Great Toe Arthritis (Hallux Rigidus)
Stiff Big Toe
Hallux rigidus is arthritis of the joint where the big toe meets the foot,
or the metatarsophalangeal (MTP) joint. Because the joint bends when a
step is taken, stiffening of the joint can lead to pain and difficulty
when walking. Hallux rigidus commonly affects people between the ages
of 30 and 60, and may result from injury and cartilage damage, or as the
result of wear and tear with aging.
As with any joint, the MTD joint has smooth articular cartilage that covers
the ends of the bones. With injury or aging, the articular cartilage can
become damaged and unprotected bone ends can rub together. This can cause
a bone spur to form on top of the bone and result in a stiff big toe (hallux
rigidus) that prevents the toe from bending properly as you walk.
Patients with hallux rigidus commonly experience activity-related pain
in the MTP joint, including pain when walking or bending the toe up and
down, swelling, bumps that may develop on the top of the foot, and general
stiffness in the big toe. Because early intervention before a bone spur
develops can make the condition easier to treat, it is important to seek
a medical examination as soon as symptoms present themselves.
Hallux Rigidus Treatment
Depending on the degree of degeneration in the MTP joint and whether bone
spurs have developed, great toe arthritis may be treated through nonsurgical
or surgical methods.
- Anti-Inflammatory medication can be used to manage pain and inflammation
- Shoe modifications – Accommodative footwear, such as shoes with a
large toe box, can reduce pressure on the toe and alleviate pain when
walking. Stiff-soled shoes, shoes with a rocker bottom, and shoes with
a metal brace in the sole can provide additional support for the foot
when walking and can reduce bending in the big toe.
- Corticosteroids – Pain and inflammation can be managed with steroid
/ cortisone injections, but may not provide all patients with full relief.
Depending on the severity of arthritis and presence of other conditions,
several surgical approaches may be taken:
- Cheilectomy – A cheilectomy may be used in mild or moderate cases
and will involve removal of bone spurs and a part of the foot bone to
provide the big toe with more room to bend through an incision in the
top of the foot. Swelling may persist for several months following surgery,
and patients may be required to wear a wooden-soled sandal for several weeks.
- Arthrodesis – Arthrodesis is the surgical immobilization of the joint
through fusion of the bones, and is typically used when cartilage damage
is severe. During surgery, damaged cartilage is removed and the joint
is fixed in place using screws, pins, or metal plates. Over time, the
bone will grow together and the toe will no longer be able to bend. However,
fusion is an effective method for reducing pain in severe cases. Casting,
crutches, and a gradual return to weight bearing will be used following surgery.
- Arthroplasty (joint replacement) – Arthrodesis has become an increasingly
used treatment for arthritis of the great toe, and involves replacing
joint surfaces with an implanted artificial toe. The result can provide
relief from pain and preserve joint mobility. However, the lifespan of
total toe implants is unclear.
Discuss Your Treatment Options During an Appointment
If you are experiencing problems with great toe arthritis, a stiff big
toe, or bone spurs, a board certified specialist on our staff is available
to help you explore your available treatment options. Call today to request
an appointment. We serve the South Bay from three convenient office locations.