Hallux Rigidus

What is Hallux Rigidus?

            Hallux rigidus is a formal term that refers to painful arthritis of the great toe joint. The great toe joint is a very important structure of the foot as it is heavily utilized when walking and with transfer of weight and pressure through the gait cycle. General wear and tear or trauma can cause this open joint space to diminish over time and cause debilitating pain and discomfort when attempting to walk. The joint space can narrow to such an extent that it essentially becomes “bone on bone” both clinically and radiographically. If not treated appropriately, all surrounding joints and osseous structures will compensate for this arthritic joint and can ultimately degenerate over time as well.

Causes

            There are various causes that can be attributed to the development and progression of hallux rigidus. Common causes can stem from the patient’s bony anatomy to faulty biomechanics that cause the joint to become arthritic over time. Depending on how you walk, the joint can be over-utilized and cause the underlying cartilage to become damaged. Injuries and traumatic causes can be attributed to progression of hallux rigidus as well. In addition to extrinsic factors, a patient may have systemic issues which can also affect the integrity of the joint. Inflammatory arthropathies such as psoriatric arthritis, rheumatoid arthritis and gout can be implicated in the development of hallux rigidus. In any case, it is crucial for your surgeon to determine the underlying cause of the underlying arthritis before pursuing definitive treatment.

Symptoms

Symptoms of hallux rigidus can be widely varied depending on the severity and extent of the underlying joint arthritis. Patients often complain of:

  • Stiffness, grinding or clicking with range of motion of the great toe joint
  • Inflammation, pain and swelling within the joint
  • Exacerbation of joint pain and tenderness with certain types of activities (i.e. running, squatting etc.)
  • Difficulty with wearing shoes due to rubbing of the bony joint prominence dorsally within the shoe
  • Pain in other parts of the foot, ankle, knee and hip due to compensatory gait changes

Diagnosis

A diagnosis of hallux rigidus is often made clinically by the treating physician. In all cases, x-rays will be obtained of the foot to evaluate the bony anatomy and to visualize the underlying arthritic changes that are contributing to the patient’s pain and discomfort.

Conservative Treatment

In many cases, conservative therapy can provide relief for hallux rigidus although success will invariably depend on the degree of hallux rigidus and how advanced the joint arthritis has become. Conservative therapy can include:

  • Rest, ice and elevation
  • Corticosteroid injection to provide temporary relief
  • NSAIDS or a short-term Medrol dose-pack
  • Shoe gear modification
  • Custom orthotics with built-in modification
  • Activity modification
  • Physical Therapy

Surgical Treatment

Once conservative therapy has been thoroughly exhausted, your surgeon will discuss with you the best options regarding surgical treatment. Generally, there are both joint sparing and joint destructive procedures depending on the extent of hallux rigidus. Procedures can range from simply cleaning out the bony joint arthritis to joint replacement and possible fusion of the joint. All procedures have different recovery times and separate indications which your surgeon will discuss with you in detail.