Each day, with every step you take, your big toe bears a tremendous amount of stress—a force equal to about twice your body weight. Most of us don't realize how much we use our big toe. We tend to take it for granted, unless a problem develops. One problem that afflicts the big toe is called hallux rigidus, a condition where movement of the toe is restricted to varying degrees. This disorder can be very troubling and even disabling, since we use the all-important big toe whenever we walk, stoop down, climb up, or even stand. If you have pain and/or stiffness in your big toe, you may have this condition.

What Is Hallux Rigidus?
Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe, and with time it gets increasingly harder to bend the toe. "Hallux" refers to the big toe, while "Rigidus" indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis (a wearing out of the cartilage within the joint that occurs in the foot and other parts of the body).

Because hallux rigidus is a progressive condition, the toe's motion decreases as time goes on. In its earlier stage, motion of the big toe is only somewhat limited—at that point, the condition is called “hallux limitus.” But as the problem advances, the toe's range of motion gradually decreases until it potentially reaches the end stage of "rigidus"— where the big toe becomes stiff, or what is sometimes called a "frozen joint." Other problems are also likely to occur as the disorder progresses.

Symptoms
Early signs and symptoms include:

As the disorder gets more serious, additional symptoms may develop, including:

What Causes Hallux Rigidus?
Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis—the kind that results from "wear and tear"—often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse—especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury—even from stubbing your toe. Or it may be caused by certain inflammatory diseases, such as rheumatoid arthritis or gout.

Diagnosis of Hallux Rigidus
The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a podiatric surgeon is when you first notice that your big toe feels stiff or hurts when you walk, stand, bend over, or squat. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.

In diagnosing hallux rigidus, the podiatric surgeon will examine your feet and manipulate the toe to determine its range of motion. X-rays are used to determine how much arthritis is present and to evaluate any bone spurs or other abnormalities that may have formed.

Treatment: Non-Surgical Approaches
If your condition is caught early enough, it is more likely to respond to less aggressive treatment. If fact, in many cases, early treatment may prevent or postpone the need for surgery in the future. That's why it is important to see your podiatric surgeon when you first begin to notice symptoms.

Treatment for mild or moderate cases of hallux rigidus may include one or more of these strategies:
• Shoe modifications. Shoes that have a large toe box should be worn, because they put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended. Most likely, you'll have to stop wearing high heels.
• Orthotic devices. Custom orthotic devices may improve the function of your foot.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to help reduce pain and inflammation.
• Injection therapy. Injections of corticosteroids in small amounts are sometimes given in the affected toe to help reduce the inflammation and pain.
• Physical therapy. Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.

When Is Surgery Needed?
If conservative treatment fails, then surgery may be the only way to eliminate or reduce pain. There are several types of surgery that can be utilized to treat hallux rigidus. These surgical procedures fall into three categories:

• Some procedures simply "clean up" the joint. The surgeon removes the arthritic damage from the joint as well as any accompanying bone spurs to eliminate pain and minimize jamming at the joint.

• Other procedures clean up the joint and realign the metatarsal utilizing a cut in the bone. These procedures are designed to preserve and restore normal alignment and function of the joint as well as reduce or eliminate pain.

• More aggressive procedures are used when the joint cannot be preserved. These may involve fusing the joint, or removing part or all of the joint and, in some cases, replacing it with an implant, such as is done for the hip or knee. These procedures eliminate painful motion in the joint and provide a stable foot.

The procedure that is used to correct hallux rigidus depends on many factors, including the cause of the condition and the severity, as well as the patient's age, occupation and activity level.

At Capital Foot & Ankle Centers, Dr. Gonzalez specializes in all aspects of Hallux Rigidus. He has co-authored a study published in the Journal of Foot & Ankle Surgery, Nov-Dec 2004, for a surgical treatment of hallux rigidus, and has lectured at various seminars on the procedure as well.

If you are experiencing a stiff toe joint, come in and we can discuss your specific problem in detail.