Hallux Rigidus – Symptoms, Causes, and Treatments

Hallux rigidus can affect quality of life. But early treatment can stop it from getting worse.

In this article, we will look at the causes of hallux rigidus so you can take steps to ensure that you have the lowest chance of developing it.

We will also look at the symptoms to identify if you have it, and treatments to prevent it from worsening.

What Is Hallux Rigidus?

Hallux rigidus is a type of progressive arthritis that affects the first joint of your big toe. The big toe is the most common area in your feet for arthritis to develop, which is why the condition is also known as Big Toe Arthritis.

Hallux refers to the big toe, while rigidus refers to a rigid toe that cannot move. This condition results in pain and stiffness in the big toe joint and a gradual decrease in mobility.

In the early stages, known as hallux limitus, your big toe joint becomes inflamed, sore, and stiff.

As the condition becomes more advanced, you’ll find that you lose the ability to move or bend your big toe. This is called a frozen joint, and it can make going about your daily activities extremely difficult.

What Are the Symptoms?

In the early stages— called hallux limitus—you’ll notice pain on the top of your big toe joint, which will worsen when you try to bend the joint.

Your big toe will feel stiff, and you’ll have trouble trying to flex it. The pain and stiffness can be aggravated by cold, damp weather.

There’ll also be swelling and inflammation around the joint, or you may notice a bony lump—also known as a dorsal bunionon top of your big toe joint.

As the condition progresses, you may experience pain in your big toe even when you’re resting your foot. The range of motion of your toe will have decreased, and you may not be able to move your big toe at all.

This will make walking, standing, or bending extremely painful. Wearing shoes might start to feel uncomfortable.

You may experience pain in your lower back, hips, or knees as you’re walking differently to accommodate your big toe. You may even start limping.

What Are the Causes?

Several factors can cause hallux rigidus, with the most common cause being overuse of the joint.

You may be at risk for developing the condition if you participate in certain sports like running or work in jobs that place a lot of pressure on the big toe. Excessive wear or stress is placed on the joint by athletes and workers who bend or squat frequently.

An injury to the big toe joint, such as spraining it or stubbing your toe, can contribute to the condition.

Other risk factors include:

  • A long or elevated metatarsal bone
  • Fallen arches
  • Overpronate excessively
  • An inflammatory disease like osteoarthritis, rheumatoid arthritis, or gout

It’s also possible to develop hallux rigidus if a family member already has it.

What Are the Treatments?

If your hallux rigidus is diagnosed early, you may be able to avoid surgery by incorporating non-surgical treatments into your days.

Apply cold and heat several times throughout the day by either applying ice or taking contrast baths.

During a contrast bath, you place your feet in warm water for 30 seconds and then straight into ice-cold water for 30 seconds.

Continue to go back and forth with this process for 5 minutes, but make sure to end off with cold water. This will help reduce inflammation and alleviate pain.

Try to limit the movement of your big toe by either taping your toe or using a Morton’s extension insert. With that said, you may have to avoid high-impact activities that place your toe joint under stress, like running.

You may want to footwear for hallux rigidus support. Look for shoes that have a wide toe box. This will help to reduce the pressure placed on the toe.

The shoes should also have a stiff sole with a rocker bottom, as this will reduce the amount of bending your toes do, and instead, you’ll “roll” over in your step.

If you’re looking for dress shoes, they should have either steel or nylon shank in the sole. This will help to support and stabilize your toe while you walk.

Avoid wearing pointed or high-heeled shoes. If you must wear flip flops, make sure they are supportive sandals for hallux rigidus.

Speak to your podiatrist about custom orthotics or over the counter inserts for hallux rigidus. These are designed to mold to the specific contours of your feet, while improving functionality and your biomechanics.

To help manage the pain and reduce inflammation, you can use anti-inflammatory medications.

In cases where the pain and inflammation is severe, your doctor may recommend cortisone injections.

Your doctor may also recommend physical therapy to help relieve the stress placed on the other joints around this big toe. This will help reduce pain and provide temporary relief.

What Different Surgery Methods Exist?

There are several different surgical options for hallux rigidus. Your doctor will discuss the recommended surgery options with you based on your toe’s severity of pain and deformity.

These surgical options include:

Cheilectomy

Your doctor may recommend this surgery when you have mild to moderate hallux rigidus.

This procedure is known as “shaving the big toe,” and it can help alleviate pain, improve the joint’s range of motion, and you’ll be able to wear any shoes comfortably.

The surgeon will make an incision on the top of the toe, then remove the bone spurs by shaving the top and sides of the joint.

In some cases, your surgeon may remove a small portion of bone after shaving the bone spurs. This is known as a Moberg Osteotomy, and it helps to create space so that your toe joint has room to move.

You’ll need to wear wooden-soled sandals for approximately 2 weeks after the procedure.

While this surgical option allows for quick recovery, your joint may remain swollen for several months post-surgery.

Interpositional Arthroplasty

This procedure may be an option for moderate to severe hallux rigidus in younger patients.

The surgeon removes some of the damaged bone and then places a “spacer”, such as a tendon or synthetic capsule, between the joint.

This helps to alleviate pain and allows for smooth motion between the bones when you bend your toe.

Arthrodesis

This procedure may be recommended if you’re in the advanced stages of hallux rigidus, and it can provide long-lasting pain relief.

Surgeons will remove the damaged cartilage and then fix the two ends of the bones together with screws and plates. As the bones heal, they’ll fuse permanently together.

While this provides long-lasting pain relief, it will prevent you from participating in activities like yoga or running as it restricts movement of the big toe.

The recovery period for this procedure is long and you won’t be able to bear any weight on the affected foot for at least 6 weeks. You’ll be able to wear “regular” shoes after approximately 3 months when the bones have completely healed.

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