Hallux Rigidus

Hallux rigidus is a common form of foot arthritis that affects the joint at the base of the big toe. This joint’s formal name is the metatarsophalangeal joint, “MTP joint” for short. Hallux rigidus results in pain that is usually localized to the top of the MTP joint. It is also associated with stiffness. In fact, the phrase hallux rigidus is Latin for “stiff big toe”.

Sometimes this condition may be associated with previous trauma or a systemic arthritis such as gout.  In most cases, however, the actual cause is unknown.

Beyond activity modification and perhaps anti-inflammatory medications for very mild disease, initial non-operative treatment for hallux rigidus may include shoes with a wide toe box to decrease pressure on spurs that form on top of the MTP joint. Similarly, a shoe-stretching device may be used to provide more space for the arthritic joint. A stiff shoe insert, such as a carbon fiber base plate, may help by reducing joint motion.

Surgery may be an option for patients with persistent pain that does not respond to non-operative measures and interferes with activities of daily living. Two commonly performed operations include a joint debridement and a joint fusion.

A joint debridement involves removing the painful bone spurs that form on top of the joint. This is most helpful when there is pain from shoes that irritate the spurs. It is also helpful for “impingement” pain. Impingement occurs when the spurs on the top of the joint pinch against each other as you push-off with the foot while walking.

A joint fusion is typically performed for more advanced disease in which there is global joint pain that is present both with and without shoes and throughout the walking cycle. With a fusion, the joint surfaces are roughened with a burr and then held together with plates or screws. The body is “tricked” into thinking that a fracture has occurred. Over the next 6-12 weeks, the body heals the presumed fracture and the two bones become one. Once the fusion is complete the arthritic joint is no longer present and pain is relieved.

Lateral x-ray of hallux rigidus. Note the spurs that form on the top of the joint.

Lateral x-ray of hallux rigidus. Note the spurs that form on the top of the joint.

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