What is Structural Hallux Limitis?
Hallux Limitis also called Structural Hallux Limitis (SHL) is a condition that affects your big toe joint where it connect to your first metatarsal. This area is sometimes also referred to as the “ball of the foot”. The first Metatarsal-Phalangeal Joint also
Motion is reduced at the first MTP
known as the first “MTP” is a mechanically and structurally important joint during normal walking and running gait as its function has global importance on the foot-ankle complex, knee joint as well as the hip and lower back.
If the first MTP joint is not moving correctly it can result in abnormal biomechanics starting with pronation of the foot and ankle (results in excessive pronation), excessive internal rotation at the knee (leads to excessive shearing forces) and excessive internal rotation of the hip which can place strain on the Sacroiliac joints (SI joints) and lower back. This means that many running or walking related injuries might be traced back to the big toe! “What is mechanically connected is functionally related”, a professor of mine used to say.
if it is connected it is related
Overtime due to excessive strain and load on your first MTP the bone and joint will begin to wear out more quickly than the other side. The end result is cartilage deterioration also known as arthritis or Degenerative Joint Disease (DJD). The first MTP joint may become swollen, red and painful during activities such as walking, running and jumping and if left untreated will result in a cascading effect that will have consequences on the rest of your foot, knee, hip and even your lower back.
What are Symptoms Associated with Structural Hallux Limitis?
Look down at your feet and ask yourself the question, “Is one of my big toe joints (first MTP) larger than the other”? Do you experience any pain in that MTP joint that is larger than the other? Does my first MTP joint hurt when I am weight bearing and run, walk or do toe raises? Have I been told I over pronate? While it is not necessary for your answers to be yes to these four questions it is significant if you answered yes to any of them and you may be suffering from structural hallux limitis.
swollen and enlarged first MTP
As was discussed earlier “What is mechanically connected is functionally related”. Because your knee is mechanically connected to your foot via your tibia bone it is possible you are experiencing pain in your knee due to structural hallux limitis. It has always been interesting to me that people accept a diagnosis of “Overuse” even though they are only experiencing pain on one side of their body. If the pain was due to overuse why would it only be on one side when you walk, run or jump on both legs and feet. The obvious answer is that something is wrong with one of your sides and unless you have been screened for Structural Hallux Limitis you may be missing the root cause of the problem. Think of this analogy, “If you step on a cat’s tail does the tail scream”?
If you step on a cats tail does the tail scream?
You can force Ibuprofen down the cats throat all day while applying ice but the problem will never go away until you remove your foot off the cats tail (by the way I love cats…it’s only an analogy people). The bottom line is that if you are experiencing pain in your foot, ankle, knee, hip or lower back and you also happen to have a painful first MTP joint or been told you over pronate you may have Structural Hallux Limitis.
How do you Diagnose Structural Hallux Limitis?
The first part of any good diagnosis starts with your history. If you answered yes to any of the four questions above regarding pain in your first MTP or over pronation than you should be screened for Structural Hallux Limitis.
You can have a doctor, therapist, friend or loved one perform this test for you. While standing, lean slightly forward so that pressure is applied across the ball of your foot. Have the person try to flex your NON PAINFUL BIG TOE back towards your shin (this movement is referred to as dorsiflexion).