Hallux Rigidus is a deformity by where the hallux (big toe) develops stiffness and is unable to move without pain. Most experts consider it a form of degenerative arthritis. The problem occurs as we walk or bend the big toe at the metatarsophalangeal joint and the diminished range of motion causes discomfort.
Most often a spur is noted but the disorder can be due to poor mechanics alone. Sadly, this condition is a progressive one that worsens over time. The early stages are more of a limitation of the joint called Hallux Limitus but as time goes on, it becomes Hallux Rigidus, which sounds as bad as it is.
There are multiple causes of this deformity. Biomechanics such as pronation and flat foot deformity can be causative. Abnormal mechanics of the joint are caused by this pronatory force. It can also be caused by either a minor or major injury. A major injury is what it sounds like, a traumatic episode. Minor trauma is consistent with the abnormal mechanics leading us down this path. If the joint continues to jam, this will be the culprit. Stooping or poor positioning can cause this as well. Lastly, arthritic inflammatory disease like gout can be a culprit.
Early signs and symptoms include pain and stiffness in the big toe during use (walking, standing, bending, etc.) Other symptoms include pain and stiffness aggravated by cold, damp weather. Difficulty with certain activities like running and squatting are often seen. Swelling and inflammation around the joint is a telltale symptom as well.
As the disorder gets more serious, additional symptoms may develop like pain, even during rest. Difficulty wearing shoes because bone spurs (overgrowths) develop especially over the top of the big toe. Dull pain can occur in the hip, knee or lower back due to changes in the way you walk. Limping can be seen in severe cases.
The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice symptoms. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.
In diagnosing Hallux Rigidus, the surgeon will examine your feet and move to the toe to determine its range of motion. X-rays help determine how much arthritis is present to evaluate any bone spurs or other abnormalities that may have formed.
In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of Hallux Rigidus may include shoe modifications like shoes with a large toe box which puts less pressure on your toe. Stiff or rocker-bottom soles may also be recommended. Custom orthotic devices may improve foot function, which can reduce pain. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Injections of corticosteroids may reduce inflammation and pain. Ultrasound therapy or other physical therapy modalities can also be used.
In some cases, surgery is the only way to eliminate or reduce pain. Several types of surgery are available for treatment of Hallux Rigidus. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the X-ray findings, your age, your activity level and other factors. The length of the recovery period will vary depending on the procedure or procedures performed.
To find out more about Hallux Rigidus or other foot and ankle problems, please call us at (609) 561-2488 or complete the consultation request form.
David Weiss, DPM, is the owner of Weiss Foot & Ankle Center located at 777 South White Horse Pike, Suite D1 in Hammonton.