A common problem which affects the big toe is called hallux rigidus or stiff big toe. ‘Hallux’ is the Greek word for big toe and ‘rigidus’ indicates the joint is stiff and inflexible.
Hallux rigidus is a form of osteoarthritis which occurs when the cartilage within the joint wears out. The London Foot and Ankle Centre has extensive experience of surgery for hallux rigidus and for some patients, we can offer hallux rigidus surgery as a minimally invasive procedure.
Your big toes bear a great deal of pressure as you walk. With every step, a force equal to about twice your body weight passes through this very small joint. The big toe is used every time we walk, bend down, climb up and even stand still.
Symptoms of Hallux Rigidus
The condition varies in terms of stiffness, pain and loss of mobility. Some people will develop what is known as hallux limitus, where mobility is restricted rather than lost.
Symptoms of hallux limitus include:
- Pain and stiffness during movement
- Problems with some activities such as running
- Swelling and inflammation around the joint
- Symptoms are worse during cold and damp weather
At a more advanced stage, symptoms include:
- Pain when resting
- Development of bony bumps (osteophyte) may develop on the top of the joint which can rub on shoes
- People may walk on the outer side of the foot to avoid pain from the big toe. This can produce pain in the ball or outside of the foot
The big toe can become what is known as a “frozen joint” when all movement is lost. At this end stage of hallux rigidus, other related problems are likely to have developed in the foot.
Hallux rigidus can start early in life, even during teenage years or the twenties. However, in the majority of cases, it does not get progressively worse. About 20 to 25 per cent of patients experience increasing stiffness and loss of mobility and are likely to require treatment.
Causes of Hallux Rigidus
Hallux rigidus can occur spontaneously, without any obvious cause. In other patients, there can be one or a combination of factors which trigger the development of this condition.
People with flat feet and other structural deformities such as fallen arches and excessive pronation (rolling in) of the ankles are particularly susceptible tohallux rigidus because of the stress placed on their big toe joints.
Some people may have a family history of the condition and inherit a foot type which is more prone to developing problems within the big toe joint. Hallux rigidus can also be triggered by injury, inflammation and infection.
Hallux Rigidus Diagnosis
The condition is simpler to treat in its early stages. Therefore it is recommended that you see a foot and ankle surgeon when your big toe feels stiff or when you experience pain as you walk, bend or stand. Once the condition becomes more advanced and bone spurs develop, it is more complex to manage.
The surgeon will examine your feet and assess your range of movement. X-rays are usually taken to evaluate the extent of arthritis and any abnormalities which may have developed.
Hallux Rigidus Treatment
If the condition is caught early, non-surgical treatment is more likely to be effective.
The joint is usually most painful when it is bent upwards during walking. Therefore it can be helpful to stiffen the sole of the shoe so it does not bend during walking. A small ‘rocker bar’ can be fitted so you can rock over while walking, rather than bending your toes. Shoes with a large toe box should be worn, because they put less pressure on the toes. High heels and shoes with pointed toes should not be worn.
These can be helpful, particularly if your condition is caused by abnormal foot biomechanics. Orthotics are designed to alter the function of your foot.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
These include ibuprofen and may be prescribed to help reduce pain and inflammation.
Injections of corticosteroids in small amounts can be helpful in terms of reducing pain and inflammation
Surgery may be considered if more conservative approaches fail to eliminate or reduce pain. There are several different types of surgery that can be undertaken for hallux rigidus.
This is a procedure which involves removing the bony lumps, inspecting and cleaning the joint and releasing the soft tissue. A cheilectomy is designed to restore normal alignment and function as well as reducing or eliminating pain. At LFAC we can undertake a cheilectomy using minimally invasive surgery if it is appropriate for you.
- Reshaping of the proximal phalanx
The proximal phalanx is the bone at the base of the big toe. This bone may be reshaped to maximise the amount of movement available following a cheilectomy. This procedure is often carried out at the same time as a cheilectomy.If the arthritis is advanced throughout the whole joint, two different types of operations can be used.
This is the best option for young people, who are active and will place the joint under more stress than an older less active person. The arthritic joint surface is removed and the metatarsal and proximal phalangeal bones are fused together using a small plate and screws. This is a very effective way of eliminating pain. However, the joint will be left stiff and shoe choice can sometimes be restricted.
- Joint replacement
This is suitable for older patients who will not place as much strain on the joint as younger people, but would like to preserve as much flexibility as possible. Replacement of the big toe joint has had mixed results, with some devices loosening. It can only be considered if the patient with Hallux rigidus (stiff big toe) is older, has low demands on the joint and there is no deformity.