What is Hallux Rigidus?
Every day, with each step you take, your big toe is forced to bear an incredible amount of stress. The force your toe bears is about double your body weight. Many people do not realize just how much we use our big toe. We have a tendency to take our toes for granted until a problem occurs. One issue which affects the big toe is hallux rigidus, a condition in which the movement of the toe is limited. This restriction of the toe varies depending on the particular case. Hallux rigidus can be a concerning condition and even, in some cases, disabling. We use the big toe whenever we walk, stoop down, climb up, and even just stand, so if it is immobilized, it has a significant impact on our movement.
What Is Hallux Rigidus?
Hallux rigidus is a disorder of the joint at the base of the big toe. The condition causes you have to pain and stiffness in the toe. Over time, it becomes more and more difficult to bend the toe normally. You may wonder why this condition is called hallux rigidus, and that is actually easily explained. "Hallux" is another word for the big toe, and "rigidus" means the toe is rigid and cannot move properly. Hallux rigidus is a kind of degenerative arthritis. Degenerative arthritis is a wearing out of the cartilage within the joint. It can happen in the foot or in other parts of the body. Hallux rigidus is a progressive disorder, meaning that the motion of the toe will decrease as time progresses. In the earlier stages, motion of the toe is only slightly limited. At that stage, the condition is called hallux limitus instead of hallux rigidus. As the condition progresses, however, the toe's range of motion slowly diminishes. The toe may eventually reach the end stage of "rigidus" where it becomes stiff. Once this occurs, it is sometimes called a "frozen joint." Other issues are likely to crop up as well as the disorder advances.
Early signs and symptoms of the disorder include:
- Pain and stiffness in the big toe while walking, standing, bending, etc.
- Pain and stiffness in the toe that is aggravated by cold, damp weather
- Trouble with some activities, such as running or squatting
- Swelling and inflammation around the joint
As hallux rigidus becomes more serious, more symptoms may begin to occur, including:
- Pain in the toe, even while resting
- Difficulty wearing footwear due to the developtment of bone spurs. Wearing high-heeled shoes can be particularly hard on you at this point.
- Changes in your gait may cause dull pain in the hips, knees, or your lower back
- In severe cases of the disorder, you may even develop a limp
What Causes Hallux Rigidus?
The development of hallux rigidus may be due to a faulty function (biomechanics) and structural abnormalities in the foot. Faulty biomechanics and structural abnormalities can cause osteoarthritis to develop in the big toe joint. Osteoarthritis results from "wear and tear" and usually develops in those who have defects that change the way their foot and big toe function. For example, people with fallen arches or excessive pronation of the ankles are more likely to develop the condition. For some, hallux rigidus is basically inherited because it develops due to the type of foot they were born with, and other members of the family may have the same problem. For others, the problem is linked to overuse, especially among those who are involved in activities or occupations which put increased stress on the big toe, like workers who are forced to stoop or squat often. Hallux rigidus can also develop due to an injury. Even from something as small stubbing your toe. It can also be caused by certain inflammatory diseases, like rheumatoid arthritis or gout. Your podiatrist will determine what happened to cause hallux rigidus in your specific case and recommend the best treatment for you.
Diagnosis of Hallux Rigidus
The sooner hallux rigidus is diagnosed, the better. The earlier you catch the condition, the easier it is to treat successfully. So if you notice your big toe feeling stiff or hurting when you walk, stand, bend over, or squat, you should see a podiatrist for an evaluation. If you wait to see your podiatrist until after bone spurs form, the hallux rigidus will most likely be much more difficult to treat. To diagnose hallux rigidus, your podiatrist will examine your feet and manuever your toe around to find out what its range of motion is. Typically, x-rays will be needed to determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have developed around the toe.
Non-Surgical Treatment Approaches:
Again, if you see a doctor early on, your condition is more apt to respond to less aggressive treatment. In fact, in many cases, early treatment can prevent or at least postpone the need for a surgerical procedure. So it's important to see your podiatrist when you first notice any symptoms. Treatment for mild or moderate cases of hallux rigidus may include one or more of the following:
- Shoe changes. You should wear shoes with a large toe box. They put less pressure on your big toe. Your podiatrist may also recommend wearing shoes with stiff or rocker-bottom soles. You will probably have to stop wearing shoes that are really hard on the toes, like high heels. Please watch our video above, to help you determine the best shoe for your foot.
- Orthotic devices. Custom orthotic devices cane help to improve your foot function.
- Medications. Your podiatrist may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, to help relieve your pain and reduce inflammation. Supplements, such as glucosamine-chondroitin sulfate and some vitamins and minerals, may also be helpful.
- Injection therapy. Corticosteroid injections may be given in small amounts in the affected toe to help reduce the inflammation and pain.
- Physical therapy. Ultrasound therapy or other types of physical therapy may be utilized as well.
When Is Surgery Needed?
For some, surgery is the only treatment option which eliminates or reduces their pain. There are several different surgerical procedures that can be performed for hallux rigidus. These procedures fall into two categories:
- The first category of procedures aim to reconstruct and "clean up" the joint. Your podiatrist will remove the arthritic damage from the joint along with any bone spurs. Then, the podiatrist changes the position of one or more bones in the toe. These surgical procedures are designed to preserve and restore normal alignment and function of the joint as well as reduce or eliminate pain.
- The second category of procedures are more aggressive. They are utilized in cases where the joint cannot be preserved. These procedures may involve fusing the joint, or removing part or all of the joint and. If the joint is removed it can be replaced with an implant, like the ones for the hip or knee. These procedures aim to get rid of painful motion in the joint and provide a stable foot for the patient. The procedure chosen to correct your disorder depends on many different factors, including the cause of your hallux rigidus and the severity, as well as your age, occupation and activity level. Your podiatrist is trained to choose the procedure best suited to your specific case. If surgery is performed for your condition, the time it takes to recover after the procedure will vary. Recovery time depends upon the procedure or procedures performed.
If you believe you are suffering from Hallux Rigidus, contact the Neuhaus Foot and Ankle office at 615-220-8788 or at our toll-free number 888-713-0906. Or, if you would prefer, you can request an appointment online.