Hallux Rigidus

What is Hallux Rigidus ?

The condition is as a form of degenerative arthritis, affecting the joint located at the base of the big toe, it results from wear and tear on the joint surface, occurring over a period of time. The term hallux refers to the big toe, while rigidus implies that the toe is rigid and hence can’t move.

The joint involved in the condition is called the metatarsophalangeal (MTP) joint, unfortunately it has to bend every time a step is taken, making it difficult to walk in a case where the joint stiffens.

When inflicted with the condition, the articular cartilage in the joint located at the base of the big toe begins to wear thin. The articular cartilage is a slick and shiny coverage on the end of the bone and can wear away until the raw bones begin to rub against each other.

A bony spur or an overgrowth is likely to eventually develop on the top of the bone, which may prevent the toe from bending as required while walking.

Hallux Rigidus is categorized as an abnormality of the bones and joints that occurs as a result of injuries to these structures or due to complications produced by diseases such as arthritis and osteoarthritis.

The condition is known to be the second most common big toe disorder, after Hallux Valgus and is a common complaint amongst runners.

The Symptoms

The presence of Hallux Rigidus is characterized by two main symptoms. i.e. pain and stiffness , loss of motion. The patient is likely to notice the discomfort in walking immediately, hence making it the most conspicuous symptom.

Other symptoms include:

• Joint pain, when in action, especially if you push-off on the toes while walking
• Swelling around the joint
• A bump, such as a bunion or callus, which develops on the top of the foot
• Difficulty in certain activities such as running, squatting
• Dull pain in the hip, knee or lower back
• Feeling of stiffness in the great toe and inability to bend it
• Limping (in severe cases)

Causes

Chief causes of Hallux Rigidus include:

• Overuse of foot joints
• Injury sustained by big toe, e.g. stubbing of the toe
• Abnormality of the structure of the foot
• Gout, rheumatoid arthritis, or complications produced by other such inflammatory diseases
• Excessive pronation of the ankles
• Toe deformities
• Heredity

Minor difference in the anatomy of the foot make certain individuals more prone to developing Hallux-Rigidus. Such minor abnormalities are likely to increase the stress that is placed on the joint while walking, which in turn adds up to degenerative arthritis over a number of years.

Medical Treatment

Three main kinds of surgical options can be considered for relief from symptoms of Hallux Rigidus, as discussed below:

i) Cheilectomy: This option is considered when damage is mild to moderate and involves removing bone spurs as well as a portion of the foot bone to enable more room for the toe to bend.

ii) Arthrodesis: Arthrodesis is carried out in case of severe damage to the cartilage and chiefly involves fusing of the bones together.

iii) Arthroplasty: This surgical treatment falls in the category of joint replacement surgery and is normally considered for older patients who are likely to place fewer demands on the feet.

Home Treatment

There are certain self care measures that can help in this condition, including:

• Wearing thick-soled shoes
• Wearing shoes with a larger-toe box and without heels
• Providing adequate rest to the feet
• Ice therapy
• Using a toe spacer between the great and second toe
• Stretching of the foot
• Avoiding high heels
• Keeping control over body weight

Taking contrast baths can also be helpful in reducing the pain and stiffness associated to the condition.

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