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.

Nonsurgical Treatment

  • 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.

Surgical Treatment

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.