What is hallux rigidus?

The most common site of arthritis in the foot is at the base of the big toe. This joint is known as the metatarsophalangeal (MTP) joint, which is covered by articular cartilage. If wear-and-tear or injury damages the articular cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when walking. The result is a stiff big toe, or hallux rigidus which can make walking painful and difficult.

Causes

Hallux rigidus usually develops in adults between the ages of 30 and 60 years. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the MTP joint. It can also be caused by wear and tear accumulated over time, causing cartilage damage, leading to arthritis of this joint.

Symptoms of a stiff big toe

  • Joint pain while walking or during activity, especially if pushing off on the toes when walking
  • Swelling
  • Stiffness in the big toe and difficulty bending it up and down
  • Pain with walking and bearing weight
  • A bump forms on top of the big toe, which indicates a bone spur

Treatment

Nonsurgical Treatment

There are nonsurgical ways to manage symptoms, but they are not enough to stop the condition from advancing and typically do not reverse the damage.

  • Anti-inflammatory pain relievers: Pain relievers, like ibuprofen, can be used to ease symptoms like inflammation, swelling and pain.
  • Ice packs and Contrast baths: Applying ice packs or taking contrast may help reduce inflammation and control symptoms for a short period of time. A contrast bath uses alternating cold and hot water to reduce inflammation. Alternate feet between cold water for 30 seconds, then immediately n the hot water for 30 seconds. Continue to alternate between cold and hot for five minutes, ending in the cold water. Contrast baths can be done up to three times a day to reduce inflammation.
  • Footwear: Wearing a shoe with a large toe box will reduce the pressure on the toe. For women, giving up high heels may be recommended.
  • Injections: Occasional steroid injections into the big toe joint can be used to temporarily reduce symptoms but do not change the ultimate course of treatment.

Surgical Treatment

There are three primary surgical procedures for a stiff big toe.

  1. Cheilectomy: This surgery is for more mild degenerative change and bone spurs. The spurs are removed surgically to allow the toe to bend again. The joint is cleaned out and loose flaps of cartilage are removed as well. Sometimes part of the bone is removed to allow improved motion. The foot is usually swollen for several months, but typically results in relief in the long run.
  2. Arthrodesis: This procedure is only for severe cases. After surgery, the toe will no longer bend. The bones of the big toe joint are fused together. Damaged cartilage is removed, and the joint is put into a set position to allow the bones to grow together. Surgery is followed by a boot immobilization and protected weight bearing for several weeks. The end result is still a stiff toe, but now without pain.
  3. Arthroplasty: This joint replacement surgery is for older patients who place few functional demands on the feet. The joint surfaces are removed and an artificial joint is implanted. This procedure may relieve pain and preserve joint motion.

Hallux rigidus and hallux valgus are common foot conditions that lead to a deterioration in health status. To learn more about hallux valgus, check out our article about bunions (hallus valgus).

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