Hallux Limitus/Rigidus (Stiff Big Toe)

[brettatk]

I've been having a lot of pain in my foor both on and off the court for the past 6-12 months. The pain is on the top of my foot where the big toe joint meets your foot. I started googling and ran across Hallux Rigidus/Limitus. It sounds like this is what I'm suffering from. It's been very busy with tennis this year so I haven't gone to the doctor to get a diagnosis. After Sectionals next weekend I think it's time to go. The pain has been getting worse and last night I could definitely tell it was hurting my first step when running for a short ball.

Anyone ever dealt with this? Is there anything you did that helped other than having surgery? I've heard recovery is a couple of months if you elect to have the surgery. That's not something I can do probably until closer to December. Thanks in advance for any help/suggestions you might have.

 

[Chas Tennis]

You don't have a diagnosis so I'll just mention my experience with toe stiffness, especially the big toe. Note doing stretches or exercises intended for healthy feet can cause farther injury.

I have played a lot of tennis for decades and I'm not young. I had some plantar fasciitis and saw a Dr. I got PT and one of my issues was very limited range of motion of my big toe. The physical therapist had me walk toward her and watched my feet. She said that I had modified my walking to accommodate the stiff big toe. I turned my feet out instead of extending the big toe.

I had noticed that my feet were not very flexible and even occasionally my toes started to go into a cramp. Often such things are attributed to aging. I have found that aging is often not the cause. I believe that the thickly cushioned shoes that have little sole flexibility is a contributing factor. I got a book on minimalist shoes and bought a pair of minimalist shoes. They worked well and I have much better flexibility in my toe area than I had a few years ago. Your foot is designed so that the big toe extends when you stride forward. http://www.hypo2sport.com/big-toe-extension-in-runners/

Also, the physical therapist who measured my toe range of motion had given me a stretch where I pull my toe back with my hand. It is much harder to get a stretch in that way than to just wear the flexible minimalist shoes and move so that my weight extends my big toe. I am sold on minimalist shoes with flexible soles especially in the big toe area.

If injured you should not diagnose or treat yourself. See a Dr and get physical therapy for your injury. Also, stop stressing the foot especially with tennis.

Recommend that you get reference book on minimalist shoes and study the subject.

In addition, I have just discovered that my big toe tilts toward the toe next to it because some foot muscles have become very inactive. I have tried to move the big toes to the side but cannot yet do it.

I did find at one point that there are 3 common toe injuries or conditions. Bunions, Hallus Rigidus, and one other. Search common toe injuries to find the third one.

Understand the anatomy of the big toe.

 

[Molk]

Was listening to Brad Gilbert talk about how wide Roger Federer's foot is and how he uses his whole foot. I know i use my big toe too much over the years. Orthotics usually make corrections from the arch back to the heel. This is different , making corrections in the forefoot. Here is the link.
http://mortonsfoot.3dcartstores.com/ The ProKinetics® Natural Body Balance Insoles kit
Lots of interesting info and a different way of looking at this problem. Disclosure-I do not work for this company and do not get paid for my endorsement.
I hope your feet get better soon!

 

[Brian O]

I've been having a lot of pain in my foor both on and off the court for the past 6-12 months. The pain is on the top of my foot where the big toe joint meets your foot. I started googling and ran across Hallux Rigidus/Limitus. It sounds like this is what I'm suffering from. It's been very busy with tennis this year so I haven't gone to the doctor to get a diagnosis. After Sectionals next weekend I think it's time to go. The pain has been getting worse and last night I could definitely tell it was hurting my first step when running for a short ball.

Anyone ever dealt with this? Is there anything you did that helped other than having surgery? I've heard recovery is a couple of months if you elect to have the surgery. That's not something I can do probably until closer to December. Thanks in advance for any help/suggestions you might have.

Custom orthotics from doctor helped alot as well as ice, rest (unfortunately. I do tape my toe up which also helps.

