Understanding Big Toe Joint Pain that Isn’t a Bunion

A common complaint we see a lot at Castle Rock Foot & Ankle Care is pain at the big toe joint that is assumed to be a bunion, but in reality is arthritis of the big toe joint.  This is called either hallux limitus or hallux rigidus depending on severity.  

What is hallux limitus?

Hallux limitus is defined as arthritic changes to the joint where motion at the joint is limited and painful.  Causes of this condition are often poor foot mechanics, prior trauma or turf-toe injury to the joint, or repetitive wear and tear due to high activity levels.  We commonly see this is long distance runners.  Symptoms include pain and stiffness at the joint, along with a painful bone spur at the top of the joint.  Depending on severity, swelling or difficulty walking or running can be seen.

What is hallux rigidus?

Hallux rigidus is very similar to hallux limitus, but with more severe symptoms, and in this case, the extent of arthritis is considered to be end-stage.  In cases of hallux rigidus, there is very little to no motion left at the joint along with extensive spurring to the joint.  This spurring can take on the appearance of the bunion as this enlarges.

Non-surgical treatment of hallux limitus/rigidus

In cases of early stage hallux limitus, symptoms can often be managed non-operatively.  Treatment options include carbon fiber insoles with a Morton’s extension.  These stiffen the shoes and limit motion at the arthritic joint.  Custom orthotics are another good option, and can be made with a Morton’s extension to correct foot mechanics and limit motion at the arthritic joint.  Beyond these options, anti-inflammatory medications or intra-articular steroid injections can help with symptoms.

Surgical treatment of hallux limitus/rigidus

When non-surgical treatments fail, there are multiple surgical options for managing these conditions.  In cases of less severe arthritis with a painful spur at the top of the joint, a cheilectomy procedure can be considered, where the spur and impinging point is removed.  This can provide significant improvement in range of motion and improvement in pain.  In cases where the arthritis had progressed to move severe levels, next options include either a joint replacement of fusion.  In the case of the big toe joint, joint replacement options preserve motion, but these implants typically last between 5-15 years, and are often not a permanent solution.  A joint fusion that is appropriately positioned is the most definitive treatment, and is a highly functional procedure.  Literature shows that patients are significantly more satisfied with joint fusions in most cases.  

Suffering with big toe joint pain?  Come see us at Castle Rock Foot & Ankle Care.  We can evaluate your pain and give you more detailed counseling depending on the extent of the arthritis along with your personal activity level and goals.

Author

Dr. Evan Smith Dr. Evan Smith is a Board-Qualified foot and ankle surgeon, providing personalized, high-quality care to the Castle Rock community as a physician with Castle Rock Foot & Ankle Care. Dr. Smith received a Bachelor of Science degree in Biology from Illinois Wesleyan University. He then went on to earn a Doctor of Podiatric Medicine degree at Des Moines University College of Podiatric Medicine and Surgery in Des Moines, Iowa, where he received The American Board of Podiatric Medicine Graduate Merit Award. Following medical school, he completed a three-year foot and ankle surgical residency program at Legacy Health in Portland, Oregon, gaining comprehensive training in all aspects of foot and ankle surgery. Dr. Smith takes pride in connecting with his patients and providing personalized care to get patients back to the activities they love.