Functional hallux limitus

Functional hallux limitus

What is Functional Hallux Limitus

Functional hallux limitus is a highly prevalent foot condition that is often overlooked in clinical examination, as pain and symptoms are often not associated with the 1st MTP (metatarsophalangeal) joint, but rather occur in remote sites due to compensations during the gait cycle. Having a clinical suspicion that functional hallux limitus is present can lead to improved outcomes.

This pathology exhibits a normal range of hallux dorsiflexion during non-weightbearing but with a significant decrease in hallux dorsiflexion during weightbearing.

Over time, repetitive jamming can contribute to arthritis of the 1st metatarsophalangeal joint (structural hallux rigidus) or formation of a bunion deformity (hallux abducto valgus or HAV).


Problems caused by functional hallux limitus

Functional hallux limitus is a common problem causing pronation of the foot at point in the gait cycle when the foot should be quite stable, and could potentially be responsible for a host of problems. These include hallux rigidus, bunion deformity, metatarsal overload, plantar fasciitis, achillodynia, as well as all the problems typically seen with over pronators.

“Identification and treatment of functional hallux limitis is simple and should be part of the protocol of every foot expert.”

What are the symptoms?

Even though the condition itself may be asymptomatic, the clinical manifestations of this condition can be associated with many common pathologies related to the foot, including heel pain, lesser metatarsal pain, mortons neuromas, achilles tendon pain, and retrocalcaneal enthesitis, as well as posterior tibial tendon dysfunction and postural alignment abnormalities of the lower extremity and lumbar spine.

Identifying functional hallux limitus

Identification of functional hallux limitus by observing dynamic gait patterns requires a very trained eye. This challenge likely contribute to the underdiagnosis of functional hallux limitus.

A typical pressure pattern for a patient with a functional hallux limitus, but not limited to, is a roll-off pattern with higher loading on metatarsals 2-5, less or almost no loading on metatarsal 1 and an increased loading on the first toe.

Functional hallux limitus prescription recommendations

Once you have made the diagnosis of functional hallux limitus, you will want to address this with an orthotic prescription.

The goal of an orthotic for functional hallux limitus is to improve and stabilize the roll-off. The following corrections are therefore important in your design, next to the regular corrections:

  • A standard heel cup.
  • The increased surface area under the arch with a wider width is more effective in preventing arch collapse and plantarflexing the first ray. You can either choose the ‘Wide’ shoe type or combine the ‘Comfort’ shoe type with the ‘High’ mediolateral support correction.
  • A medial heel wedge can be added to reduce heel eversion.
  • A meta 2-5 forefoot correction (also known as the reverse Morton’s extension) is important and will improve first ray plantarflexion

A simple and quick Materialise Phits Suite dynamic gait analysis can help identify functional hallux limitus, a condition that is currently underdiagnosed and, consequently, undertreated. Once identified, functional hallux limitus can be effectively managed with Materialise Phits Suite orthotics.

Check out our website for more information on Materialise Phits Suite.