 

[brettatk]

Reviving my old thread here. Well life got in the way (and sucky insurance) but I finally went to the doctor last month about my foot. I was spot on with my diagnosis. Doctor said Hallux Limitus looking at the x-rays but when he saw the lack of mobility he changed it to Rigidus. I basically have two options. I can have it fused which he did not recommend. The pain will be gone but you are always going to be putting stress on that area since it will never bend. Second option is to have joint replacement surgery. The pain will be gone and I'll have more mobility than I do now. All sounds good but then I can't drive for 2-3 weeks due to the boot on my foot and I'm out of tennis for probably 6-8 weeks. That in itself will pose a problem with work as I work 25 miles from my house. He basically said I'd know when it was time. For now I did get some custom orthotics and he gave me a prescription of Duexis. I save that for periods I know I'm going to be extra active. I guess I still have a decision on my hands. But that time looks to be getting closer and closer.

 

[ByeByePoly]

Unfortunately, I know something about this ... hallux limitus ... right big toe.

First ... based on my visits to an orthopedic surgeon and a podiatrist, the Cheilectomy is usually the first surgery option. Make sure with your doc why that isn't what he is suggesting.

Before you let anyone cut on you, try other measures first. My foot orthopedic surgeon came right out and said they do not have toe surgeries down like knee replacements.

I have gone from bad pain and icing toe after every match, to virtually a non-issue. Really with only two things ... wider tennis shoes and I take Turmeric every day (now just 500mg a day, but 1000 when it was bad. Google it .. I think you can take more than 1000mg a day). I also rubbed Biofreeze gel on the big toe joint every morning when it was at it's worse. I doubt that helped with any healing, but maybe.

I never had a toe issue until three years ago. I started learning how to hit a 2hbh, and hit 1000s of 2hbhs with ball machine for 3+ months. I think I was up on the right big toe more ... with rotational force on it I didn't have with the 1hbh. I don't notice that now, so it was just a initial flawed extreme rotation, or I have subconsciously learned to compensate/avoid the extra stress.

So three years ago I would literally use a rubber band to hold a couple ice cubes on that joint after matches. I can remember driving home from USTA state playoff, and my toe hurt like he!! for the two hour drive home.

I went from that to hardly even noticing the toe anymore. Both of the docs I visited said Cheilectomy was the way to go. The ortho surgeon smiled and said if I keep playing tennis, I would see him soon. The only orthodic he offered was a stiff one that reduced the flex in the toe box. I tried it in my tennis shoes at the appointment, but didn't like the feel so didn't buy it. I now play with a Kirkland tennis shoes ... really wide, and toe box does seem stiffer than the New Balance 4E I had worn for years. New Balance 4E are no longer true 4E anymore.

So ... before surgery, try:
- wider shoes in toebox
- ice the joint after matches
- biofreeze ... can't hurt
- 1000+ (google) mg turmeric daily ... keeps you from nsaids

Good luck ...

 

[ByeByePoly]

Reviving my old thread here. Well life got in the way (and sucky insurance) but I finally went to the doctor last month about my foot. I was spot on with my diagnosis. Doctor said Hallux Limitus looking at the x-rays but when he saw the lack of mobility he changed it to Rigidus. I basically have two options. I can have it fused which he did not recommend. The pain will be gone but you are always going to be putting stress on that area since it will never bend. Second option is to have joint replacement surgery. The pain will be gone and I'll have more mobility than I do now. All sounds good but then I can't drive for 2-3 weeks due to the boot on my foot and I'm out of tennis for probably 6-8 weeks. That in itself will pose a problem with work as I work 25 miles from my house. He basically said I'd know when it was time. For now I did get some custom orthotics and he gave me a prescription of Duexis. I save that for periods I know I'm going to be extra active. I guess I still have a decision on my hands. But that time looks to be getting closer and closer.

Holy cr@p ... Duexis is frickin expensive.

 

[brettatk]

Unfortunately, I know something about this ... hallux limitus ... right big toe.

First ... based on my visits to an orthopedic surgeon and a podiatrist, the Cheilectomy is usually the first surgery option. Make sure with your doc why that isn't what he is suggesting.

Before you let anyone cut on you, try other measures first. My foot orthopedic surgeon came right out and said they do not have toe surgeries down like knee replacements.

