Hallux Rigidus – Arthritis of the Big Toe

If you have pain, stiffness and or limited movement in the joint where your big toe (the hallux), joins your foot, you may be suffering from a form of degenerative arthritis called hallux rigidus.  After bunions, hallux rigidus is one of the most common disorder of the toe. The condition can progressively get worse over time, making walking or even standing painful.

Some common big toe arthritis symptoms include:

• Pain
• Swelling
• Stiffness (sometimes the result of weather)
• Bump on top of the big toe

Causes of Hallux Rigidus

Hallux rigidus may develop because of overuse of the joint, such as in workers who have to stoop and squat or athletes who place a great deal of stress on the joint.

It may occur after an injury, such as stubbing the toe or spraining the joint (called “turf toe” in athletes).

For some, hallux rigidus runs in the family and comes from inheriting a foot type or a way of walking that may lead to this condition.

Osteoarthritis and inflammatory diseases such as rheumatoid arthritis or gout are other possible causes of hallux rigidus.

How is hallux rigidus diagnosed?

An orthopedic surgeon can diagnose hallux rigidus by testing the range of motion of the joint, how far the toe can bend up and down and conducting a physical exam of the foot. X-rays may be taken to view the extent of the arthritis of the big toe and to check for abnormalities in the bone or bone spur development.

Hallux Rigidus Treatment Options

Treatment of hallux rigidus often has to be surgical but the joint can be made more comfortable with an appropriate shoe modification. The principle with orthotic management is to offload the big toe during walking. To treat the pain in the big toe joint, simple measures can be adopted:

• Shoes can be modified by stiffening the sole, inserting a stiff orthotic arch support in the shoe and adding a small rocker effect (called a metatarsal bar) that is glued to the bottom of the sole of the shoe.
• Wearing shoes with plenty of room for your toes and placing pads in your shoe to limit movement of your big toe helps ease pain.
• Thin-soled shoes and high heels aggravate this condition because more stress is placed on the joint, increasing pain.
• High-impact activities, such as jogging should be avoided
• Taking non-steroidal anti-inflammatory medications, such as ibuprofen, help relieve the pain and reduce swelling in your big toe. But if pain persists, then your doctor may recommend corticosteroid injections into the joint.

Surgical Treatment

Surgical treatment options for hallux rigidus are determined by the level of pain, the presence of deformity and radiographic stage of degeneration. The chance of success is weighed against the degree of restriction following treatment to reach an informed decision as to which of the many surgical therapies will be most appropriate.

1. Injection/manipulation: This can be useful in the early stages of arthritis. The effects are often temporary.
2. Cheilectomy: For the more minor type of hallux rigidus, shaving the bump of the bone on top of the metatarsal is sufficient.
3. Osteotomy: As the stiffening of the big toe joint increases, an additional bone cut is needed on the big toe in order to realign or shorten the big toe.
4. Arthroscopic debridement: A minimally invasive technique, generally for patients with moderately severe symptoms but lesser degrees of x-ray changes.
5. Open debridement: Any loose cartilage within the joint is removed and any discreet areas lacking cartilage are drilled with fine wires
6. Kellers/Hamiltons arthroplasty: A good option in the less mobile, more elderly patient. This involves removal of one side of the painful joint. This stops the pain of the arthritic joint but the big toe sometimes becomes floppy.
7. Big Toe Fusion: After a successful big toe fusion the two bones which formed the joint, metatarsal and proximal phalanx, are permanently “bonded” together and no longer move.

Complications can occur with any type of surgery, but are not frequent after surgery for hallux rigidus. Complications may include infection, joint stiffness, progression of the arthritis, recurrence of the deformity, and persistent swelling.

The recovery time after surgery depends on the procedure but generally, you will be able to return to work between four and eight weeks after surgery, depending on the type of job you have, activity level, and your response to surgery.

While there is no definite way to prevent hallux rigidus, you may be able to slow its progress by doing exercises to keep the joint mobile, resting the joint when it becomes painful, and wearing good-fitting shoes that have enough space around the toes.