Hallux Rigidus

What Is Hallux Rigidus?

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. "Hallux" refers to the big toe, while "rigidus" indicates that the toe is rigid and cannot move.

Because hallux rigidus is a progressive condition, the toe's motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called "hallux limitus". But as the problem advances, the toe's range of motion gradually decreases until it potentially reaches the end stage of "rigidus", in which the big toe becomes stiff, or what is sometimes called a "frozen joint".

Causes

Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis - the kind that results from "wear and tear" - often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

Symptoms

Early signs and symptoms include:

  1. Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
  2. Pain and stiffness aggravated by cold, damp weather
  3. Difficulty with certain activities (running, squatting)
  4. Swelling and inflammation around the joint

As the disorder gets more serious, additional symptoms may develop, including:

  1. Pain, even during rest
  2. Difficulty wearing shoes because bone spurs (overgrowths) develop
  3. Dull pain in the hip, knee, or lower back due to changes in the way you walk
  4. Limping, or favoring the big toe joint

Diagnosis

The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice symptoms. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.

In diagnosing hallux rigidus, the surgeon will examine your feet and move the toe to determine its range of motion. X-rays help determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.

Non-Surgical Treatment

In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include:

  • Shoe modifications - Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.
  • Orthotic devices - Custom orthotic devices can improve foot mechanics.
  • Medications - Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce pain and inflammation.
  • Injection therapy - Injections of corticosteroids may reduce inflammation and pain.
  • Physical therapy

When Is Surgery Needed?

In some cases, surgery is the only way to eliminate or reduce pain. In milder cases, the arthritic portions of bone are removed from the joint. In cases where hallux rigidus is more advanced, the doctors of North Shore Foot & Ankle use a mirror-like implant to resurface the arthritic joint. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors.

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