Do you notice pain and/or stiffness in your big toe? If so, the cause might be hallux rigidus, a condition where movement of the big toe is restricted to varying degrees. As you can imagine, this can be very troubling and even disabling, since we use the all-important big toe whenever we walk, stoop down, climb up or even stand. If you have pain and/or stiffness in your big toe, please come in for a consultation.
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 and because it’s a progressive condition, you’ll find that bending your big toe will become increasingly more difficult with time.
For those who enjoy medical jargon, “hallux” refers to the big toe, while “rigidus” indicates that the toe is as the word suggests, rigid. This condition is actually a form of degenerative arthritis, which is basically a wearing out of the cartilage within the joint that occurs in the foot and other parts of the body.
If you’re in an earlier stage, you’ll find that motion of your big toe is only somewhat limited. At this point, the condition is called “hallux limitus.” However, as the problem advances, your toe’s range of motion will gradually decrease until it potentially reaches the end stage of “rigidus” and becomes stiff. We often call this a “frozen joint.” Other problems are also likely to occur as the disorder progresses. That’s why it’s so important to jump on treatment as soon as possible.
What are the symptoms?
Early signs and symptoms include:
- Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
- Pain and stiffness aggravated by cold, damp weather
- Difficulty with certain activities (running, squatting)
- Swelling and inflammation around the joint
As the condition becomes more serious, additional symptoms may develop, including:
- Pain, even during rest
- Difficulty wearing shoes because bone spurs (overgrowths) develop. Wearing high-heeled shoes can be particularly difficult.
- Dull pain in the hip, knee or lower back due to changes in the way you walk
- Limping, in severe cases
What causes Hallux Rigidus?
Common causes 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, if you have fallen arches or excessive pronation (rolling in) of the ankles, then you’re susceptible to developing hallux rigidus.
Hallux rigidus may even run in your family. In other cases, it’s associated with overuse — especially if you’re engaged in activities or jobs that increase the stress on your big toe, such as folks who often need to stoop or squat a lot.
Hallux rigidus can also result from an injury – even from stubbing your toe. Or it may be caused by certain inflammatory diseases, such as rheumatoid arthritis or gout. Our podiatric foot and ankle surgeons will determine the cause of your hallux rigidus and recommend the best treatment for you.
What does diagnosis of Hallux Rigidus involve?
The sooner this condition is diagnosed, the easier it is to treat. So, the best time to come see us is when you first notice that your big toe feels stiff or hurts when you walk, stand, bend over or squat. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.
In diagnosing hallux rigidus, we would examine your feet and manipulate your toe to determine its range of motion. X–rays are usually required to determine how much arthritis is present, as well as to evaluate any bone spurs or other abnormalities that may have formed.
Treatment: Non–Surgical Approaches
If your condition is caught early enough, it’s more likely to respond to less aggressive treatment. In many cases, early treatment can even prevent or postpone the need for surgery in the future. Again, that’s why it’s important to get a consultation when you first begin to notice symptoms.
Treatment for mild or moderate cases of hallux rigidus may include one or more of these strategies:
- Shoe modifications. We recommend that you wear shoes with a large toe box because they put less pressure on your big toe. We may also recommend stiff or rocker-bottom soles for you. Most likely, you’ll need to stop wearing high heels, though. Sorry!
- Orthotic devices. We can prescribe custom orthotic devices that may improve the function of your foot.
- Medications. We might prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to help reduce pain and inflammation. Supplements such as glucosamine–chondroitin sulfate and some vitamins and minerals may also be helpful.
- Injection therapy. We might give you injections of corticosteroids in small amounts in the affected toe to help reduce the inflammation and pain.
- Physical therapy. We also might prescribe ultrasound therapy or other kinds of physical therapy to provide temporary relief.
When might you need surgery?
In some cases, we find that surgery is the only way to eliminate or reduce your pain. There are several types of surgery we can look at together, depending on your particular condition. These surgical procedures fall into two categories:
- Some procedures reconstruct and “clean up” the joint. We would remove the arthritic damage from the joint, as well as any accompanying bone spurs, and then alter the position of one or more bones in your big toe. These procedures are designed to preserve and restore normal alignment and function of your joint as well as reduce or eliminate your pain.
- We might opt for more aggressive procedures when your joint cannot be preserved. These may involve fusing the joint, or removing part or all of the joint and, in some cases, replacing it with an implant (similar to what is done for the hip or knee). These procedures eliminate painful motion in the joint and provide a stable foot. That’s a good thing!
The procedure that is used to correct hallux rigidus depends on many factors. We’ll consider the cause of the condition and its severity, as well as your age, occupation and activity level. Remember, we’re trained to select a surgical procedure best suited to your particular condition and needs. You’re in good hands.
If we do perform surgery, the length of your recovery period will vary, depending upon the procedure or procedures performed.