STIFF BIG TOES?

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YOU MAY HAVE HALLUX LIMITUS…

When thinking about the important load bearing-joints you may be forgiven for overlooking your Big Toe Joint, or Metatarsophalangeal, or MTP Joint for short. While much smaller compared to your Hip, Knee and Ankle joints it is arguably one of the most important for Gait… Just imagine how challenging it would be to walk, run, squat, bend over or even balance without the aid of your big toe.

The MTP joint joins the first long bone (metatarsal) in the forefoot to the first bone of the big toe (phalanx). Everytime you take a step the MTP joint bends, allowing the foot to roll forward and push off. During this phase of walking cycle, the joint supports 50% of the body’s weight! They work so hard! Is it any wonder that without sufficient movement at the joint, the foot and ankle can become unstable and compensatory gait patterns form resulting in issues further up your kinetic chain.

Limitations in the MTP may be due to trauma, gender, family history, joint shape (flat metatarsal head) and foot function biomechanics. However, when it comes to running runners can develop Hallux Limitus due to the high levels of pressure and repetitive force that go through the joint during running. These ongoing forces cause inflammation of the joint lining and overtime potentially wear away at the cartilage.

MTP restriction can be broken down in three sub categories.

Functional Limitus– where full movement >65 degrees of movement at the joint is available when non-weight bearing, when weight bearing there is an insufficient amount of movement. Often at this stage there may be no pain experienced at the big toe joint itself.
Structural Limitus- where there is a restricted or insufficient mobility available in non-weight bearing. This is often bone or joint related.
Hallux Rigidus- where there is no movement in the big toe joint at all. Related to a loss of joint space and arthritis.

An important fact to note is that limitus often precedes a rigidus change over a long period time. The stiffness and discomfort experienced by runners around their big toe will most certainly be Hallux Limitus.

Symptoms of Hallux Limitus
In the early phases of a structural limitus the joint itself may be stiff, grinding or crunching and sore with activities that bend the toes backwards. Long term as the joint changes, bony lumps may form on the top of the joint. These hard bony lumps are called exostosis and can develop into conditions such as bunions, turf toe, synovitis and osteoarthritis. With exostosis the joint will begin to become more rigid in its movement.

Often Podiatrists and Physiotherapists see people who have a non painful hallux limitus  but present with painful areas which have formed due to the resultant compensation. Some of the common compensatory problems may include:

– Callus’ around the 1st toe or outside of the foot may develop.
– Pain in the ball of the foot under the lesser toes due to excessive lateral weight bearing
– Neuroma or neuroma like symptoms may develop
– Excessive wear on the bottom surface of a shoe
– Plantar arch or heel pain
– Due to limited movement of the big toe the foot may be picked up off the ground earlier in gait resulting in shortening and tightness of the calf complex.
– Due to excessive use of the muscles lifting the foot, pain may arise in the front of the legs developing into Shin Splints.

Treatment
If you are a regular runner and any of these symptoms ring a bell then we first and foremost recommend you present to an experienced physiotherapist or podiatrist to prevent further deterioration.
A Biomechanical assessment will determine whether orthotics are required to help position the foot correctly. Should the MTP joint structure still allow, treatment is aimed at restoring full range of motion.

If you think you show signs of Hallux Limitus it is good practice to look after your MTP joint by:

  • Wearing comfortable shoes that fit properly. Avoiding shoes that squeeze your toes together and limiting time spent in high heels where pressure through the toes and ball of foot is inceased. The front of your shoes (called the toe box) should be roomy enough to allow you to wiggle your toes.
  • Stretch the calf muscle complex.
    20 second holds x 3 x 5 daily
  • Foam Roll the calf and shins regularly and consider a monthly sports massage on the legs.
             
  • Massage the sole of the foot using a Spikey Peanut Ball, focusing under the big toe and into the arch. 5 mins daily in a standing position.
  • Strengthen the intrinsic foot muscles with specific exercises such as ‘Towel Toe Curls’
    10 X 5 reps
  • Ice the foot specifically around the MTP for 20 mins after a run or at the end of a long day on your feet.
  • Wear a gentle Silicone Toe separators at night to gently help realign the toes. We like these ones.
  • Gently stretch the toe against the wall, making sure not to push into pain. 20 sec holds.
  • Maintain a Healthy Weight

Surgery is almost always the last resort, only used when everything else fails and the person is suffering from significant levels of pain. Outcomes for runners aren’t always fantastic which is why, like nearly everything else, prevention is much better than cure!

Are you looking for an experienced Podiatrist? We Recommend the podiatrists based in Element Podiatry in Newtownards who are specialists in Biomechanics and keep many of our province wide athletes’s feet in good nick!

By Rebecca McNamara
PHYSIOTHERAPIST at PURE PHYSIO CLINIC