Hallux rigidus is a “stiff big toe joint”. Patients with this condition, which is a form of arthritis, often report that it feels as if they have to force their big toe to bend at the joint when “toeing off” from the ground while walking. Often times, hallux rigidus results in the joint becoming completely rigid. Movement of the big toe joint occurs typically in an up and down plane only. The upward motion is dorsiflexion and the downward motion is plantar flexion. The normal upward movement is approximately 70 degrees and the downward movement is about 25 degrees. You need at least 60 degrees of upward movement of the big toe joint to prevent limping.
How Hallux Rigidus Occurs
The cause of hallux rigidus is wear and tear on the joint (gout, trauma, rheumatoid arthritis, etc.) The ultra-smooth, thin hyaline cartilage that covers the ends of the bones in joints starts to wear out.
In a normal joint, hyaline cartilage is naturally lubricated by fluids from joint lining called synovium. The lubricated cartilage allows the joint to move smoothly and painlessly. When the hyaline cartilage wears out, joint lubrication is disrupted. This speeds up the degeneration. Joint space narrows and the ends of bones in the joints become exposed.
Treatment of hallux rigidus often has to be surgical, but the joint can be made more comfortable with an appropriate shoe modification. To treat the pain in the big toe joint, the shoes are modified by stiffening the sole, inserting a stiff orthotic arch support in the shoe and sometimes adding a small rocker which is glued on to the bottom of the sole of the shoe.
Thin-soled shoes and high heels aggravate this condition because more stress is placed o the joint, increasing pain.
Hallux rigidus can often become simply too painful to live with and may require surgical intervention. There are now several types of surgery and refined techniques that can alleviate stiff big toe joint symptoms.
The decision regarding the most appropriate surgical approach will be based on your orthopedic surgeon’s examination of the foot and x-rays. The surgical treatment for hallux rigidus is determined by the extent of the arthritis and deformity. Generally hallux rigidus surgery is preformed to help the big toe resume its upward movement. Sometimes the arthritis is so severe that you may require a fusion of the big toe joint to stop painful motion of the big toe joint
- Thin-soled shoes and high heels aggravate this condition.
- Mild inflammation and “turf toe” may improve with nonsurgical treatment.
- Surgery is recommended for daily pain or stiffness that is intolerable.