Hallux Rigidus

Hallux rigidus is the Latin phrase for a disorder which quite literally means “stiff big toe”, and is a joint problem characterised by the stiffening of the toe and is generally accompanied by pain on movement. The pain is experienced when there is dorsiflexion – movement of the foot at the ankle joint upwards, and plantar flexion, movement in the opposite direction. As the toe becomes more rigid the range of movement of the big toe becomes more limited.

The problem occurs at the first metatarsal joint, where the big toe joins with the foot and since it is the same joint which is affected by bunions, many people commonly misdiagnose the condition at home. In contrast to bunions, with hallux rigidus there is no bony lump on the outside of the joint, although a lump can often be felt on the top of the joint.
The treatment options for both conditions vary, so getting an accurate diagnosis is important. In addition to a stiff toe, there is sometimes swelling at the joint and inflammation, with the problem becoming more severe when the feet are cold, or in damp weather conditions as with any arthritis condition.

Hallux Rigidus is a type of osteoarthritis, and will deteriorate over time if treatment is not sought. The condition can also have a knock on effect on other parts of the foot, which is due to the walking and standing gait being changed due to the inflexibility of the big toe. Typically the metatarsals of the lesser toes are made to take an increased strain, as the body weight shifts to the outside of the foot. Due to the postural changes, it is possible that there will be a knock on effect on other joints, with the ankles, knees, hips and shoulders becoming painful. As the condition worsens, bone spurs can form which add to the pain and discomfort. Bone spurs are new bony deposits which are laid down as the body tries to correct the problem.

The condition is most often seen in males, and can be the source of considerable pain and discomfort, with not only big toe pain, but sometimes pain in the ball of the foot and in the plantar fascia, the fibrous ligament which runs from the heel to the toes, which will cause bottom of foot pain.

Hallus Rigidus Causes

The condition has a number of causes, with the following conditions and structural problems the most common culprits although any activity which places a strain on the big toe can be a contributory factor. The problem can be caused by a single traumatic event such as a badly stubbed toe, or from repetitive forces from running and exercise, or even crouching a lot at work.

  • Osteoarthritis
  • Excessive pronation
  • Fallen arches
  • Trauma
  • Rheumatoid Arthritis
  • Gout and pseudogout

Hallux Rigidus Treatment

A doctor will check for the condition by examining the toe and checking the degree of movement which is possible, and will usually order an X-ray to check to see how severe the arthritis of the joint has become. This will help to determine the best treatment program. In cases where there is severe pain, cortisone injections are often used, although this will only offer short term treatment of the pain.

As with many degenerative arthritic conditions, early diagnosis and treatment makes the treatment much faster and more effective. The problem can be treated non-surgically in the majority of cases, although when Hallux Rigidus has progressed, minor surgical treatments are required.

In most cases, there are a range of non invasive treatments which can be used, which can stop the condition from progressing and they will delay the need for surgical intervention. Treatment options first target the inflammation and pain, and secondly will help correct the walking gait and the movement of the foot. Pain treatment is usually from NSAID’s such as Advil and Ibuprofen, or with corticosteroid injections.

Orthotic insoles, both custom and over the counter options such as Orthaheel, Superfeet, and Sorbothane are some of the most common recommendations. Rocker bottom shoes can also be highly beneficial, for the help they offer in terms of increasing movement of the foot. The force on the forefoot will be lessened, although simply inserting a metatarsal bar will offer instant relief. These are often recommended to help improve movement at the toes and to offer greater support.