The painful ‘big toe’ (hallux) joint explained – hallux limitus

Our task as clinicians is to prevent worsening of the painful bunion – hallux valgus or stiff toe known as hallux limitus. Long term failure to act means the joint fails to work. Two main reasons arise: The toe is misshapen, forming a bunion OR it becomes stiff.  The stiffness is often called arthritis but degenerative changes are more likely the reason for pain. Four conditions are considered –

  • Spasm due to inflammation (repeated strain)
  • Loose body (not necessarily fracture)
  • Split or worn cartilage
  • An excessive outgrowth of bone (spurs or osteophytes)

You can download a PDF version with diagrams


The condition is often time-delayed. This means pain arises later or repeats and forms part of the concept of timeline development.  You may be fine now, but later problems peak again. Many of such conditions are highlighted on my website ConsultingFootPain. An event when young (10-25) may not show up until 45-65.  Exercise often provokes an existing problem in older age.  

Lubrication

The surface of the bone requires lubrication. The oil or synovial fluid makes the process work smoothly. If the fluid increases within the joint, the toe can become painful, or, if it may dry out, causing the surfaces to scrape against each other. This in turn causes impingement which then creates symptoms associated with pain.

What causes these stiff toes?

Lack of movement leads to poor lubrication, BUT, if the cartilage is split or damaged then flexibility (hydro elastic property) is lost. This hydroelasticity is the bounce-back ability following compression. Cartilage must be able to deform during joint movement. Once this process disappears the cartilage leads to the bone being exposed. The joint then becomes inflamed and repair cells (white cells and platelets) create more fluid. Small clot formations fill in gaps but tether down movement further. This is where steroid injections may offer some benefit as they can reverse early scar tissue 

Joint protection

In the early stages, the big toe joint has a protective mode. The muscles tighten around the joint and go into spasm. All movement is lost at this point. The toe may reverse, improve or stay like this and worsen. An injection of steroid, or anaesthetic, can expose this as spasm. Part of the joint, the sesamoid bone, can also be involved. This ball bearing like bone jams on movement and can cause spasm (sesamoiditis).

Bone spurs

When a joint is affected with long-standing inflammation, new bone forms. This will cause a spur to arise around the top of the joint and sides. These horn-like projections (osteophytes) jam the joint further. Fluid lubrication stops. The effect of the toe joint stiffening affects more than the ankle, knee and hip because each works to provide smooth walking. One joint out of action creates a knock-on effect so that lack of movement can affect the body elsewhere. 


Thanks for reading ‘the stiff big toe joint explained’ by David R Tollafield

Published by Busypencilcase Communications Est. 2015
18 June 2021

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