Hallux Rigidus - Stiff big toe

The hallux, commonly known as the big toe is one of five digits located on the front of the foot. The primary function of the big toe is to provide additional leverage to the foot in assisting it to push off the ground during running, walking, or pushing things. The big toe and the little toe collectively assist in maintaining the body's balance.

Overview

Hallux Rigidus, sometimes referred to as Stiff Big Toe, is basically a progressive arthritis of the big toe joint that often affect athletes and other active individuals which creates pain and stiffness of the big toe. This joint is called the metatarsophalangeal (MPT) joint and is very important because it has to bend every time a step is taken. If the joint starts to stiffen, walking can become painful and difficult. The loss of joint cartilage on the top half of this joint leads to increased pressure across the joint as the toe bends upward. If this worsens and the remaining cartilage cover the joint surface also experiences major wear-and-tear, the result can be a significantly worse and more painful arthritic joint.

Symptoms

Most individuals who have developed hallux rigidus experience the following symptoms:

• Swelling, redness, or soreness around the big toe joint
• A bulging bump like a callus or bunion on the top of the foot
• Inability to bend the big toe up or down due to stiffness
• Pain in the joint that worsens with activity especially when "pushing-off"

If these symptoms persist and are causing an individual to walk on the outside of his/her foot because of the pain, it's recommended to see a physician right away as hallux rigidus is easier to treat when the condition is caught in the early stages.

Diagnosis

Diagnosis of hallux rigidus can be made primarily upon physical examination. The physician will examine the foot, specifically the big toe, for the symptoms mentioned above and to determine the range of motion possible without pain. The physician may order an X-ray of the foot to help identify the severity of the condition, the size and location of bone spurs, in addition to the degree of degeneration in the cartilage and joint space.

Treatment

Treatment of hallux rigidus varies depending on the severity of the condition and the amount of pain it causes. In most cases, hallux rigidus can be treated successfully using non-operative measures to decrease the inflammation in the arthritic joint by limiting the motion through the joint.

Stiff-Soled Shoes - Shoes with a stiffer sole and a slight rocker bottom contour that restricts movement of the toe.

Medication - Over-the-counter anti-inflammatory medication such as ibuprofen and naproxen usually help reduce pain and swelling. If these are deemed insufficient by your physician, they might prescribe stronger medication (NSAID's) to relive pain and reduce inflammation.

Contrast Baths - A contrast bath using both cold and hot water can help reduce inflammation. Using two buckets - one with water as cold as can be tolerated and another with water as warm as can be tolerated - immersing the affected foot in the cold water for 30 seconds, immediately followed by placing it in hot water for 30 seconds can help soothe the pain. This alternating process should be repeated for five minutes, ending with the cold water. Contrast baths can be done up to three times a day, but it is advised to avoid extreme temperatures in the water, especially if the individual's feet are NOT very sensitive to heat or cold as they may cause burns.

Surgery - In some cases, surgery might be deemed necessary by your physician in order to avoid further problems in the joint or the foot. Some common operative treatments are:

• Cheilectomy - this procedure is typically recommended when the damage is mild or moderate and is essentially a "clean out" procedure. It involves removal of the bone spurs as well as a portion of the foot bone to provide more room for the toe to bend.
• Arthrodesis- this procedure is recommended when the damage to the cartilage is severe. In involves the removal of the damaged cartilage and the placement of pins, screws, or a plate to fuse or fix the joint in a permanent position. After this procedure, the big toe will no longer be able to bend at all, but this is most reliable way to reduce pain in severe cases.
• Arthroplasty - this procedure is ideal for older patients who don't put too much pressure on the joint and the feet are idea candidates as this is a joint replacement surgery. The joint surfaces are removed and an artificial joint is implanted. As a result, the joint motion is preserved and the pain is relieved.

Recovery

The recovery time varies based on the type of operative treatment an individual undergoes. A cheilectomy might only a few days, though swelling may last several weeks or months. Arthrodesis will require the individual to protect the toe in a boot for upwards of six to eight weeks, but will require around three months to be fully functional. Lastly, arthroplasty will vary significantly from patient to patient depending on the desired level of activity and the age of the individual.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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