-important big toe whenever we walk, stoop down, climb up, or even stand. If you have pain and or stiffness in your big toe, you may have this condition.
What Is Hallux Limutus?
Hallux limitus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe, and with time it gets increasingly harder to bend the toe. “Hallux” refers to the big toe, while “limitus” indicates that the toe is limited in its movement and may eventually become striff and cannot move. Hallux limitus is actually a form of degenerative arthritis, a wearing out of the cartilage within the joint that occurs in the foot and other parts of the body. Because hallux limitus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, motion of the big toe is only somewhat limited, at that point, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “hallux rigidus”, where the big toe becomes stiff, or what is sometimes called a “frozen joint.” Other problems are also likely to occur as the disorder progresses.
Early signs and symptoms include:
· Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
· Pain and stiffness aggravated by cold, damp weather
· Difficulty with certain activities (running, squatting)
· Swelling and inflammation around the joint
As the disorder gets more serious, additional symptoms may develop, including:
· Pain, even during rest
· Difficulty wearing shoes because bone spurs (overgrowths) develop. Wearing high-heeled shoes can be particularly difficult.
· Dull pain in the hip, knee, or lower back due to changes in the way you walk
· Limping, in severe cases
What Causes Hallux Limitus?
Common causes of hallux limitus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis, the kind that results from “wear and tear”, often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux limitus. In some people, hallux limitus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse, especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux limitus can also result from an injury, even from stubbing your toe. Or it may be caused by certain inflammatory diseases, such as rheumatoid arthritis or gout. Dr. Giacalone can determine the cause of your hallux limitus and recommend the best treatment.
Diagnosis of Hallux Limitus
The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see Dr. Giacalone is when you first notice that your big toe feels stiff or hurts when you walk, stand, bend over, or squat. If you wait until bone spurs develop, your condition is likely to be more difficult to manage. In diagnosing hallux limitus Dr. Giacalone will examine your feet and manipulate the toe to determine its range of motion. X-rays are usually required to determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.
Treatment: Non-Surgical Approaches
If your condition is caught early enough, it is more likely to respond to less aggressive treatment. In fact in many cases, early treatment may prevent or postpone the need for surgery in the future. That’s why it is important to see Dr. Giacalone when you first begin to notice symptoms. Treatment for mild or moderate cases of hallux limitus may include one or more of these strategies:
· Shoe modifications: Shoes that have a large toe box should be worn, because they put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended. Most likely, you’ll have to stop wearing high heels.
· Orthotic devices: Custom orthotic devices may improve the function of your foot.
· Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to help reduce pain and inflammation. Supplements such as glucosamine-chondroitin sulfate and some vitamins and minerals may also be helpful.
· Injection therapy: Injections of corticosteroids in small amounts are sometimes given in the affected toe to help reduce the inflammation and pain.
· Physical therapy: Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.
When Is Surgery Needed?
In some cases, surgery is the only way to eliminate or reduce pain. There are several
types of surgery that can be undertaken to treat hallux limitus. These surgical procedures fall into two categories: Some procedures reconstruct and “clean up” the joint. The surgeon removes the arthritic damage from the joint as well as any accompanying bone spurs, and then alters the position of one or more bones in the big toe. These procedures are designed to preserve and restore normal alignment and function of the joint as well as reduce or eliminate pain. More aggressive procedures are used when the joint cannot be preserved. These may involve fusing the joint, or removing part or all of the joint and, in some cases, replacing it with an implant, such as is done for the hip or knee. These procedures eliminate painful motion in the joint and provide a stable foot. The procedure that is used to correct hallux limitus depends on many factors, including the cause of the condition and the severity, as well as the patient’s age, occupation and activity level. Dr. Giacalone is trained to select a surgical procedure best suited to your particular condition and needs. If surgery is performed, the length of the recovery period will vary, depending upon the procedure or procedures performed. Surgery is performed on an outpatient basis with local and intravenous anesthesia.
Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders. Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone performs surgery at Hackensack University Medical Center in Hackensack, Hackensack University Medical Center @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.