HALLUX RIGIDUS

ach day, with every step you take, What Is Hallux Rigidus? Wearing high-heeled shoes can be E your big toe bears a tremendous Hallux rigidus is a disorder of the particularly difficult. amount of stress—a force equal to joint located at the base of the big toe. •Dull pain in the hip, knee, or about twice your body weight. Most It causes pain and stiffness in the big lower back due to changes in the of us don’t realize how much we use toe, and with time it gets increasingly way you walk our big toe. We tend to take it for harder to bend the toe. “Hallux” refers •Limping,in severe cases granted, unless a problem develops. to the big toe, while “rigidus” indicates One problem that afflicts the that the toe is rigid and cannot move. What Causes Hallux Rigidus? big toe is called hallux rigidus, a Hallux rigidus is actually a form of Common causes of hallux rigidus are condition where movement of the degenerative arthritis (a wearing out faulty function (biomechanics) and toe is restricted to varying degrees. of the cartilage within the joint that structural abnormalities of the foot This disorder can be very troubling occurs in the foot and other parts of that can lead to osteoarthritis in the and even disabling, since we use the the body). big toe joint. This type of arthritis— all-important big toe whenever we Because hallux rigidus is a pro- the kind that results from “wear and walk, stoop down, climb up, or even gressive condition, the toe’s motion tear”—often develops in people who stand. If you have pain and/or stiff- decreases as time goes on. In its earlier have defects that change the way ness in your big toe, you may have stage, motion of the big toe is only their foot and big toe functions. For this condition. somewhat limited—at that point, the example, those with fallen arches or condition is called “hallux limitus.” excessive pronation (rolling in) of the But as the problem advances, the toe’s ankles are susceptible to developing range of motion gradually decreases hallux rigidus. until it potentially reaches the end In some people, hallux rigidus runs stage of “rigidus”— where the big toe in the family and is a result of inherit- becomes stiff, or what is sometimes ing a foot type that is prone to devel- called a “frozen joint.” Other problems oping this condition. In other cases, it are also likely to occur as the is associated with overuse—especially disorder progresses. among people engaged in activities Normal Function Early signs and symptoms include: or jobs that increase the stress on the •Pain and stiffness in the big toe big toe, such as workers who often during use (walking, standing, have to stoop or squat. Hallux rigidus bending, etc.) can also result from an injury—even •Pain and stiffness aggravated by from stubbing your toe. Or it may cold, damp weather be caused by certain inflammatory • Difficulty with certain activities diseases, such as rheumatoid arthritis (running, squatting) or gout.Your podiatric foot and ankle Limited Motion •Swelling and inflammation surgeon can determine the cause of around the joint your hallux rigidus and recommend the best treatment. As the disorder gets more serious, additional symptoms may develop, Diagnosis of Hallux Rigidus including: The sooner this condition is •Pain, even during rest diagnosed, the easier it is to treat. • Difficulty wearing shoes because Therefore, the best time to see a Rigid Deformity bone spurs (overgrowths) develop. podiatric surgeon is when you first notice that your big toe feels stiff or Most likely,you’ll have to stop the joint as well as any accompa- hurts when you walk, stand, bend wearing high heels. nying bone spurs, and then alters over,or squat. If you wait until bone • Orthotic devices. Custom orthotic the position of one or more bones spurs develop, your condition is likely devices may improve the function in the big toe. These procedures to be more difficult to manage. of your foot. are designed to preserve and In diagnosing hallux rigidus, • Medications. Nonsteroidal anti- restore normal alignment and the podiatric surgeon will examine inflammatory drugs (NSAIDs), function of the joint as well as your feet and manipulate the toe to such as ibuprofen, may be reduce or eliminate pain. determine its range of motion. X-rays prescribed to help reduce pain •More aggressive procedures are are usually required to determine how and inflammation. Supplements used when the joint cannot be much arthritis is present as well as such as glucosamine-chondroitin preserved. These may involve to evaluate any bone spurs or other sulfate and some vitamins and fusing the joint, or removing part abnormalities that may have formed. minerals may also be helpful. or all of the joint and, in some • Injection therapy. Injections of cases, replacing it with an implant, Tr ea t ment: corticosteroids in small amounts such as is done for the hip or Non-Surgical Approaches are sometimes given in the affected knee. These procedures eliminate If your condition is caught early toe to help reduce the inflammation painful motion in the joint and enough, it is more likely to respond and pain. provide a stable foot. to less aggressive treatment. If fact, • Physical therapy. Ultrasound in many cases, early treatment may therapy or other physical therapy The procedure that is used to prevent or postpone the need for modalities may be undertaken correct hallux rigidus depends on surgery in the future. That’s why it to provide temporary relief. many factors, including the cause of is important to see your podiatric the condition and the severity,as well surgeon when you first begin to When Is Surgery Needed? as the patient’s age, occupation and notice symptoms. In some cases, surgery is the only activity level. Your podiatric surgeon Treatment for mild or moderate way to eliminate or reduce pain. is trained to select a surgical proce- cases of hallux rigidus may include There are several types of surgery dure best suited to your particular one or more of these strategies: that can be undertaken to treat hallux condition and needs. • Shoe modifications. Shoes that have rigidus. These surgical procedures fall If surgery is performed, the length a large toe box should be worn, into two categories: of the recovery period will vary, because they put less pressure on •Some procedures reconstruct and depending upon the procedure or your toe. Stiff or rocker-bottom “clean up”the joint. The surgeon procedures performed. ▲ soles may also be recommended. removes the arthritic damage from

This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons. Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards. Copyright © 2004, American College of Foot and Ankle Surgeons • www.acfas.org