Hallux Rigidus is taken from Greek and literally means stiff (rigidus) big toe (hallux).
In the early stages, the motion of the big toe is limited but not rigid and is given the name Hallux Limitus. As the condition progresses, the toe becomes frozen.
A common problem, Hallux Rigidus is basically an arthritic big toe joint, where the cartilage within the joint wears out.
- Stiff, inflexible big toe joint
- Pain – especially when walking (at a more advanced stage, pain may also be experienced while resting)
- Swelling and inflammation around the joint
- Symptoms that are worse during cold or damp weather
- Bone spurs may develop, making footwear uncomfortable
Often there is no obvious cause for Hallux Rigidus, but in other cases there are underlying factors that cause this to develop.
Structural deformities such as flat feet, fallen arches, and excessive pronation (rolling in) of the ankles can put excessive stress on the big toe joints, making them more susceptible to developing Hallux Rigidus.
This may mean it is hereditary – with a certain foot type that is susceptible to the condition being inherited – or it could also be a result of overusing the toe joint in day-to-day life, for example in a job that requires a lot of squatting.
A previous trauma, such as a cartilage injury or a fracture of the big toe joint may lead to big toe arthritis many years later, as in some cases the original injury is missed and thus not treated correctly.
Inflammatory diseases such as gout and rheumatoid arthritis may also lead to big toe arthritis.
In the early stages, non-surgical treatment may be the best course of action. The sooner the condition is diagnosed, the easier it is to treat (maybe even preventing the need for surgery in the future), so a GP should be contacted as soon as any symptoms are noticed.
Non-surgical treatments can include shoe modifications where the sole is stiffened to prevent bending while walking or a rocker sole added to allow mobility without the need to bend the toe joint; or custom orthotics which limit motion across the joint, especially in cases of abnormally shaped feet – i.e. flat feet.
Anti-inflammatory drugs such as ibuprofen can reduce pain and inflammation, as could a course of steroid injections – although these are now often only used in circumstances, such as where a patient is too old or frail for surgery.
If non-surgical measures fail to reduce or eliminate pain, surgery may be considered. There are several types of surgery to correct Hallux Rigidus, depending on individual circumstances, such as the underlying cause of the arthritis.
Cartiva® toe implant – An exciting, relatively new alternative to fusion, a Cartiva® toe implant offers immediate relief from arthritic pain in severely arthritic joints. The implant is placed into the bone of the big toe, providing a smooth, slippery, load bearing surface allowing for an improved range of motion.
Cartiva implants have been shown to be an effective alternative for people who wish to maintain joint movement, but patients should be aware that further surgery may be required at some stage in the future.
Cheilectomy – Any bony bumps are removed, the joint is cleaned and tight soft tissue released. A cheilectomy can restore normal alignment and function, and reduce pain in patients with milder forms of arthritis.
Standard joint replacement – Like a hip or knee replacement, the joint is replaced, allowing motion to be preserved. This can last for 10-15 years. Patients need to be aware that joint replacement is frequently reserved for older people who do not place as much stress on the joint.
Fusion (arthrodesis) – Used for severe forms of arthritis in young, active people, fusion involves the removal of the joint and joining of the remaining bones. The bones are held in place with a plate and screws. Very effective at removing pain, the negative is the toe is permanently stiff, and shoe choice is restricted (a rocker sole could help maintain mobility).