Running: Hallux Limitus and Hallux Rigidus

By Dr. Donald A. Ozello DC

Las Vegas Informer

Healthy big toes are essential in running. The importance of proper motion and strength in the big toes are vital for proper foot function. Learn to keep your big toes and feet functioning at optimal levels to decrease injury risk, prevent arthritis and elongate your running career.

Anatomy: The big toe is often called the great toe. In medical terminology the great toe is named the hallux.

The great toe contains two bones called phalanges. The proximal phalange articulates with the first metatarsal bone. The joint between the proximal phalange and first metatarsal bone is named the 1st Metatarsophalangeal joint or 1st MTP joint.

The 1st MTP is the location of Hallux Limitus and Hallux Rigidus.

Definitions: Hallux Limitus refers to limited motion in the great toe.  Hallux Rigidus means the great toe is rigid or cannot move. Hallux Rigidus is a progression of Hallux Limitus.

Classification: Hallux Limitus and Hallux Rigidus are classified as degenerative joint diseases (DJD), also known as osteoarthritis (OA). Hallux Limitus & Hallux Rigidus are degenerative joint diseases of the 1st MTP joint.

Degenerative joint disease is a wear and tear disorder. When a larger than normal demand is placed on a joint, deterioration occurs through breakdown and loss of cartilage. The result is reduced joint space, limited motion and pain.

Symptoms: Symptoms of Hallux Limitus and Hallux Rigidus include: Limited motion of the 1st MTP joint, especially in raising the toe upward. Pain, stiffness, swelling and tenderness at the 1st MTP joint. Weight bearing activities, including standing, walking, running, jumping, stooping, squatting and toe walking, intensify the pain.

Symptoms increase during cold and damp weather. The level of pain slowly progresses and limited motion gradually worsens over time. The great toe may deviate as the joint degeneration worsens.

Intrinsic Sources: Several intrinsic sources contribute to the formation of Hallux Limitus and Hallux Rigidus. A collapsed transverse arch, weak toe flexor muscles, tight toe extensor muscles, overpronation and a longer than normal 1st metatarsal bone are intrinsic factors in the formation of Hallux Limitus and Hallux Rigidus.

Extrinsic Sources: Hallux Limitus and Hallux Rigidus are progressive wear and tear disorders brought about by overloading the joint. Primary extrinsic sources are overtraining, limited cross training, improper fitting shoes, improper supporting shoes, shoes which as too tight, inadequate warm-up and insufficient cool down.    

Prevention: Formulate a training schedule which allows sufficient rest and recovery between runs. A comprehensive warm-up and quality cool down are essential.

Cross training is a must. Build strong and flexible feet with strengthening and stretching exercises. Utilize the short foot exercise, towel toe grab, toe curling, toe splaying and alphabet writing to strengthen the feet. Perform passive and active stretches to improve flexibility and joint motion.

The most important exercises in the prevention of Hallux Limitus and Hallux Rigidus strengthen the toe flexors and stretch the toe extensors. Therefore toe curling and stretching the top of the forefoot are indispensable. This combination strengthens the toes and the transverse arch while simultaneously improving motion.

Wear running shoes which fit and support your feet. Disregard any shoes that compress the toes together. Utilize custom fit orthotics and toe spacers if needed. Toe spacers which cover the entire length of the toes are most effective.    

Self- Management: Start self-treatment if symptoms of Hallux Limitus and Hallux Rigidus begin. Take immediate action to combat this condition and slow its progression.

Consistently perform self-massage and passive range of motion exercises to the forefoot, especially the 1st MTP joint. Execute active range of motion exercises such as alphabet writing to improve strength, range of motion and coordination. Actively and passively move the toes and forefoot through pain-free ranges of motions to maintain joint motion and muscle flexibility. Strengthen the structures that support your arches and toe flexors while stretching the top of your foot.

Work with a running shoe expert to determine the best shoe for your feet. Invest in a set of custom fit orthotics to provide your feet the personalized support needed. Use toe spacers to decrease toe compression and slow progression or DJD.

Chiropractic Care: Seek chiropractic care for professional evaluation and treatment. Chiropractic treatment to the spine and lower extremities restores proper skeletal motion and optimizes nerve flow. Chiropractic adjustments to the feet, especially the metatarsal bones and 1st MTP joint, improve function and may lessen symptoms. Chiropractic treatment will not lessen the level of degenerative joint disease but it will improve function of degenerative joints by maximizing their current capabilities. Chiropractic care may slow the progress of further degeneration.

Conclusion: Utilize these training and treatment strategies to prevent and manage Hallux Limitus and Hallux Rigidus. Healthy and properly functioning great toes are paramount to running success. Implement training and treatment techniques to optimize the function of your feet.

Dr_Donald_A_Ozello_thumb_medium150_Dr. Donald A. Ozello DC

Dr. Donald A. Ozello DC is the owner and treating doctor at Championship Chiropractic. 8871 W. Flamingo Rd, Suite #202, Las Vegas, NV 89147.  His web address is He can be contacted at (702) 286-9040 and

Dr. Donald A. Ozello’s mission is to educate and inspire others to live healthier, fitter, more functional lives.

Dr. Donald A. Ozello DC is the author of the book “Running: Maximize Performance & Minimize Injuries: A Chiropractor’s Guide to Minimizing the Potential for Running Injuries.” He writes a weekly health, fitness and nutrition column for The Las Vegas Informer. He is published in OnFitness and He has educational health, fitness and nutritional videos on Informer TV, and YouTube.

Dr. Donald A. Ozello DC proudly handles Standard Process Supplements and Foot Levelers Orthotics.

Dr. Donald A. Ozello DC is an award-winning public speaker. He has spoken to numerous groups on the importance of health, fitness, exercise, ergonomics, nutrition and injury prevention.

Dr. Donald A. Ozello DC is a fitness enthusiast. Functional kettlebell training, running and bike riding are his favorite types of exercise.

Before pursuing his career in Chiropractic, Dr. Donald A. Ozello DC served in the United States Navy aboard the USS Bremerton, SSN 698.

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