We may not often notice it, but we use the big toe whenever we move around: when we stand, walk, climb up, or stoop down. So when there’s pain or stiffness in the joint where it meets your foot, the discomfort can make it difficult for you to complete your daily activities.
This condition is known as hallux rigidus, and it’s a progressive disorder that can affect teens and adults alike and worsen over time. While there’s no clear cause for most people, some factors known to contribute to this condition include injuries and overuse of the joint.
We’ll look at what hallux rigidus is, its causes, stages, and the surgical and nonsurgical treatment options available to you.
What is Hallux Rigidus?
Hallux rigidus is degenerative arthritis of the joint located at the base of the big toe. This progressive disorder worsens over time, starting with minor stiffness and pain. Eventually, it gets increasingly more painful and harder to bend or flex the toe at this joint. The joint at the base of the big toe is called the 1st metatarsophalangeal joint (1st MPJ). Hallux refers to the big toe, and rigidus indicates the toe is rigid or stiff, resulting in decreased ROM of the big toe joint. The milder stage of this condition is sometimes referred to as hallux limitus as the joint motion is limited.
In the big toe joint(1st MPJ), the ends of the bones are covered by smooth cartilage. Arthritis is a natural wear-and-tear or damage to the cartilage surface that worsens over time. As the cartilage erodes, the bone becomes exposed, and the natural cushion is no longer available to protect the bone and allow it to glide smoothly throughout its range of motion.
As you can imagine, bone rubbing against bone isn’t a pleasant feeling and causes pain and inflammation with activity. This can also lead to a large bony bump or bone spur developing over the top of the joint. As the arthritis worsens the big toe joint may not be able to bend as much as is needed to walk normally.
As mentioned, hallux rigidus is a progressive condition. The pain, inflammation and the toe’s motion worsen over time. In the early stages, this disorder can be called hallux limitus due to the joint motion being slightly limited.
What causes Hallux Rigidus?
Structural abnormalities and biomechanics of the foot and lower extremity can lead to osteoarthritis of the big toe joint. This type of arthritis is more of the wear and tear type that worsens over time. The biomechanics of your foot and lower extremity affect the amount of force applied to the 1st MPJ. People with various conditions such as excessive pronation or flat feet are more susceptible to developing hallux rigidus.
Overuse can also result in hallux rigidus for people engaged in activities or jobs that increase stress and pressure on the big toe joint. Such activities include squatting, running, lunges, climbing. Or just being on your feet all day without proper support.
In some instances, hallux rigidus runs in the family and results from inheriting a foot type susceptible to developing hallux rigidus.
Inflammatory diseases, such as rheumatoid arthritis or gout, may result in hallux rigidus.
Can you reverse Hallux Rigidus?
Hallux rigidus is a progressive degenerative condition and cannot be reversed. Methods can be taken to slow down the condition’s progression by being evaluated and treated by a foot and ankle specialist upon first symptoms. Earlier treatment will lead to a better prognosis, and you may even be able to avoid surgical intervention.
What is the difference between Hallux Rigidus and Hallux Valgus?
A bunion, also known as Hallux Valgus, is a painful bony prominence or bump that can be felt on the side of the big toe joint. This occurs when a mal-alignment of the bones at this joint causes your big toe to deviate laterally or move towards your smaller toes. This causes a bump to form and, over time, become larger. This also causes your joint to become more inflamed with motion because it is out of alignment.
Both conditions affect the joint at the base of the big toe also known as the hallux, but hallux rigidus leads to more stiffness and lack of range of motion, and a bump on the top of the joint. The bump or bone spur is caused by bone on bone contact due to wearing down of the cartilage.
What is the Treatment for Hallux Rigidus?
The sooner you are evaluated and diagnosed, the easier it is to treat. This is the case for most conditions and injuries. Seeing a specialist upon first notice of symptoms can increase your chances of recovery.
- A joint reshaping or arthroplasty surgery is recommended when the joint damage is more on the mild to moderate side. This is also an excellent procedure to have in the early stages of hallux limitus before the condition progresses to hallux rigidus. Surgery consists of cleaning up the joint by shaving down and removing any painful or motion limiting bone spurs and drilling eroded portions of cartilage in the joint to stimulate healing. Sometimes we may also make an osteotomy to move the joint into a better position to prevent further joint breakdown over time.
- A joint replacement may be an option for certain patients. The joint surfaces are removed, and an artificial joint is placed to relieve pain and preserve some joint motion.
- 1st MPJ fusion. Fusing the bones of a joint together is called arthrodesis and is an excellent option if there is severe damage to the cartilage. The joint is prepared and then connected with screws and a plate to hold the joint in a permanent position while it fuses together. After this procedure your joint will no longer bend, but you will have a great reduction in pain and often times a pain free foot that you can put full weight on and resume high level activities such as running and jumping.
How do you fix Hallux Rigidus without surgery?
When hallux rigidus becomes too far gone, surgical intervention is the only way to eliminate or reduce pain and restore function to the foot. Several types of surgery can be performed to correct the disorder, and you will need to be evaluated by a foot and ankle specialist to determine the best procedure for you. We will take into consideration the severity of your hallux rigidus based on in – office digital x-ray findings, physical exam findings, your activity level, age, advanced imaging and more.
- Choosing the right footwear can greatly affect the pressure on your big toe joint. Consider a supportive athletic shoe with a stretchy, soft top covering that is more forgiving on your joint than the traditional hard leather material. Also, rocker-bottom or stiffer soles can help relieve pain from joint motion.
- At YF&A we have shoe inserts available that you can walk out with the same day to provide immediate support and relief to the joint.
- Custom orthotics can improve foot function leading to a reduction in pain. Here at Yeargain Foot & Ankle, we offer 3D scanning technology to capture a digital image of your feet that allow our laboratory to make the necessary modifications to functionally correct or accommodate your feet. This can allow your joint to move better and experience less pain and inflammation while still doing the sports and activities you love.
- Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be used to alleviate pain and inflammation. Prescription-strength NSAIDs are another option to help reduce pain without taking several pills a day.
- Corticosteroid injections may also help reduce inflammation and pain in the joint.
- Physical therapy can help decrease pain and inflammation of the joint as well as stretch and strengthen your surrounding soft tissues decreasing the peak pressure at the joint.