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Hallux Rigidus (Stiff Big Toe)

What is Hallux Rigidus?

Stiffness (restricted motion), and usually swelling at the base of the big toe. The technical name of this joint is the metatarsophalangeal joint.
The big toe is an important part of walking, as it is involved in push-off and moving the body forward. Once the joint stiffens, walking becomes more painful and difficult.

Joints are lined with cartilage, a smooth surface that acts as a layer for the underlying bones to glide against one another during motion and walking.

Injury or wear and tear can occur to joints, causing the cartilage to wear away, and the bones to rub against one another. In response to injury to cartilage and the joint, the body may form a bone spur, or overgrowth at the edges of the joint. In the big toe, this can cause a bony “bump” on the top of the joint. This bump can stop the toe from bending all the way upward and limit motion and walking. Hallux rigidus usually develops in adults between ages 30 and 60 years old. It may be the cause of an injured toe that can result in damaged cartilage. There may be a genetic component to patients with hallux rigidus.

Symptoms

  • Pain in the joint with activity that requires bending or push-off with the toes
  • Swelling around the joint
  • A bump on the top of the joint
  • Stiffness that limits the ability to bend the toe up or down

Diagnosis

  • If you find it difficult to bend your toe up or down, or that you are walking on the outside of your foot because of pain at the big toe, you should see your doctor.
  • Your doctor will examine the motion at the big toe, if there are any bone spurs around the toe, and the rest of your foot to see if there are conditions contributing to the big toe pain or if the big toe is causing other conditions in the foot.
  • X-rays will be taken which can show narrowing of the joint spaces and bone spurs

Treatment

  • Non surgical
    • Pain relievers and anti-inflammatories can reduce swelling and ease pain
    • Applying ice may help to reduce symptoms for short periods of time
    • Shoes with a large toe box can reduce pressure on the big toe joint
    • Stiff-soled shoes with a slightly curved bottom may help
    • A steel or carbon-fiber in-sole can also help support the foot and limit motion at the joint, thus limiting pain
    • High-heeled shoes will typically make pain and symptoms worse and should be avoided
  • Surgical
      • You should speak with your doctor about specific treatment options as there are several available for the treatment of hallux rigidus depending on how advanced the problem is
      • Treatment can range from removing bone spurs to improve motion, joint replacement (controversial), and fusing the bones together to stop motion and reduce pain.

    PROstep MIS Cheilectomy Animation Video

All of the ROC foot and ankle surgeons have extensive experience with the treatment of hallux rigidus. Call for an appointment if you are experiencing any of the described symptoms above!

Adapted from:

https://orthoinfo.aaos.org/en/diseases–conditions/stiff-big-toe-hallux-rigidus