Hallux Rigidus (Stiff Big Toe)

The big toe, medically referred to as the hallux, comprises two phalangeal bones. These bones meet to create two joints: one at the base and another in the middle. The ends of these bones are covered in protective cartilage, which allows for smooth movement during activity. The joint at the base of the toe, where hallux rigidus develops, is known as the metatarsophalangeal (MTP) joint.

The precise cause of hallux rigidus remains unclear. However, degenerative arthritis often leads to the breakdown of protective cartilage in the MTP joint, resulting in bone-on-bone friction and subsequent stiffness. The formation of abnormal bony growths, or bone spurs, can further limit joint mobility.

Hallux rigidus commonly affects individuals aged 30 to 60, often following an injury, trauma, or excessive strain. Researchers have yet to determine why some people develop this condition while others do not.

Individuals with hallux rigidus typically experience stiffness and swelling in the big toe. Pain often intensifies during physical activities, and a bump or callus may form on the top of the foot.

This condition tends to worsen over time, leading to significant limitations in big toe mobility. It can impact your ability to walk, stand, and engage in daily activities, and discomfort may persist even during rest.

If you suspect hallux rigidus, it’s important to consult your doctor. Early diagnosis and treatment are linked to more favorable outcomes.

Your doctor can confirm the diagnosis by reviewing your medical history and conducting a physical examination. X-rays will be performed to identify arthritis, bone spurs, and other structural issues.

Early treatment of hallux rigidus can help avoid the need for surgery later on. A range of non-surgical options are available. It’s advisable to refrain from wearing high-heeled shoes and to opt for stiff-soled footwear with a spacious toe box. Custom orthotics can relieve pressure and enhance foot function. Over-the-counter anti-inflammatory medications, like ibuprofen, may alleviate pain and swelling. For more severe cases, steroid injections into the toe joint may be recommended.

Surgery is typically considered when non-surgical treatments fail to provide relief or restore function. The type of surgery performed will depend on the severity of the condition.

• Cheilectomy: This procedure involves removing excess bone and bone spurs to improve toe mobility. It is best suited for mild to moderate cases and is performed through an incision on the top of the foot. A rigid-soled shoe is required for a few weeks post-surgery, and most patients experience significant pain relief.
• Arthrodesis (fusion): This surgical option permanently fixes the toe joint in place and is intended for severe cases. The procedure includes removing damaged cartilage, aligning the bones, and securing them with surgical hardware. Post-surgery, the foot is placed in a cast for about six weeks, and patients will need crutches during this period. Eventually, the bones fuse, alleviating pain.
• Arthroplasty: In this procedure, the toe joint may be replaced with artificial implants to restore motion and relieve pain. It is often a suitable choice for older adults.

Recovery from hallux rigidus surgery varies based on the severity of the condition and the specific treatment undertaken. Your recovery will be personalized, and your doctor will provide guidance on what to expect.