I have gone from bad pain and icing toe after every match, to virtually a non-issue. Really with only two things ... wider tennis shoes and I take Turmeric every day (now just 500mg a day, but 1000 when it was bad. Google it .. I think you can take more than 1000mg a day). I also rubbed Biofreeze gel on the big toe joint every morning when it was at it's worse. I doubt that helped with any healing, but maybe.

I never had a toe issue until three years ago. I started learning how to hit a 2hbh, and hit 1000s of 2hbhs with ball machine for 3+ months. I think I was up on the right big toe more ... with rotational force on it I didn't have with the 1hbh. I don't notice that now, so it was just a initial flawed extreme rotation, or I have subconsciously learned to compensate/avoid the extra stress.

So three years ago I would literally use a rubber band to hold a couple ice cubes on that joint after matches. I can remember driving home from USTA state playoff, and my toe hurt like he!! for the two hour drive home.

I went from that to hardly even noticing the toe anymore. Both of the docs I visited said Cheilectomy was the way to go. The ortho surgeon smiled and said if I keep playing tennis, I would see him soon. The only orthodic he offered was a stiff one that reduced the flex in the toe box. I tried it in my tennis shoes at the appointment, but didn't like the feel so didn't buy it. I now play with a Kirkland tennis shoes ... really wide, and toe box does seem stiffer than the New Balance 4E I had worn for years. New Balance 4E are no longer true 4E anymore.

So ... before surgery, try:
- wider shoes in toebox
- ice the joint after matches
- biofreeze ... can't hurt
- 1000+ (google) mg turmeric daily ... keeps you from nsaids

Good luck ...

Thanks for all the info. I'm not sure why a Cheilectomy wasn't mentioned. I went to a Podiatrist and was telling my dad about it. He said he'd go to an Orthopedic surgeon over a Podiatrist. To be honest I didn't realize the difference. Maybe I'll go see an Orthopedic surgeon now and see what they say. Then I can specifically ask them about a Cheilectomy and whether they think I'd be a good candidate. At times there is great pain on the top of my big toe. I can only assume that is due to bone spurs. That pain comes and goes, the other pain is fairly constant. I think I'll look into shoes with a wider toe box and the turmeric. I think I actually got some Tumeric a few months ago and never opened it. I'm for trying anything I can that will help with the pain.

I saw your comment about Duexis. I looked it up when I knew that was what they were prescribing. I couldn't believe how expensive it was. I got mine for a $10 copay so I wasn't complaining. I guess it works ok. If I took it 3 times a day like it says to I'm sure it would work better. But I'd need to refill my prescription every month and not sure I'd be able to do that.

 

[ByeByePoly]

Thanks for all the info. I'm not sure why a Cheilectomy wasn't mentioned. I went to a Podiatrist and was telling my dad about it. He said he'd go to an Orthopedic surgeon over a Podiatrist. To be honest I didn't realize the difference. Maybe I'll go see an Orthopedic surgeon now and see what they say. Then I can specifically ask them about a Cheilectomy and whether they think I'd be a good candidate. At times there is great pain on the top of my big toe. I can only assume that is due to bone spurs. That pain comes and goes, the other pain is fairly constant. I think I'll look into shoes with a wider toe box and the turmeric. I think I actually got some Tumeric a few months ago and never opened it. I'm for trying anything I can that will help with the pain.

I saw your comment about Duexis. I looked it up when I knew that was what they were prescribing. I couldn't believe how expensive it was. I got mine for a $10 copay so I wasn't complaining. I guess it works ok. If I took it 3 times a day like it says to I'm sure it would work better. But I'd need to refill my prescription every month and not sure I'd be able to do that.

I definitely would go see the orthopedic surgeon for a second opinion. Don't mention Cheilectomy until he/she makes a recommendation. I think my podiatrist was good, but she was talking about shaving down connecting bone angle to the joint. The thinking was ... my bone spurring wasn't very bad, and joint spacing wasn't as good as it should be .. but not terrible. Therefore pressure coming from connecting bone steep angle. All I know is my toe hardly hurts now ... and that would have been an unnecessary surgery (at least so far) with all the risks that came with it.

btw .. I read on another thread here talking about allergies, someone was taking 4000mg turmeric a day. I have no idea what a safe limit is, but getting away from nsaids has to be a good thing. When my toe was at it's worse, I would take an Aleve on match days only.

