Home Functional Hallux Limitus Diagnosis Signs and symptoms
Diagnosis
Signs and symptoms of FHL
The signs involve the foot, particularly the base of the big toe, but can also appear at a distance — in the knee, the hip or the back — in connection with the overall disruption of gait.
Diagnosis section
Six pain zones, a single cause
Functional Hallux Limitus is not limited to the foot. When the flexor hallucis longus tendon no longer glides freely in the retro-talar tunnel, gait is disrupted and the entire lower limb compensates. The pain appears as it travels up the chain, which explains why a patient sometimes seeks care for years for their knee or back before the origin is identified at the big toe.
Local symptoms in the foot
In the foot, several characteristic pains can appear. They are often correlated with physical activity and with the intensity and repetition of exertion. Running, walking downhill and excessive loading are the most frequent triggers.
Pain under the sole of the foot, often at the base of the big toe, with a sensation of tension linked to the bowstring effect of the tendon (tenodesis).
Pain on the dorsal surface of the big toe, corresponding to cartilage damage, early hallux valgus or a hyperpressure syndrome heralding osteoarthritis.
Pain at the back of the foot, over the flexor hallucis longus tendon, sometimes mistaken for plantar fasciitis.
Corns and hyperkeratosis on the medial border of the hallux or the first metatarsal, indicating abnormal pressures.
Blockage of extension of the big toe during the propulsive phase of walking, with a sensation of progressive stiffness.
Differential diagnosis
What if it were not plantar fasciitis?
Pain under the sole of the foot is often attributed to plantar fasciitis. Yet in many cases it is actually a tenosynovitis of the flexor hallucis longus tendon, and therefore an FHL. This confusion explains why some plantar fasciitis treatments remain ineffective. A targeted clinical examination makes it possible to reach the right diagnosis.
Associated deformities
As FHL progresses, bony or joint deformities can appear. They are not the cause of the condition but its consequence over the medium and long term.
Hallux valgus, lateral deviation of the big toe with a medial prominence (bunion).
Hallux rigidus, progressive stiffness of the metatarsophalangeal joint of the big toe.
Clawing of the second toe or interphalangeal hyperextension, a consequence of the pressure imbalances in the forefoot.
Distant symptoms
This is the signature of FHL. When the foot can no longer propel correctly, the rest of the body compensates, and pain appears far from its origin. These signs reflect a disruption of the roll-over of the step with knock-on repercussions throughout the entire lower limb.
- Patellofemoral pain syndrome, pain at the front of the knee
- Pes anserine tendinitis, on the medial side
- Lateral overload, iliotibial band syndrome
- Chronic instability
- Recurrent sprains promoted by poor initial contact
- Peroneal tendinopathies
- Pelvic imbalance
- Femoroacetabular impingement
- Excessive internal rotation
- Piriformis contracture
- Postural low back pain
- Forward projection of the trunk
- Lumbopelvic imbalance
« Unexplained chronic low back pain that worsens with walking and running should raise the suspicion of a big-toe dysfunction. »
Centre Orthopédique d’Ouchy
Do you recognize your symptoms?
This list helps you identify whether your pain could be linked to FHL. The more items you check, the more a consultation at the Centre Orthopédique d’Ouchy is recommended.
Quick self-assessment
Check the items that match your situation
My pain worsens when walking, running or going downhill
I have already felt tension under the sole of my foot
My big toe seems less mobile than before
I have knee or hip pain of unexplained origin
My low back pain keeps coming back despite treatment
I have had several ankle sprains with no clear cause
A plantar fasciitis treatment had no effect
When to seek care
If your pain persists beyond a few weeks despite rest, if it prevents you from carrying out your usual physical activity, or if it affects several areas of the lower limb at once, a specialist consultation is warranted. An early diagnosis makes it possible to avoid progression toward irreversible bony deformities.
Quick summary
Areas affected
6
Local symptoms
5
Distant symptoms
4 regions
Population affected
> 50 %
Go further
Other pages in the diagnosis section
A scientific approach
Reference page produced by the Centre Orthopédique d’Ouchy in partnership with Hirslanden Clinique Bois-Cerf. Content validated by international experts and open-access scientific publications.