Hallux Rigidus
This series of educational material is a broad overview of foot problems, and not as detailed as an actual podiatrist visit. I recommend you to see a podiatrist for professional evaluation of your foot and ankle problems. This is for educational purposes only.
This material is from my own experiences seeing patients. Other podiatrists may have different recommendations. Each examination has nuances and details too small to mention in this type of presentation.
What is Hallux Rigidus?
At the base of the big toe is a joint that connects the toe to the foot. This joint allows the big toe to move up and down. When people get osteoarthritis a lot of bone builds up on both sides of the joint. This extra bone limits how much the big toe can move up and down. Also, as the toe moves up and down the bones rub against each other and cause inflammation and pain. This lack of movement is called hallux rigidus.
Causes
Like most all foot deformities, this is usually genetic. It could also be due to severe trauma such as getting your foot run over by a car.
Some conditions can make it worse than it otherwise would be.
Obesity
Diabetes
Arthritis
Gout
Symptoms
Aching pain in the joint that connects the big toe to the foot.
Pain increases with physical activity that aggravates or uses the joint.
The pain can come and go over the course of 1-2 weeks or be a constant ache that lasts for months.
If the pain is sudden with redness, swelling, and pain with a blanket or sheet lightly rubbing on the skin, that is more consistent with gout. Hallux rigidus is gradual build up of pain that can come and go over longer periods of time. Gout is sudden a bout of extreme pain with redness, swelling, and warmth.
Treatment
Your best treatment is discussion you have with your podiatrist. Treatments change based on circumstance and needs of the patient.
The problem is extra bone that rubs against each other that cause inflammation, bone and joint damage, and pain. There are two treatment options. Nonsurgical and Surgical.
Nonsurgical / Conservative – Prevent the bones from rubbing against each other
Wear stiff soled shoes that don’t let the big toe move up and down.
Put a carbon fiber insert into the shoe to prevent the toe from moving up and down. Carbon fiber inserts are very hard, put it underneath the insert the shoe comes with or put a memory foam insert on top of it to give your foot padding.
Continue using stiff soled shoes and/or carbon fiber inserts for remainder of your life.
Anti-inflammatories (topical or oral) to decrease inflammation and pain.
Steroid injection – you can only get this from a podiatrist or other physician.
Ice 2x day 10 mins each when painful.
Surgical – There are 3 types of surgery.
Joint fusion – the makes the big toe and foot bone into one single bone. The big toe no longer moves up and down but it no longer has pain either. This is the most definitive and most long-lasting treatment. If your goal is to get one surgery and not have any more problems, this is the one to pick.
Joint Shaving – The extra bone around the joint is removed to all the joint to move freely again with out rubbing. Sometimes this procedure has great results, sometimes the bone regrows and a person needs another surgery.
Joint Replacement – The extra bone is removed and joint surfaces replaced with metal or silicone. This can be good for elderly patients that are not very active and insist on keeping motion at the joint. It can also be good for someone needing to work a few more years before retirement and they work on ladders or squat down a lot so need the motion. You are pretty much guaranteed to return for a joint fusion in 3-10 years. On average it lasts 5 years before a person needs a 2nd surgery to correct the damage.
I hope this educational article has been helpful for you. Feel free to share it with family and friends.