Hallux Limitus Treatment Guidelines

Conservative Management

The American Diabetes Association recommends appropriate footwear selection, focusing on shoes that have adequate depth to accommodate toe deformities, are adjustable to accommodate dressings if needed, and minimize mechanical trauma to the feet 1, 2
The British Association of Dermatologists suggests using emollients and non-adherent dressings to protect the skin after any debridement procedures, as well as cushioning to reduce pressure and hyperkeratosis build-up 2

The American College of Radiology recommends joint arthroplasty for a neuropathic hallux ulcer when non-surgical offloading treatment fails, with a strength of evidence level of moderate 3, 4
The American College of Radiology suggests metatarsal head resection may be considered for neuropathic plantar metatarsal head ulcers that fail non-surgical treatment 3
The American Diabetes Association recommends Achilles tendon lengthening in cases with an equinus position of the foot 5
The American Diabetes Association suggests digital flexor tenotomy is recommended for neuropathic plantar or apex ulcers on digits 2-5 with flexible toe deformities, but is not typically recommended for the first toe 5

The American College of Radiology recommends considering imaging (radiographs, MRI, or CT) to determine the extent of joint damage, with a strength of evidence level of high 6, 7

The British Association of Dermatologists warns that excessive debridement of hyperkeratotic lesions can lead to increased blistering and tenderness, especially in patients with sensitive skin conditions 2
The American Diabetes Association advises against performing digital flexor tenotomy on the first toe, as hallux ulcers are typically caused by other deformities or limited joint motion 5
The American Diabetes Association emphasizes the importance of providing adequate offloading devices after surgical interventions, which are essential for optimal healing 3, 4