What Is Hallux Rigidus?

Hallux rigidus, also known as great toe arthritis, is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. Hallux rigidus is actually a form of degenerative arthritis.

Great Toe ArthritisThis disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up or even stand.

Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment. Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on.

In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff, or what is sometimes called a “frozen joint.”

Causes of Hallux Rigidus

Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis – the kind that results from wear and tear – often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

Hallux RigidusIn some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse – especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat.

Hallux rigidus can also result from an injury, such as stubbing your toe. Or it may be caused by inflammatory diseases such as rheumatoid arthritis or gout. Dr. Butler can determine the cause of your hallux rigidus and recommend the best treatment.

Hallux Rigidus, Stiff Big Toe

Hallux rigidus or osteoarthritis of the first MP joint (great toe joint) is a very common condition affecting adults. The symptoms are pain and stiffness in the toe. Patients also have difficulty getting up on their toe, running and wearing a high-heeled shoe. Most patients notice a bump on the top of the foot at the big toe joint and a stiff and painful toe. The non-operative treatment for hallux rigidus involves shoe modification, which includes a rocker bottom to their shoe, custom orthotics or sometimes injections. Most patients with a hallux rigidus benefit from surgical intervention.

There are three types of procedures we do for hallux rigidus. The first procedure is called Moberg cheilectomy. In this procedure, we do a cheilectomy (a shaving on the bone off the top of the foot). This helps take the spurs off the joint. The second part of procedure is to wedge the toe a little bit up so that it bends more. This involves taking a small wedge out of the toe bone itself and inserting a small screw. This procedure is very effective for mild to moderate hallux rigidus and most patients can return to full activity afterwards.

Hallux Rigidus Treatment | Stiff Big Toe Treatment | Manhattan | New York City Hallux Rigidus Treatment | Stiff Big Toe Treatment | Manhattan | New York City

The next procedure we do for hallux rigidus, reserved for more severe cases, is called capsular interpositional arthroplasty. In this procedure, we try to make a new joint in the arthritic joint. This is reserved for patients with very severe hallux rigidus or very severe arthritis. This procedure leads to some shortening in the toe but leads to markedly increased range of motion and very good pain relief. It is usually reserved for patients who are not high level athletes but who want to be able to walk comfortably, wear high heels, and participate in some recreational sports.

The final procedure we do for hallux rigidus is fusion of the first MP joint. This procedure is for patients with severe arthritis in the joint and often patients who have had previous surgery that has failed. This is a very effective treatment for relieving pain in the first MP joint. Patients are able to wear normal shoes but not able to wear more than a two-inch heel. They are able to walk because the joint in front of the big toe joint is not fused and the foot bends as well.