Do you have a visual bump on top of the joint? I never did.

 

[brettatk]

I definitely would go see the orthopedic surgeon for a second opinion. Don't mention Cheilectomy until he/she makes a recommendation. I think my podiatrist was good, but she was talking about shaving down connecting bone angle to the joint. The thinking was ... my bone spurring wasn't very bad, and joint spacing wasn't as good as it should be .. but not terrible. Therefore pressure coming from connecting bone steep angle. All I know is my toe hardly hurts now ... and that would have been an unnecessary surgery (at least so far) with all the risks that came with it.

btw .. I read on another thread here talking about allergies, someone was taking 4000mg turmeric a day. I have no idea what a safe limit is, but getting away from nsaids has to be a good thing. When my toe was at it's worse, I would take an Aleve on match days only.

Do you have a visual bump on top of the joint? I never did.

Yes, you can see the bump. I'll start researching orthopedic surgeons. The thing that's going to kill me is the inability to drive. Even with the Cheilectomy it says it can be 2-4 weeks before you'd be able to safely drive. Not sure how I'd work that out with my current employment.

 

[ByeByePoly]

Yes, you can see the bump. I'll start researching orthopedic surgeons. The thing that's going to kill me is the inability to drive. Even with the Cheilectomy it says it can be 2-4 weeks before you'd be able to safely drive. Not sure how I'd work that out with my current employment.

Cheilectomy is not a minor recovery from what I read. My guess is once the bump is visible, probably pretty good spurring. If you go to orthopedic surgeon, please report back on what he says. It still might be in my future. Search this forum, I found a discussion on it here once. How old are you? I'm 60, so I'm not flying around the court anyway.

 

[brettatk]

Cheilectomy is not a minor recovery from what I read. My guess is once the bump is visible, probably pretty good spurring. If you go to orthopedic surgeon, please report back on what he says. It still might be in my future. Search this forum, I found a discussion on it here once. How old are you? I'm 60, so I'm not flying around the court anyway.

I'm 46. I can start seeing my quality of life going down just a little bit. I don't exercise as much as I used to. I used to run a lot but that is gone now. The constant pounding is too great on my toe. When I'm at the gym I either do the elliptical or the bike machine. At times just going for a walk with my girlfriend is extremely painful.

 

[ByeByePoly]

I'm 46. I can start seeing my quality of life going down just a littel bit. I don't exercise as much as I used to. I used to run a lot but that is gone now. The constant pounding is too great on my toe. When I'm at the gym I either do the elliptical or the bike machine. At times just going for a walk with my girlfriend is extremely painful.

Yeah ... if you Google Cheilectomy, you will see a lot of discussion on runners forums. Go get a second opinion. Both the podiatrist and ortho told me Cheilectomy is usually tried first, because it doesn't prevent other choices later. The podiatrist said she recently performed Cheilectomy on someone that she suspected would need something more, and it worked great. My take is there is some guessing involved.

Keep posting what you find out. I will check in.

 

[ByeByePoly]

I'm 46. I can start seeing my quality of life going down just a little bit. I don't exercise as much as I used to. I used to run a lot but that is gone now. The constant pounding is too great on my toe. When I'm at the gym I either do the elliptical or the bike machine. At times just going for a walk with my girlfriend is extremely painful.

FYI ... forgot to tell you, walking the dogs with the wife 1+ miles actually helped the toe even when it was at it's worse. I think that's the way arthritis works ... inactivity makes it worse. The ortho said to make a point to really stretch that big toe during/after walking while in the shoe. Just really flex the front part of the foot/toe. I can remember the toe feeling better after a walk... strange.

 

[brettatk]

I think it's more to do with the bone spurs. The pain is almost unbearable at times.

 

[ByeByePoly]

I think it's more to do with the bone spurs. The pain almost unbearable at times.

I would try the Biofreeze daily. My podiatrist provided it ... and not very expensive ... $10 a tube I think. Your pain might be past it helping, but the joint is very near the surface. You figure it’s a chronic inflammation, so anything that might work against that seems worth trying. It takes very little of the gel each time, and it absorbs pretty quickly.

 

[brettatk]

I think I will try that. Thanks!