Hallux Rigidus – Arthritis and pain of the big toe

Hallux rigidus refers to arthritis of the joint at the base of the great toe. It can cause pain, stiffness and decreased range of motion of the great toe joint.

Hallux refers to the big toe

Rigidusrefers to reduced, abnormal, or no motion of the joint

This disorder can have a significant impact on foot function and affect quality of life. The great toe joint (also known at the 1st metatarsophalangeal joint — 1st MTP) supports the majority of the body’s weight as the foot is pushing off the ground while walking or running.

Hallux rigidus can be confused with a bunion. These two conditions are not the same and are treated differently both conservatively and surgically.

By definition, hallux rigidus is progressive in nature. With time, the available motion of the great toe joint will decrease and this could potentially lead to increased pain and disability.

There are many causes of hallux rigidus. The more common causes are genetics, foot structure/biomechanics and trauma to the joint.

Symptoms of Hallux RIgidus

  1. Pain with activity
  2. Pain at rest
  3. Trouble with shoes due to bone spurs (extra growth of bone)
  4. Pain in others joints due to alterations in how you stand/walk
  5. Limping

Diagnosis can be made by visiting your foot and ankle specialist who will perform a history, physical examination and obtain x-rays of the foot.

Non-surgical treatment options include shoe modifications, orthotics, injections, pain medications and physical therapy.

Surgical treatment is reserved for cases that do not respond to the above conservative options and if there is impact on daily activities, work and/or athletics. Dr. Nodelman offers two different treatment options for hallux rigidus.

A cheilectomy refers to a joint “clean-up”. With this procedure, bone spurs, loose fragments of bone and inflammed tissue are removed from the joint. Because bone spurs are removed from the top of the joint, range of motion is increased after this procedure. This procedure works well for individuals who have mild-to-moderate degrees of hallux rigidus.

For more advanced hallux rigidus (large bone spurs, significantly decreased motion, extensive arthritis) the best treatment option is a fusion of the joint. This is also known as an arthrodesis. By fusing the joint in an anatomically appropriate position (so you can still walk, run, etc…) it locks the joint so that it no longer moves. The big toe bone (phalanx) is fused to another bone part of the joint called the 1st metatarsal. Because the joint is fused, pain associated with arthritis is eradicated.

Here are some before and after x-rays after the fusion procedure has been performed:

Here is an example of an actual surgery sped up showing a great toe joint fusion/arthrodesis: