Arthritis is one of the most pervasive and unpleasant conditions around. There exists over 100 different types of arthritis, not to mention conditions related to arthritis.
While arthritis does occur more frequently as people grow older, it currently afflicts more than 50 million adults and over 300,000 children in America alone. To put it simply, arthritis is a way to refer to any joint pain or disease anyone of any age, race, or sex can have.
Hallux rigidus is just one of the many types of arthritis that exist. It is a form of degenerative arthritis, which is when the cartilage that cushions your bones wears away and leaves your bones to scrape against one another instead.
This worn-down cartilage is typically the result of excess weight, a family history of this condition, age, and previous injuries.
Hallux rigidus affects the big toe of your foot. This is actually the most common site of arthritis in the foot, and is the second most common disorder of the big toe (the first being hallux valgus, or bunions).
It affects the metatarsophalangeal joint (or MTP joint for short). This joint connects your big toe to your foot, and it bends every time you take a step. Hallux rigidus progressively makes it more and more difficult to bend this joint (and therefore the toe) as time wears on.
At the very last stage of this condition, you will not be able to bend your big toe at all, making it extremely difficult and painful to walk. As such, hallux rigidus can become very problematic for those who are constantly on the move.
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Hallux Rigidus Symptoms
Early signs of hallux rigidus include:
- A somewhat limited motion of your big toe (a condition also known as hallux limitus).
- Pain or stiffness in the big toe during use, especially when walking.
- Pain or stiffness that becomes aggravated by cold weather.
- Difficulty with certain physical activities such as running or squatting.
- Swelling or inflammation around the MTP joint.
- Difficulty moving and/or bending the big toe.
- Calluses, which are thick or hardened parts of the skin, on your foot or big toe.
If left untreated, more serious symptoms may include:
- Frozen joint, or when your MTP joint becomes so stiff that you cannot bend or move the big toe at all.
- Constant big toe joint pain, even while resting.
- Bone spurs, or hard outgrowths of bone that interfere with the joints and can make wearing shoes or walking difficult.
- Bunions, or bony bumps that form at the start of your big toe due to the joint growing larger and sticking out. It can also make wearing shoes or walking difficult.
- Dull pain in your hips, knees, or lower back due to shifting how you walk to avoid the pain in your big toe.
- Limping, in especially severe cases.
Causes of Hallux Rigidus
There are several causes of hallux rigidus, including:
Overpronation
Overpronation is when your feet tend to roll too far inward at the ankle when you walk. Because of this, your big toe and second toe bear more weight as you push it off the floor to take a step, which may, in turn, flatten out your feet.
Because most of your bodyweight lies on your big toe and second toe as you walk, the joints and bones within these toes are forced to wear down faster, which can result in joint deterioration, hallux limitus, and eventually hallux rigidus.
Overpronation can be the cause of a number of other different foot conditions or problems as well.
Family History
If your family has a history of hallux rigidus, or any other form of degenerative arthritis that affects the feet, then you may inherit a foot type that is more prone to such deterioration as well.
In this case, it’s just a matter of poor genes.
Overuse
Hallux rigidus, as well as a number of other foot conditions or problems, may be a result of overuse.
By constantly putting your feet under too much pressure, or by participating in rigorous physical activity, you can strain the joints and bones of your feet.
Work that requires a lot of walking or moving about, standing around for long periods of time without rest, or participation in high-impact sports such as basketball, tennis, or running without allowing your feet to rest, may result in this wearing away of your joints or bones.
Hallux rigidus is most common in those who are engaged in jobs or activities that increase the stress on your big toe, namely through having to stoop or squat continuously throughout the day.
Previous Injury or Other Preexisting Conditions
Any previous injuries to your big toe may result in hallux rigidus. Even an injury as simple as a stubbed toe may cause this condition.
Inflammatory diseases in your foot, such as rheumatoid arthritis or gout may also be the cause of your hallux foot.
Excess Weight
Excess weight puts further pressure on the forefront of your feet, which makes your bones and joints more susceptible to wearing away and causing hallux rigidus.
Age
The simplest explanation is age. Because hallux rigidus is a form of degenerative arthritis, it would make sense that, given time, your joints and bones will wear themselves down through the years.
Typically, hallux rigidus can affect any adult between 30 to 60 years old.
Diagnosis and Treatment
Diagnosis
The sooner hallux rigidus is diagnosed, the easier it will be to treat before you develop any severe problems.
It is best to see your doctor if you experience any of the early symptoms. However, if your condition has already advanced to the point where you have developed bone spurs, then your hallux foot will be much more difficult to manage.
Your doctor will most likely ask about your daily routine, your hobbies, and your occupation to figure out the root cause of this condition if you do not already suffer from some form of osteoarthritis.
After that, they will examine your feet and move your toe around to determine the range of motion it can handle without pain or limitation. Your doctor may also check your foot for any possible bone spurs that have grown as well. Typically, hallux rigidus can be determined in this manner alone.
X-rays may be conducted to figure out the extent of your joint deterioration or the degeneration of your cartilage, or to show the location and size of your bone spurs, should you end up having any.
Treatment
There are both nonsurgical and surgical treatment options for hallux rigidus. Typically, doctors will always opt for nonsurgical treatments first, as these usually help patients much faster than surgery.
Your doctor or physician may advise you take pain relievers or anti-inflammatory medication such as ibuprofen to reduce any big toe joint pain. They may advise you to use ice or heat packs to decrease pain as well.
To help correct the rigid state of your big toe, your doctor may also suggest that you wear custom orthotic devices, such as arch supports, or to simply change the types of shoes you wear.
Shoes that provide a larger space for your toes help to minimize compression on your joints and allow them to heal. Stiff or rocker-bottom-type shoes may also be recommended. Avoid wearing thin-soled shoes or shoes with high heels.
Your doctor may also prescribe platelet-rich plasma injections, injections of corticosteroids, or other similar injections into the joint to help reduce inflammation or pain. Such injections tend to vary in their effectiveness, however.
Keep in mind that these nonsurgical treatments are meant to help decrease symptoms. They may not completely halt the progress of your hallux foot.
Surgery may be required if these nonsurgical treatments prove ineffective or if you still feel pain after undergoing such treatments.
The type of surgery that you will undergo will depend on the extent of your arthritis and the possible deformity in your toe based on X-rays, your age, your general activity level, and other factors.
For those who have developed bone spurs, you may have to get a cheilectomy. This is when surgeons remove some bone, as well as the bone spur that rests on top of the metatarsal and proximal phalanx.
This will then leave your toe with more room to bend and will alleviate the pain you feel when having to push off on your big toe. This procedure may be combined with other procedures that will change the position of the big toe to further alleviate any pressure felt at the top of the joint.
Surgery
For those who are in the advanced stages of hallux rigidus, you may have to undergo an arthrodesis, or when surgeons remove your damaged cartilage to fix the two bones together with screws or plates, allowing them to grow back together.
This surgery will greatly reduce your pain, but it also restricts the movement of your big toe.
If you wish to avoid this loss of motion in your big toe, you may instead opt for an interpositional arthroplasty, or when surgeons take away some of the bone (much like in a cheilectomy) and place a spacer in between to minimize the bones’ contact with one another.
This surgery is performed in two different ways. Typically, a piece of soft tissue taken from your foot or another part of your body is used as this spacer. This method preserves some motion, but relief from big toe joint pain is more variable.
The second method is much newer but has demonstrated good results that appear to hold up over time. A synthetic cartilage implant made out of polyvinyl alcohol is used as a spacer, and appears to be very effective in alleviating pain and preserving movement.
Here’s a video showing more details on hallux rigidus.
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