Hallux Rigidus

Hallux rigidus is not a bunion, but still affects the same joint as bunions – the first metatarsophalangeal joint. Like the bunion (hallux valgus), the term hallux refers to the big toe, so hallux rigidus is a rigid big toe. This means that there is no motion or next to no motion in that joint. When there is very limited motion it is often accompanied by osteoarthritis, though there can be some confusion about this.

The problem is often caused by osteoarthritis and there may be history of an old injury to the joint.

The consequences of a hallux rigidus is that it alters the way you walk. The big toe joint is so crucial for normal function, as it has to bend so the body can move forward over the foot. If the big toe joint does not move, then that movement has to be achieved by movement at other joints, which may or may not be able to take it. If they can’t then this can cause problems in those other joints.

The conservative treatment for hallux limitus is pain management initially, the use of physical therapy and the use of stiffer shoes or a rocker sole shoe to stop the joint from moving as much. Often the conservative treatments are not that satisfactory (just look at all the questions in forums about it!). Surgical options range from a fusion of the joint to help with the pain; to the removal of any bony blocks that is causing a limitation in the motion; to a type of joint replacement with a spacer in the joint.

Functional Hallux Limitus

Functional Hallux Limitus is a hypothetical problem that, like bunions, affects the first metatarsophalangeal joint. It is hypothetical as there is some controversy about it. Functional hallux limitus is defined as a condition in when the first metatarsophalangeal joint has a full normal range of motion during non-weightbearing, but during the weightbearing gait the joint just does not seem to want to bend. As a results there are some compensations, such as “overpronation”, elsewhere in the foot that can result in symptoms.

There are a number of different pathomechanical entities that can cause functional hallux limitus. Most of these exert there effect by preventing plantarflexion of the first metatarsophalangeal joint

If it is present then the standard approach to treatment is to use foot orthotic designs that facilitate motion of the joint by allowing plantarflexion of the foot.

Just to be clear: Bunions terminology

A bunion is really just an enlargement of the joint, typically the big toe joint. Invariably it is mostly bone, but there is often some bursa and soft tissue swelling involved as well.

Hallux Valgus is the term that was traditionally used to describe the angulation of the big toe (hallux) over towards the lessor toes. However, valgus is a term that describes a position in the frontal plane, whereas that angulation of the big toe over towards the lessor toes occurs in the transverse plane, so it should have been called hallux abductus and not hallux valgus. But, as well as abducting in the transverse plane, the hallux does also rotate in the frontal plane, so it does go into valgus in that place.

For the technically correct use of terminology, the correct term should be hallux abducto-valgus (HAV)

Bunions and the Fitting of Children’s Shoes

The correct fitting of children’s shoes is crucial to the normal and natural development of the growing foot. That growing foot is malleable and easily deformed. There is some controversy around the use of supportive features in children’s shoes and care needs to be given when it comes to giving advice in that context. Some argue that the shoe should be minimal and not interfere with the foot’s development and others argue that there should be some support to encourage the foot to develop properly. This is not the place to get into this debate, as we focus here on bunions.

Which ever school of thought you are biased towards, there can be no doubt that the shoe for children must be wide and long enough in the forefoot to prevent any pressures that might increase the risk for bunions. The shoe must be checked and replaced at regular intervals as the child’s foot grow to prevent any problems developing.

Depression and Bunions

Who would have thought that something like a bunion or hallux valgus on the foot would affect your mental health status?

hallux valgus anddepression

Well it does. This study looked at 102 people and used the Beck Depression Inventory and measured the angle of hallux valgus and found the greater the ankle of the hallux valgus, the more depressed. Unfortunatly they did not include a group of people of a similar age, gender and body weight (etc) to compare them to, but never-the-less the results are interesting.

It is a chicken-and-egg situations. Did having the pain, discomfort, shoe fitting problems, embarrassment, etc contribute to the symptoms of being more depressed? Or is there a genetic risk profile for depression, that is also a risk factor for hallux valgus? Either mechanism is probably plausible. Either way, there are mental health issues involved and as part of the holistic management of any patient they need to be taken into account.