What is it?
Hallux rigidus is a joint disorder located at the base of the big toe. It causes pain and stiffness in the joint, and with time it becomes more difficult to bend the toe. “Hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and cannot move. It is a degenerative type of arthritis that affects the large joint at the base of the big toe. Degenerative arthritis results from wear and tear on the joint surface over time.
In case you may be wondering, this is not a bunion. While it is associated with the big toe, it is a different condition.
What causes it?
In most people there is no definite cause, it just develops. Probably the main reason why this joint is particularly subject to wearing out, is because it is under tremendous stress in walking. With each step that is taken, a force equal to twice your body weight passes through this very small joint.
In a few people, it may be caused by an injury or another medical problem such as gout, or an infection in the joint. There are a lot of theories about why the joint becomes arthritic. However, as yet, none of them seem very helpful in treatment or prevention of this condition.
What problems does it cause?
The most common problem is the pain in the big toe joint. In some people the pain is present whenever they walk or even at rest; but in others, it only occurs when they attempt to turn the big toe up as far as it will go.
The other common problem of stiffness causes loss of the ability to turn the big toe upwards, although it can usually be turned downwards. Sometimes it gets so stiff, it points downwards and cannot be laid flat on the floor.
A bony bump or “dorsal bunion” may develop on top of the joint. This is your body’s natural response to the worn joint. The bump may rub on the shoes. In some people this is their only problem. Because of the painful big toe, some people tend to walk on the side of the foot. This in turn may produce pain in the ball of the foot, or down its outside border.
Sometimes the joint wears down more on the outer side, towards the lesser toes, than on the inner side. This may make the toe tilt towards the second toe, and the toes may rub together.
Treatment begins with anti-inflammatory medications to control the pain, swelling, heat, and redness of the degenerative arthritis. Special shoes that reduce the amount of bend in the toe during walking will also help the symptoms initially. A rocker type of sole allows the shoe to take some of the bending force, and may be combined with a metal brace in the sole. This would limit the flexibility of the sole of the shoe, and reduce the motion needed in the joint. An injection of cortisone into the joint may give temporary relief of symptoms.
Surgery and Other Procedures
There are other surgical procedures that are slight variations of these approaches. The surgeon removes a wedge-shaped piece of bone (an osteotomy), from the middle toe bone in order to take pressure off the joint. Some patients can be successfully treated with just the osteotomy procedure.
Another alternative approach (more for the younger patient) is the interpositional arthroplasty. In this procedure, the surgeon removes the base of the toe bone and places a “spacer” in the hole left. The spacer is made up of a rolled up piece of tendon. The surgeon may have to release the tendon that inserts into the base of the phalange for this to work best. This decision is made at the time of the surgery.
If your doctor recommends nonsurgical treatment, you should begin to see some improvement in your symptoms within a few days. Anti-inflammatory medications may take up to seven to 10 days to become effective. A cortisone shot usually works within 24 hours. Alterations to your shoes may take several weeks to have an effect.
It will take about eight weeks before the bones and soft tissues are well healed. You may be placed in a wooden-soled shoe or a cast during this period, to protect the bones while they heal. You will probably need crutches briefly.
During your follow-up visits, X-rays will probably be taken so that the surgeon can follow the healing of the bones if a fusion was performed. X-rays are also important if an artificial joint was used to make sure the implant is properly aligned and positioned.
Your feet mirror your general health . . . cherish them!