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Hallux Rigidus (Stiff Big Toe)

What is Hallux Rigidus?

Hallux Rigidus Definition

Hallux rigidus literally means "stiff great toe"; however, limitation of the motion of the big toe is only one element of the range of symptoms that constitute the diagnosis of hallux rigidus. Hallux rigidus encompasses mild to severe degenerative arthritis of the first metatarsophalangeal (MTP) joint of the foot causing walking can become painful and difficult.

Hallux Rigidus Symptoms & Anatomy

Symptoms can range from mild to disabling. The condition, which occurs in adolescents and adults, can be associated with a history of previous trauma, although many patients present without such a history. Hallux rigidus usually develops in adults between the ages of 30 and 60 years. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.

Hallux Rigidus Symptoms

  • Pain in the joint when you are active, especially as you push-off on the toes when you walk
  • Swelling around the joint
  • A bump, like a bunion or callus, that develops on the top of the foot
  • Stiffness in the great toe and an inability to bend it up or down

Hallux Rigidus Treatment

Non-Surgical Treatment

Pain relievers and anti-inflammatory medications such as ibuprofen may help reduce the swelling and ease the pain. Applying ice packs or taking contrast baths (described below) may also help reduce inflammation and control symptoms for a short period of time. But they aren't enough to stop the condition from progressing. Wearing a shoe with a large toe box will reduce the pressure on the toe, and you will probably have to give up wearing high heels. Your doctor may recommend that you get a stiff-soled shoe with a rocker or roller bottom design and possibly even a steel shank or metal brace in the sole. This type of shoe supports the foot when you walk and reduces the amount of bend in the big toe.

Surgical Treatment

Cheilectomy - This procedure involves removing the bone spurs as well as a portion of the foot bone, so the toe has more room to bend.

Arthrodesis - Fusing the bones together (arthrodesis) is often recommended when the damage to the cartilage is severe. The damaged cartilage is removed and pins, screws, or a plate are used to fix the joint in a permanent position.

Arthroplasty - In select patients, the joint surfaces are removed and an artificial joint is implanted. This procedure may relieve pain and preserve joint motion.

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