Big Toe : Stiff situation

A common presentation in runners is a stiff big toe joint. The runners we see complaining of this symptom are often sprinters. This is because of the fact they are up on their toes due to the speeds they’re running, and the high loads that are associated with the particular activity.

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Often runners present after an acute episode and physiotherapy modalities can help restore the lost range. However, there are times when runners explain that the joint has slowly ached, that the range has been slowly reducing, and that certain modalities that were once useful have become less effective.

When this occurs we start to predict a condition know as hallux limitus or hallux rididous. 

Hallux limitus:

– When the great toe begins to lose its range due to anatomical / pathological changes in the 1st MTP joint.

Hallux Rigidous:

– a progression of hallux limitus when ankylosis of the joint occurs.

Causation:

When recently discussing this case with a prominent foot and ankle surgeon they explained that there is not direct correlation between certain activities and the start of Hallus limitus.  However it has been hypothesised that it might be due to trauma secondary to chondral damage, or repetitive weight-bearing dorsiflexion in the 1st MTP joint.

Clinical signs:

– Slow onset of symptoms / trauma to the joint
– Limited range through 1st MTP joint < 60 degrees extension
– Tender to touch on the top/base of the toe
– Tender to touch on the outside of the toe (webbing between 1st and 2nd toe)
– Symptoms (often sharp/ache) when placed into dorsiflexion
– Can manage symptoms with anti-inflammatory medication
– Imaging findings: spurring on the dorsal aspect of the 1st MTP: top and lateral, reduced joint spacing at 1st MTP, pain on palpation at the correlating sites (superior lateral joint),  increase in synovial fluid that can be palpable

 

Clinical Tips:

– Physiotherapy consultation to improve joint range of motion
– Individually designed orthotic from a leading sports podiatrist
– Bend your footwear, and ensure that it is relatively rigid (shouldn’t bend in the middle)
– Sprinting spikes with a rigid spike plate
– Taping for additional support

Nicholas Cross
Physiotherapist, Exercise Physiologist

#STRIDEON(tealandblack)

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