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Orthopaedic Specialties

Hallux Rigidus

Hallux Rigidus is a condition that causes the joint at the base of the big toe to become stiff until it can no longer move, causing pain. Frequently, it develops in adults between the ages of 30 and 60 years. The specific causes of Hallux Rigidus are unknown and why it develops in some people and not others.

Possible causes could be:

  • An injury to the toe that damaged the articular cartilage.
  • Inflammatory diseases, like gout or rheumatoid arthritis.
  • Overuse of the big toe joint.
  • Foot structure abnormalities that caused increased stress on the joint.
  • A bone spur, or an overgrowth, may develop on the top of the big toe bone.

This condition can be very incapacitating because we use the big toe to stand and walk. Hallux Rigidus evolves slowly, meaning it is unnoticeable at first and gets worse over time.

Every time you take a step, the big toe has to bend; if the joint begins to stiffen and become rigid, walking can become difficult and painful.

Hallux Rigidus worsens over time, causing increased pain and stiffness until treated.
Hallux Rigidus can often be treated non-surgically, but surgery is generally advised if the non-surgical treatments are unsuccessful or if the Hallux Rigidus has become severe.

Symptoms

Early symptoms and signs include:

  • Pain in the joint of the big toe when you are active, particularly as you push-off on the toes when you are walking.
  • Difficulty with specific activities, for example, squatting or running.
  • Swelling and inflammation around the joint of the big toe.
  • A bump that develops on the top of the foot.
  • Bone spurs might appear.

As the condition gets worse, the following symptoms will begin to appear:

  • Chronic toe pain.
  • Limping.
  • Constant pain in the knee, hip, or lower back.

Diagnosis

Hallux Rigidus is much easier to treat when it is caught early. If you delay until you see a bony bump on the top of your foot, bone spurs will have already developed, and your toe will be more difficult to treat.

If you find it hard to bend your toe up and down or notice that you are walking on the outside of your foot trying to prevent pain in your big toe, see a physician right away.
Your Orthopaedic Associates of St. Augustine physician will examine your foot and look for evidence of bone spurs. They may move the toe around to inspect your range of motion is possible without pain. X-rays will indicate the size and location of any bone spurs, along with the degree of deterioration in the joint space and cartilage.

Treatment Options

Hallux Rigidus can be treated both surgically and non-surgically. Non-surgical treatments are usually suggested first. Surgical treatments are recommended if non-surgical treatments are ineffective or if the Hallux Rigidus is severe.

Non-Surgical Treatments

Non-surgical treatment is most effective in patients where the Hallux Rigidus is discovered early. Here are several non-surgical treatment options available:

  • Pain relievers and anti-inflammatory medications such as Advil and Motrin (ibuprofen) can help to reduce the pain and inflammation.
  • Orthotic devices – Custom orthotic devices can ease pressure on the big toe and reduce pain.
  • Suitable footwear – Shoes with a rocker bottom will relieve pressure on the afflicted big toe and reduce pain. Shoes that have a large toe box will put less pressure on the toes. If you wear high heels will likely have to give them up.
  • Physical Therapy – Some types of physical therapy may provide temporary relief.
  • Injection therapy- Injections of corticosteroids may also be suggested to reduce pain and inflammation.
  • Ice packs – Applying ice packs for short periods may also help reduce inflammation and control symptoms temporarily.

Surgical Treatments

Cheilectomy is a very common surgical procedure utilized to treat Hallux Rigidus. It is usually recommended when damage is mild or moderate. During surgery, the bone spurs and a portion of the bone on the top of the toe joint are removed, giving the big toe more space to bend and move. The afflicted big toe will have more room to move and is no longer rigid. Cheilectomy is an excellent option for Hallux Rigidus because it maintains motion and stability while preserving the joint itself.

The toe and the operative area may remain swollen for several months following surgery, and you will need to wear a wooden-soled sandal for at least two weeks after the surgery to protect the foot. Most patients do experience long-term relief.

Arthrodesis (Fusion) – When the damage to the cartilage is severe, fusing the bones together is recommended. Fusion is very reliable at eliminating pain permanently from the joint. With this type of surgery, the toe will permanently not be able to bend at all. The damaged cartilage will be removed, and screws, pins are used to repair the joint in a permanent position. Slowly, the bones grow together. Fusion is also a good option for people with arthritis connected to a deformity of the toe. It is the best way to reduce pain in the most severe cases. Several studies have revealed good restoration to the gait with little functional limitations.

After surgery, you will wear a cast for approximately six weeks. Then you will be using crutches for another six weeks. You may need to wear shoes with a rocker-type sole, and you will not be able to wear high heels.

Arthroplasty – Some older patients who don’t lead an active lifestyle may be candidates for joint replacement surgery. After the joint surfaces are removed, an artificial joint is implanted. This surgery helps to relieve pain and preserve joint mobility.

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