Hallus Rigidus – “Stiff Big Toe”

Hallux rigidus means “stiff big toe,” which is the main symptom of the disorder. Hallux rigidus is a form of degenerative arthritis, which can cause pain and stiffness in the metatarsophalangeal joint (the joint where your big toe—the hallux—joins your foot).  Because hallux rigidus is a progressive condition (gets worse over time), the toe’s motion decreases as time goes on, making walking or even standing painful. The pain and stiffness may get worse in cold, damp weather, and the joint may become swollen and inflamed. A bump, like a bunion or callus, often develops on the top of the foot and makes wearing shoes difficult.

There is no single cause of hallux rigidus. It may develop because of overuse of the joint, such as in workers who have to stoop and squat or athletes who place a great deal of stress on the joint. It may occur after an injury, such as stubbing the toe or spraining the joint (called “turf toe” in athletes). In some people, hallux rigidus runs in the family and comes from inheriting a foot type or a way of walking that may lead to this condition. Osteoarthritis (wear and tear arthritis) and inflammatory diseases such as rheumatoid arthritis or gout are other possible causes of hallux rigidus.

Your doctor can diagnose the condition by testing the range of motion of the joint—how far the toe can bend up and down. X-rays can show if there are any abnormalities in the bone or bone spur development.

Early treatment of hallux rigidus usually includes the following measures:
• Wearing appropriate shoes with plenty of room for your toes. Some patients find that shoes with very stiff soles relieve pain. Women should avoid wearing high heels.
• Placing pads in your shoe to limit movement of your big toe
• Avoiding high-impact activities, such as jogging
• Taking non-steroidal anti-inflammatory medications, such as ibuprofen, to help relieve the pain and reduce swelling in your big toe. Your doctor may recommend corticosteroid injections into the joint.

If pain and stiffness continue, surgery may be necessary. Shaving the bone spur (cheilectomy) may help relieve the pain and preserve joint motion. Sometimes it may be necessary to cut the bone (osteotomy) in order to realign or shorten the big toe.  If the condition is severe, joint fusion (arthrodesis) may be the best option for long-lasting pain relief.