Big Toe Arthritis (Hallux Rigidus)

Hallux rigidus is an arthritic condition characterised by stiffness and rigidity of the big toe. Arthritis of the foot commonly occurs at the big toe joint (1st metatarsophalangeal [MTP] joint). The condition can be quite painful as the big toe usually bends with every step you take.

Causes

The condition may occur due to age related wear and tear or an injury sustained to the joint.  This can lead to loss of the cartilage from the joint which provides a cushioning effect and allows smooth movement and flexibility of the big toe. The bones may rub against each other causing pain and the development of bone spurs that further restrict toe movement. The toe subsequently becomes stiff and walking is painful. Hallux rigidus usually occurs between 30 and 60 years of age. It may be more common with certain types of foot anatomy which place more stress on the big toe joint.

Symptoms

Pain is present at the base of the first toe, especially when pushing off as you walk. It may be associated with swelling around the joint, a bony bump on the top portion of the foot as well as rigidity and inability to bend the toe.

If you find that your toe is painful and stiff causing you to bear weight on the outside of your foot, you might be suffering from hallux rigidus. It is recommended that you get it evaluated during the initial stages of the disease before any bone spurs develop.

Diagnosis

The diagnosis of hallux rigidus is made after a medical history and careful clinical examination. Weightbearing x-rays of the foot are the most important imaging test, but in some cases a CT scan is also required to evaluate the joint.

Treatment

Non-surgical treatment in the form of pain-relieving medications and anti-inflammatories are recommended to reduce pain and swelling. Changing your shoes to ones with a broader, deeper toebox, as well as a stiff or rocker-bottom sole may help reduce pressure on the toe. Some people find a Morton’s extension insole to be helpful in reducing painful big toe movements.

If these non-surgical treatment modalities do not provide relief, then surgery may be recommended. The type of surgery depends on the degree of the disease process, and can include:

  • Cheilectomy: Removal of bone spurs as well as a small portion of the bone from the joint to allow more big toe movement. It is usually recommended in more mild forms of the disease.
  • Arthrodesis: Fusing the big toe joint. This is usually recommended if the cartilage is severely eroded and movement of the toe is very painful.
  • Arthroplasty: Resurfacing of the metatarsophalangeal joint with an artificial implant. ¬†This procedure aims to relieve pain whilst also maintaining movement of the toe.