What Is Hallux Rigidus?
Hallux rigidus is a term used to describe a disorder of the metatarsal-phalangeal joint located at the base of the big toe. The condition causes pain and stiffness in the big toe. The big toe is also known as "Hallux” and the rigidus portion of the name indicates that the toe is rigid and stiff. Hallux rigidus is a form of degenerative arthritis.
The toes consist of 5 bones numbered in the sense that your big toe is 1st and your little toe is your 5th. The big toe is divided into two parts; there is a distal section (the section under your nail) and a proximal section (the section that connects to the metatarsals). The first joint is known as the metatarsal-phalangeal joint (the joint that connects the metatarsals to the phalanges), the last joint is the interphalangeal joint (ip joint) that connects the distal and proximal bones. The formation of the joints allows a wide range of movement in flexion and extension and also allows you to curl your toes.
The big toe plays a vital role in the biomechanics of the foot we use whenever we walk, stoop down, climb up, or even stand. In fact it plays an extremely important part in the balance of our body. Due to this hallux rigidus can cause severe problems and disability. Many patients confuse hallux rigidus with a hallux valgus which is more commonly known as a bunion. A bunion affects the same joint, but is when the big toe becomes deformed and bent inwards; it also requires very different treatment.
Why and when does hallux rigidus happen?
Hallux rigidus is normally the result of poor foot biomechanics or posture like flat feet or high arches. Altered function of the feet in these circumstances leads to increased pressure through certain joints like the metatarsophalangeal joint at the base of the toe. This consistent increase in pressure causes a progressed development of wear and tear degeneration (osteoarthritis) through the joint.
Hallux rigidus can be the result of an injury, such as stubbing your toe. It has also been known to run in the family due to an increased likelihood of inheriting a foot type that is prone to developing the condition. The development of the condition is also associated with overuse. Those who partake in sports or activities that increase the pressure on your toes are more likely to suffer with the condition. For example ballerinas who spent allot of their time on tiptoes or tradesmen who spend allot of time stooped and squatting down. Inflammatory diseases such as rheumatoid arthritis or gout may also cause hallux rigidus.
What does hallux rigidus feel like?
In the first stages of stiffness the condition is referred to as hallux limitus as the joint range of motion is limited but not completely diminished. Hallux rigidus is however a progressive condition and over time the big toes will become completely stiffened and almost frozen. In the early stage of hallux limitus the symptoms will include pain and stiffness in the big toe, more noticeable during or after activities like walking, running and standing. The stiffness and discomfort will heighten in cold and damp weather conditions and there may be noticeable swelling around the joint line. As the condition progresses to hallux rigidus then the symptoms will worsen with the pain and discomfort being felt even at rest. Pain levels will be increased and the joint will start to completely seize, the possible development of bone spurs around the joint line may create problems with footwear. As the symptoms have progressed your body will have learnt to compensate by altering how you walk, as a result of this you may find you are having problems with your low back, hip or knee.
How is hallux rigidus diagnosed?
Your GP or podiatrist/chiropodist should be able to diagnose you by listening to your symptom history and thoroughly examining the big toe. Your doctor will most likely order an X-ray of the foot and toe to determine the extent of the joint degeneration and the location on any boney spurs that may have developed.
What treatments are available for hallux rigidus?
The treatment options for hallux rigidus vary depending on how early the condition is diagnosed. The earlier the condition is diagnosed, the easier it is to treat. Therefore, it is advisable that report to your doctor when you first notice symptoms. If you wait until bone spurs develop, the condition will be more difficult to manage. In the early stages most doctors will recommend conservative treatment to prevent and delay the need for surgical intervention in the future. Conservative treatment will include shoe modifications with larger big toe compartment or stiffened soles and Orthotics to improve any poor foot posture or biomechanics. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling there is also the option of corticosteroid injections to reduce persistent inflammation and pain. Your doctor may refer you to a podiatrist/chiropodist or physiotherapist who may use ultrasound or manual therapy to reduce pain levels.
Doctors will normally recommend surgical intervention in more severe, progressed cases or when conservative treatment fails. You will be referred to a specialist ankle and foot orthopaedic surgeon who will recommend the type of surgery based on your health, activity level and the severity and extent of your condition. The recovery and results you see after surgery will vary, depending on the type of procedure performed.