Hallux rigidus is defined as pain and stiffness in the big (1st) toe joint caused by osteoarthritis(OA). 1st Metatarsal Phalangeal Joint (MTPJ) OA is a progressive condition that arises when degenerative arthritis causes the hallux (your big toe) to jam against the 1st metatarsal head. This causes loss of cartilage, joint space and the joint’s natural lubrication. Additional bony growth (spurs) can also occur.
The hallux MTPJ involves the spherical head of the 1st metatarsal and concave surface of the base of the hallux proximal phalanx. The joint also consists of articulation between the plantar surface of the metatarsal head and seasamoid complex, which includes the tibial and fibular seasamoids. The main function of the hallux MTP joint is to provide plantarflexion and dorsiflexion of the hallux.
Arthritis of the hallux MTP joint is most commonly attributed to previous trauma, including fractures involving the articular surfaces of the joints, as well as discrete chondral injuries to the articular surfaces of the joints that can occur after repetitive microtrauma or significant compression injuries to the chondral surfaces. Ligamentous injuries, including plantar plate ruptures, can lead to joint instability, which can result in aberrant motion and resultant injury to the cartilage surfaces of the joint. Degenerative changes can also be the result of inflammatory arthritic processes, such as rheumatoid arthritis, or in the setting of recurrent crystalline arthropathies such as Gouty Arthropathy. Chronic deformity can also lead to degenerative changes, including hallux valgus or varus deformitions.
Most patients experience pain to the big toe, rubbing against their shoes, reduced range of motion of the joint. Some people may experience no pain with Hallux Rigidus.
Non- Surgical Treatment
To treat this condition, the mobility of the joint needs to be restricted in order to prevent the bone on bone jamming. This is accomplished by wearing a custom made orthotic with a rigid splint built under the 1st toe as well as supportive rocker soled shoes.
Other treatment modalities include:
- Rest. Avoiding movements that exacerbate your pain.
- Heat and Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
- onsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
- Physiotherapy. Under the direction of an experienced physiotherapists, many patients do well by Increasing the range of motion
- Shoe Spot-Stretching to Accommodate Spurs
- Steroid (Depo-Medrol, Kenalog, Decadron)
- Lubrication (Viscosupplementation)
- Blood (PRP – Platelet Rich Plasma)
Surgery is rarely our 1st line of treatment for hallux rigidus. Typically we recommend trialling a course of conservative treatment options including those listed above for 3 to 6 months. Failing conservative therapy or in conjunction with them, we may decide to proceed with surgery. Determining which surgery is right for you often depends on the severity of your condition. The two kinds of surgery are called a cheilectomy and a fusion.
For more information regarding hallux cheilectomy, please click here
For more information regarding hallux fusion, please click here