Why the big toe joint is so important

The big toe joint is an important joint for normal biomechanics and walking. When we are walking and the foot is flat on the ground, that big toe joint needs to bend as the heel comes off the ground. If that joint does not bend then walking is going to be much more difficult. More energy is required so walking becomes very fatiguing. As the motion that is not able to happen at the big toe joint still needs to happen, other joints can be forced to move more at a time that they are not supposed to be moving. This abnormal movement can become painful.

There are number of things that can go wrong with that big toe joint and interfere with that normal function. One of the more common ones is a condition that often gets called hallux rigidus and as its name implies, the joint is rigid and does not move. The most common reason for this is osteoarthritis of that joint. This can be quite painful and the rigid joint makes walking very difficult. The most common treatments for this are drugs for pain relief, rocker sole shoes to allow some motion to happen and surgery on the joint.

A less severe form of hallux rigidus is a condition called hallux limitus in which the joint is not rigid but has a reduced range of motion. As a full range of motion is needed at the big toe joint for normal function, this limited motion is still a problem. The most common reason for this problem is osteoarthritis. Typically the management of hallux limitus is pain relief with medicine, sometimes strapping is used to restrict motion even more so that it is not so painful. Foot orthotics are sometimes used to encourage a more normal motion of the joint. In the most painful cases surgery can be an option in which a joint replacements could be done or the joint surgically fused to stop it moving.

Another common problem is what is called a functional hallux limitus. This is called functional as during a non-weightbearing examination the joint has a normal range of motion, but when functioning with the foot on the ground it just does not have a full range of motion. The reason for a functional hallux limitus is just not known and the reason why that big toe joint does not work during weightbearing is not clear. It just seems to happen in some people. A number of theories have been advanced, most of which seem plausible but there is no direct evidence for one over the other.

There are a number of treatment options for a functional hallux limitus that are aimed at restoring normal function to the joint. Podiatrists often use foot orthotics with different modifications such as a first ray cut out, a Kinetic Wedge or a Cluffy Wedge. All of these designs try to increase the flexion at the big toe joint to make the joint function more efficiently and stop the functional hallux limitus from happening.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.