Hallux rigidus is a condition of the joint located at the big toe. It causes pain and stiffness in the joint, and with time it becomes harder to bend the toe. Hallux refers to the big toe, while rigidus indicates that the toe is becoming increasingly rigid and cannot move. This is a form of degenerative arthritis and is progressive (can worsen). In the earlier stages the motion is limited in the big toe but as the disorder advances the range of motion gradually decreases until it becomes rigid/stiff.
Causes
Usually this condition is caused by a biomechanical or structural abnormality of the foot that can progress to osteoarthritis and continued wear and tear of the joint. This disorder can be caused by a flat foot and excessive pronation, by overuse due to increased activities that causes stress to the great toe, by a traumatic injury, by an inflammatory disease such as gout/rheumatoid arthritis, as well as an inherited family trait.
Symptoms
- Pain and stiffness in the big toe during use (i.e. walking, standing, bending)
- Pain and stiffness aggravated by cold, damp weather
- Difficulty with certain activities (running, squatting, sports)
- Swelling and inflammation around the joint
- Difficulty wearing shoes because bone spurs (overgrowths) develop
- Dull pain in the hip, knee, or lower back due to changes in the way you walk
- Limping (in severe cases)
Diagnosis
In diagnosing Hallux Rigidus, your surgeon will examine your feet and move the toe to determine its range of motion. X-rays will be ordered to evaluate the extent of arthritis as well as other bony abnormalities. A CT or MRI scan may be ordered as well for advanced cases or cases that develop secondary to another condition.
Non Surgical Treatments
Early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of Hallux Rigidus may include:
- Ice. Putting an ice pack on your foot for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and the area of discomfort; do not apply ice directly to the skin.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
- Orthotic devices. Custom or over the counter orthotic devices that fit into your shoe help improve the underlying mechanical structure of the foot.
- Bracing. May reduce pain during walking and help prevent further deformity.
- Physical therapy. Exercises to strengthen the muscles may provide greater stability and help avoid injury that might worsen the condition. Other physical therapy modalities may provide temporary relief.
- Stretching exercises. Exercises that stretch out the calf muscles as well as muscles surrounding the arthritis.
- Avoid barefoot. When you walk without shoes, you put increase strain and stress on your arthritis.
- Limit activities. Reduce extended physical activities
- Shoe modifications. Wearing supportive shoes with a wider toe box will put less pressure on your toe. Rigid soled shoes or rocker bottom soles may proved relief.
- Injection therapy. Injections of corticosteroids in the joint may reduce inflammation and pain.
In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. 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. The length of the recovery period will vary, depending on the procedure or procedures performed.
Surgery
When Hallux Rigidus has progressed or failed to improve with non-surgical treatment, surgery may be recommended. In some advanced cases with extensive arthritis, surgery may be the only option. The goal of surgery is to decrease pain and improve function. Your surgeon will consider a number of factors when selecting the procedure best suited to your x-ray findings, your age, your activity level, your condition and your lifestyle.
Surgery is typically an outpatient procedure (day surgery) and scheduled at your convenience.
A splint or boot will be placed on your surgical foot/ankle after surgery. No weight to the surgical foot/ankle is advised until your surgeon encourages weight bearing.