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Hallux Limitus / Rigidus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by G Flanagan, Nov 5, 2008.

  1. G Flanagan

    G Flanagan Active Member


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    Hi All,

    Please forgive my ignorance if this issue has already been vastly considered in previous literature.

    After a heated discussion with a colleague today, my argument was of the opinion that except in its functional state hallux limitus is non existent, as the staging system for hallux rigidus covers the realm of hallux limitus. e.g hallux limitus is in fact stage 1/2 hallux rigidus. Yet i see Pod's using the term hallux limitus frequently.

    What are other opinions?

    Thanks

    George
     
  2. George:

    Interesting topic. There are many ways, and to my knowledge, none that are more correct than others, to describe the structure and function of hallux limitus/rigidus deformity. As we learn more about this important joint, I believe we will rely more on measuring the dorsiflexion stiffness of the hallux to grade the internal resistance of the hallux to dorsiflexion (i.e. the internal first metatarso-phalangeal plantarflexion (MPJ) moment). I generally reserve the term "hallux rigidus" for those 1st MPJs that dorsiflex less than 10 degrees during non-weightbearing examination.

    Maybe someone with more knowledge on the various grading systems for hallux rigidus/limitus can point us to a reference that will give us all the variety of ways to describe this common deformity.
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. Ignorance only requires forgiveness if it is not sought to be corrected! No forgiveness required. Good topic:drinks.

    This one did come up. I'll admit i'm with your colleague! So far is i can see there are only two grades of hallux rigidus.

    1. The patient has it.
    2. They don't.

    Rigid suggests a fairly binary classification to me! Much like death or a broken leg. It is or it isn't.

    I'm not at all happy with classifying limitus as 1/2 rigidus because that presumes that the joint will end up rigid, which most don't! It is measuring something from a possible end state rather than a base state.

    When classifying ulcers we don't consider them as 1/2 down to bone, we consider their depth from the base state of normal. When examining circulation we do not consider tissue to be 70% completely necrotic, we consider it by what qualities it lacks (colour, temperature, pulses, etc.)

    Also, as Kevin alluded, any classification of HL must consider the origin of the internal planterflexion moments to be a useful clinical tool. 50 % rigid gives no information as to whether that is a bony limitation, a soft tissue adaptation or a functional tightening of the planter apeurneurosis. It also gives no distinction between range and quality of movement.

    Anywho. I'm off to eat 60 % of the lunch it would require to make me unwell. :rolleyes:;). Some might call that "a burger" or "a burger and fries" but i think it is covered by the staging system of "Far far too much protein". *

    Kind regards
    Robert Isaacs

    *Sorry if i'm being flippant. I don't mean to cause you 25% of an insane psychotic rage!:D


    PS invite your friend along to the thread.:drinks
     
  5. David Smith

    David Smith Well-Known Member



    C'mom everybody, laugh out loud, this is good stuff.

    I have to agree with Robert, rigid is rigid and limitus is some range of motion less than the expected normal. As a general discription these are quite useful in a limited way. In order for the information about the hallux action to be clinically useful we need to know about the quality of RoM and location of RoM and stiffness of RoM. EG its rigid and plantarflexed or its rigid and dorsiflexed, its limitus with 10dgs dorsiflexion of RoM from position of reference, it is not rigid or limitus but extremely stiff thru the full range of motion etc etc.

    Dave
     
  6. N.Knight

    N.Knight Active Member

    have a search for some papers by Paul Besson as he is has done quite a bit of work on HL/HR and i belive he is doing his PHD on it, I will speak to him tomorrow

    nick
     
  7. Steve The Footman

    Steve The Footman Active Member

    I consider Hallux Rigidus to be no movement of the joint caused by a bony block or total joint destruction. I don't think this is too common in the non-geriactric population. I consider hallux limitus a reduction in range of motion of the joint in OKC to between 60 to 10 degrees. You can have Hallux Limitus with or without a functional component. The implications for treatment are significant as you will not get any function back into a rigid joint but may be able to assist a joint with limited ROM.

    In the end it is really a bit of semantics - but jargon does help to clear up subtle distinctions. In Hallux Limitus it is likely that the body is changing the joint towards splinting it by fusion. Rigidus is the likely outcome if they live long enough.
     
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