Treatment of Hallux Limitus

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This is an example of an orthotic with a Kinetic Wedge

When a patient presents with symptoms of hallux limitus, it is important to take into account the severity of their deformity as well as the level of pain and how the pain limits daily activities in order to determine what treatment would be most appropriate. A variety of treatment options can be considered, including both conservative and surgical procedures.

Early stages or minimal discomfort from hallux limitus are often approached using conservative treatments. One popular method of conservative pain control is to take oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin. Keep in mind that taking this medication does not cure the condition causing the pain. This method of treatment can be used to treat acute flair-ups of pain and swelling.

Foot orthotics are another conservative option to treat hallux limitus and have been shown to relieve pain better than the use of oral anti-inflamatories alone (1). Examples of custom modifications of orthotics used to treat this condition include the Kinetic Wedge and Morton’s extensions. These specialized foot orthotics can help alleviate pain in the 1st MTPJ. By providing functional correction of deformities with the proper orthotic, 1st MTPJ discomfort can be improved. Foot orthotics are inserted into shoes and can be moved from shoe to shoe.

Physical therapy is also another conservative option that may be of some benefit in early stages of the condition.

Steroid injections can be administered in the doctor’s office. A steroid or cortisone shot is given into and around the joint this may help to relieve pain.  The reduction in swelling and pain from this type of injection may not last long. The injection can be repeated, however since over use of steroid can breakdown tissue there is a limit to the number of injects patients can receive.

If the conservative therapy that has been reviewed does not reduce pain, then surgical intervention may be necessary. The major goals of surgery are to reduce pain and improve daily function. Depending on the nature of the patient’s foot and the degree of joint destruction, other goals could include improving joint motion, recreating a joint space in the 1st MTPJ and reducing deformities of bone.

Operations that are able to preserve the joint involve removing any abnormal bone formations around the joint in order to improve mobility. However, there are instances in later stages of hallux limitus and hallux rigidus where preservation of the joint is not possible. In this case, the joint articulations or cartilage may be removed and replaced by an artificial joint or the joint may require to be permanently locked together also known as joint fusion.

If you believe you are feeling symptoms of hallux limitus or hallux rigidus, it is important to address the pain with your doctor as early as possible. May people that have pain in this area assume that they have a “bunion”.  An earlier and accurate diagnosis opens the possibility of a variety of noninvasive, conservative treatments that can help reduce pain while walking.

References:

1. Shurnas PS. Hallux limitus: etiology, biomechanics and nonoperative treatment. Foot Ankle Clin. 2009 Mar; 14(1):1-8.

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