Overview of Hallux Rigidus Symptoms and Treatments

Hallux rigidus is a form of degenerative arthritis (osteoarthritis.) Hallux (refers to the big toe) rigidus (refers to stiffness) usually affects adults between 30 and 60 years of age, and often it is the result of a prior high school sports injury. Arthritis of the big toe is the most common site of arthritis in the foot, affecting 2.5 percent of people over the age of 50.

It is the joint at the base of the big toe (metatarsophalangeal joint, or MTP joint) that is affected and the condition develops gradually over time. Not all injured athletes develop hallux rigidus which begs the question: Why do some develop hallux rigidus but others do not?

Who Develops Hallux Rigidus?

People who participate in sports where loading, stressing, and extending movements are required of their feet become susceptible to micro-trauma and sprains in the joint at the base of the big toe. "Turf toe," the name given to these injuries, can also cause bone spurs or osteophytes to develop. Soccer and football played on artificial turf cause most toe injuries in sports. If not treated properly, turf toe can lead to hallux rigidus.

Not only athletes develop hallux rigidus though. People who have fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus. It can run in families as certain foot types are more prone to developing hallux rigidus than others. Hallux rigidus may also be caused by specific inflammatory diseases, such as rheumatoid arthritis or gout.

Why Treatment Is Important

The lack of proper treatment for big toe injuries can have serious consequences. Treatment is imperative so that the condition does not become debilitating. Advanced hallux rigidus can cause:

• Pain, even during rest
• Pain which worsens with use of the big toe, such as with jumping
• Difficulty wearing shoes because of bone spurs
• Difficulty wearing high-heeled shoes
• Dull pain in the hip, knee, or lower back caused by changes in how someone walks
• Limping

Treatment Options

There are both non-surgical and surgical options for treating hallux rigidus. Ideally, hallux rigidus will be diagnosed in the early stages when non-surgical options alone may be used. If the condition is causing pain at rest or significant limping, surgery may be needed.

Non-surgical treatment options include:

• Shoe modifications (for example, shoe pads designed to stop movement under joint of the big toe, stiff soled shoes which also reduce movement at the joint, or adding a rocker bottom to shoes.)
• Activity modifications (for example, low impact exercising.)
• Anti-inflammatory medications (such as Advil (ibuprofen) or steroid injections.

Surgical treatment options include:

• Cheilectomy, also known as shaving the big toe joint (for people trying to preserve the joint, mobility, but end up with less pain.) This is considered a "joint-sparing" technique as the mobility at the metatarsophalangeal joint is preserved.
• Arthrodesis, also known as joint fusion (for people seeking lasting pain relief even though the fused joints will no longer bend.) Arthrodesis is considered a "joint-sacrificing technique" as fusion of the joint removes any further range of motion at the joint. For people with end-stage hallux rigidus, however, arthrodesis can result in long-term control of pain and good functional results.
• Newer procedures such as implant arthroplasty are being evaluated but nobody is yet certain of their long-term effectiveness or safety.

Seeking Treatment

If you have symptoms of hallux rigidus, make an appointment to see your healthcare provider right away. Early treatment and early diagnosis yield the best results. Over time, hallux rigidus can lead to life-limiting pain, problems with range of motion of your foot, and gait disturbances. Early on, conservative measures such as shoe modifications, activity limitation, steroid injections, and anti-inflammatory medications may be enough to reduce your pain and limit motion in the joint. That said, if you are experiencing pain even at rest or if the condition is affecting your gait, surgical treatment may be needed to relieve pain.