Hallux Rigidus Causes and Treatment

What is hallux rigidus and is surgery necessary to treat it?

I’m going to go out on a limb here and guess that you rarely give much thought to your big toe. That changes in an instant, of course, if you try walking across the floor in the middle of the night without turning on a light and catch that toe on the edge of a table leg. The same is true for those who may have an ingrown toenail or similar issue, but, for the most part, the big toe just does its job without us giving it much thought. 

Despite a lack of fanfare, the big toe plays a huge role in our daily lives. Without it functioning properly, it becomes extremely difficult, if not impossible, to walk, run, bend over, squat down or simply keep our balance. Those who develop the condition, hallux rigidus, find it difficult to do all of those things, as well as experience pain in the area of the big toe.

What Is Hallux Rigidus? 

The big toe area of the foot is actually fairly complex. There are two joints in the big toe that facilitate its ability to perform the various movements and balancing that we require. The metatarsophalangeal (MTP) joint connects the phalanx, which is the first bone in the big toe, with the metatarsal, the long bone in the forefoot. The second joint is at the knuckle of the big toe and is the interphalangeal (IP) joint. These joints are surrounded and stabilized by a series of ligaments and tendons.

Hallux rigidus, which literally means “stiff big toe”, affects the larger of the joints in the big toe, the metatarsophalangeal joint. To keep the bones that meet in the MTP joint from damaging each other and also to aid in smooth movements, there is cartilage surrounding the ends of the bones. When this cartilage is damaged through injury or begins to wear away due to aging through osteoarthritis, the result is pain, stiffness and inflammation. 

As the degenerative process continues, there may also be osteophytes, or bone spurs, that begin to grow around the joint, particularly on the top of the bones in the joint. This leads to lessened space in the area, which also affects the joint’s ability to function. 

Treatment Options

It is important to seek treatment for hallux rigidus, as there are treatments that can decrease pain. There is also the potential of developing pain in other areas, like the knee, hip, or lower back, due to altering stride to compensate for the pain in the MTP joint area. 

If caught early, conservative methods may be enough to reduce symptoms. These typically include some combination of:

  • avoid activities that create high-impact stress on the foot
  • shoes should fit properly, have adequate toe room and stiffer bottoms
  • orthotics may be suggested

For more painful cases of hallux rigidus, surgery may be recommended. The most common types of procedures are cheilectomy, in which the bone spurs are removed, Cartiva implant, which maintains joint motion, and arthrodesis, which involves joint fusion. Surgical treatments are individualized depending on degree of arthritis, deformity, and patient goals and activities.

If you have questions about hallux rigidus or about any other foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon with Ortho-Care Wayne in Passaic County New Jersey and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC.

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