Hallux Rigidus

Hallux rigidus is degenerative arthritis of the big toe joint (metatarsophalangeal or MTP joint). It is the most common arthritic condition of the foot. The condition occurs more often in females than males, and typically manifests between the ages of 30 and 60 years. Patients often feel pain on the top of the big toe when walking, standing or when they bend or push off their big toe.

Causes

While the true cause of Hallux rigidus has not been determined, there are a number of risk factors that can come into play such as an abnormally long or elevated first foot bone (metatarsal) or genetic structural abnormalities that interfere with the proper functioning relationship with the foot and big toe such as fallen arches or ankles with excessive pronation. A traumatic injury, such as a severely stubbed or broken toe creates susceptibility as well. In these situations, the protective articular cartilage around the joint becomes worn and damaged, causing the raw bone ends to rub together. A bone spur or overgrowth on top of the bone may develop, which can prevent the toe from bending properly.

Symtpoms

• Stiffness and inability to move the big toe up or down
• Pain, inflammation and swelling around the toe joint
• A boney protrusion similar to a bunion or bone spur, EXCEPT on top of the toe

Diagnosis

In most cases, a physician can diagnose Hallux rigidus through examination and manipulation of the toe joint. X-rays may be needed to help determine the severity of the condition, and the size and location of bone spurs, if any are present. Hallux rigidus is easier to treat when caught in its early stages, before significant cartilage is lost.

Treatment

Mild to moderate conditions usually can be treated non-surgically with:

• Changes in footwear to decrease pressure on the joint, a larger toe box, or generally more comfortable shoes
• Ice/heat packs or anti-inflammatory medicines such as ibuprofen
• Cortisone injections to reduce inflammation in the joint

In some cases, one of the following surgical procedures may be necessary:

• Cheilectomy: In some mild to moderate cases, creating more space for toe to move by removing the bone spur and/or shaving part of the foot bone will allow the toe to bend properly. This procedure can be combined with a microfracture to restore normal cartilage. Following the procedure, patients will have to wear an open-toed surgical sandal for 2-4 weeks, and the foot may remain swollen for several months. However, patients experience significant long-term pain relief.
• Arthrodesis: If there is severe damage to the articular cartilage, arthrodesis is the most reliable way to reduce pain. The damaged cartilage is removed and the joint is held place with a plate, pins and screws. Over time, the bones will fuse together. As a result, this joint in the toe will not move, but patients typically walk better due to decreased pain, and the foot still moves. Patients are typically kept completely off of the foot anywhere from 1-3 weeks using crutches, a scooter, or a walker. The total recovery can take 3-6 months.
• Arthroplasty: Certain patients are candidates for replacement surgery, which removes the joint surfaces and replaces them with an artificial joint. This procedure was very unsuccessful historically, with high revision and failure rates. Newer implants and techniques are available and could be a good option to discuss in detail with your surgeon. Successful arthroplasty can relieve pain and maintain motion in the toe joint.