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Functional hallux limitus

Functional hallux limitus is a little-known condition that affects more than half of the population. This condition is characterized by limited mobility of the big toe, not due to direct joint damage, but to a blockage of the long flexor tendon in the hindfoot. This biomechanical restriction disrupts normal gait and can lead to painful compensations throughout the lower limb, from the foot to the lumbar region.

Causes

This pathology results from a tendon impingement located in the retrotalar tunnel, where the flexor hallucis longus tendon can no longer slide freely under its fibrous pulley. Predisposing factors include muscle hypertrophy, a very distal musculotendinous junction, or an inflammatory condition such as tenosynovitis. Patients often report a history of repeated ankle sprains, prolonged immobilization of the lower limb, or intensive practice of sports that involve the balls of the feet, such as ballet. This biomechanical condition creates a tenodesis effect, i.e., a taut rope under the sole of the foot during dorsiflexion of the ankle.

Symptoms

Local manifestations include the appearance of corns on the inner edge of the big toe and at the base of the head of the first metatarsal, indicating a hyperpressure syndrome. Painful tension may be felt under the arch of the foot along the tendon path. Patients also describe a sensation of stiffness in the big toe when walking, with an inability to lift it normally at the end of the step. Long-term repercussions are common: knee pain such as patellar syndrome, recurrent tendonitis, piriformis contractures, or chronic lumbopelvic imbalance.

Treatments

Conservative management is the first line of treatment. Adapted foot supports allow for better load distribution and relieve areas of excessive pressure. Specialized physiotherapy aims to restore joint mobility and relax the musculoskeletal structures. Osteopathic techniques can release mechanical blockages and rebalance the muscle chain. Adapting footwear by a specialist helps limit painful conflicts and friction. A foot core strengthening and overall core strengthening program improves dynamic stability and reduces pathological compensations.

Surgery

When conservative treatment remains insufficient after several months, surgery may be considered. The procedure involves releasing the retrotalar fibrous pulley that compresses the tendon, thus restoring its normal sliding. This minimally invasive technique is performed arthroscopically or through a small incision, with generally simple postoperative outcomes. Walking is resumed gradually with suitable footwear, followed by specific rehabilitation to restore a harmonious gait. This tendon release is systematically associated with hallux valgus corrections, considering the role of functional hallux limitus in the onset of this deformity.

Want to learn more about functional hallux limitus?

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This article is original and was created entirely by our team of referring physicians. Last updated September 17, 2025.

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Dr Jacques Vallotton

  • Referring Physician
  • Specialist in orthopedic surgery and traumatology. SEMS sports physician
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Photo - Dr. Patrick Vienne

Dr Patrick Vienne

  • Referring Physician
  • Specialist in orthopedic surgery and traumatology. Foot and ankle surgery.
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