Hallux Rigidus

Hallux (big toe) limitus (stiffness) starts out as a stiff big toe.

Over time, this develops into hallux rigidus (inability to bend), a condition where the big toe's ability to move is severely limited and may be "frozen" and unable to move at all. It is a form of degenerative arthritis, when cartilage in the joint at the base of the toe is worn away.

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Symptoms

Symptoms of hallux rigidus include:

  • Inability to feel comfortable in shoes, particularly high heels for women
  • Increased pain during cold, damp weather
  • Over time, increased difficulty in bending the toe
  • Pain and stiffness in the joint at the base of the big toe when walking, standing or bending
  • Reduced range of motion
  • Swelling or inflammation around the joint, especially the top

 

Causes and Risk Factors

The exact cause of hallux rigidus is unknown.

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Diagnosis

Early detection of hallux rigidus is crucial to decrease the knee, hip or lower back pain that may result when patients adjust their stride to compensate for the pain. Bone spurs, which commonly develop in patients with hallux rigidus, may cause an uncomfortable prominence on the top of the toe, making show wear difficult.

A physician will test the toe's range of motion before taking an X-ray to determine how much arthritis is present and if there are any bone abnormalities.

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Treatments

Early conservative treatment options that offer relief from pain and may slow the progression of hallux rigidus include:

  • Wearing shoes with plenty of room for the toes, preferably shoes with stiff bottoms
  • Women should avoid high heels, especially above 2½ inches
  • Shoe orthotics to correct for abnormalities
  • Nonsteroidal anti-inflammatories for inflammation and pain
  • Corticosteroid injections for inflammation and pain are occasionally used
  • Physical therapy and ultrasound therapy may provide some relief

Surgery is often an option to relieve hallux rigidus. A surgeon removes the arthritic damage and any bone spurs in the big toe so they may function normally. Depending on the severity of the condition, joint fusion or joint replacement also may be options.

Patients should contact a foot and ankle specialist to discuss the treatment option that fits their lifestyle.