Hallux rigidus is the medical name for arthritis that occurs at the base of the big toe. The joint at the base of the big toe is called the first metatarsophalangeal joint, or MTP joint. This is the junction of the long bone of the forefoot and the small bone of the big toe.
Because of the mechanics of our feet, this joint is especially prone to developing arthritis. In fact, hallux rigidus, or big toe arthritis, is the most common site of arthritis in the foot.
The most common symptom and the most common reason to seek medical attention for this problem is pain around the base of the big toe. This pain is accentuated with activity, especially running or jumping. Wearing firm-soled shoes that prevent motion at the base of the big toe will help relieve symptoms. Other common symptoms include swelling at the base of the big toe, a lump next to this joint due to bone spur formation, and calluses from the abnormal shape of the toe.2
The common signs people with hallux rigidus notice include:
Pain at the base of the big toe
Swelling of the toe
Difficulty with activities including running, waling up hills
The symptoms are typically worsened when the big toe has to bend upwards, as is the case when you are walking up a steep incline or running.1 When the toe is forced upwards, the bone spurs that have formed are pinched together causing pain and inflammation. This is the reason that footwear and activity modifications can help significantly relieve symptoms.
The diagnosis of hallux rigidus is made by testing the mobility of the MTP joint, usually comparing it to the opposite foot to see how much motion is lost at the joint.3 X-rays are performed to determine how much of the joint cartilage has worn away and to see if bone spurs have formed in this area. Determining the extent of arthritis will help guide treatment.
The first steps of treatment are in choosing the right footwear and reducing inflammation. These include:3
Wearing Stiff-Soled Shoes: Stiff-soled shoes limit motion at the base of the big toe. Inserts can be made for shoes that can help support your existing footwear. Alternatively, when buying shoes, look for types with a less-flexible sole that will prevent the arthritic joint from bending.
Adding a Rocker Bottom to Shoes: A rocker-bottom is a curved sole that can be added to your footwear. The rocker-bottom, much like the bottom of a rocking chair, helps the foot smoothly transition from the heel to the toe while walking. This modification also limits the movement of the arthritic toe joint.
Anti-Inflammatory Medications: These medications will help to decrease pain and swelling at areas of inflammation. If the oral medications are not sufficient, an injection of cortisone may also be considered. Injections of cortisone into the big toe can be painful because there is not much space for the medication to be injected (compared to a knee or shoulder), but the relief is often rapid and can be long-lasting.
Is Surgery Necessary?
Surgery is sometimes the best treatment for hallux rigidus, especially if the more conservative measures are not working for you. Surgery is rarely the first step in treatment, and generally, people should try simple steps before moving on to more invasive treatments.3 The two most common surgical procedures are called a cheilectomy or an arthrodesis (fusion). The cheilectomy is a procedure done to remove the bone spurs. The cheilectomy often helps if the bone spurs are limiting the joint motion.2
The concern with performing a cheilectomy is that while the bone spurs are removed, the joint is still arthritic, and the spurs can return. While the pain caused by limited motion may be improved, the pain coming from worn out cartilage may remain. A more extensive surgery called a joint fusion may be necessary for these patients. A fusion is an excellent procedure at eliminating much of the pain, but it will cause the toe to be permanently stiff.1