Hallux Rigidus

  What is hallux rigidus?

Hallux rigidus is arthritis of the main joint of the big toe. The cartilage covering the joint becomes damaged or worn, causing the joint to become painful and stiff.

As the arthritis progresses, extra bone can form around the joint, particularly on the top of the foot. This is sometimes called a bone spur.

Despite the name "rigidus", the amount of stiffness varies considerably between individuals.

What symptoms and signs might I experience?

Common symptoms include:

• Pain around the big toe joint.
• Stiffness and reduced movement of the big toe.
• Pain when pushing off during walking.
• Pain when running or participating in sport.
• Swelling around the joint.
• A hard lump on the top of the joint.
• Difficulty wearing certain shoes.
• Pain when walking uphill or using stairs.
• A change in the way you walk to avoid bending the toe.

Some people have significant arthritis on an X-ray but relatively few symptoms.

How is it diagnosed?

Diagnosis is usually made through your symptoms and clinical examination.

Weight-bearing X-rays can show:

• Joint-space narrowing.
• Bone spurs.
• Loss of cartilage.
• Changes in the shape of the joint.
• The severity and position of the arthritis.

Occasionally, other imaging such as CT or MRI may be required.

How is it treated without surgery?

Treatment aims to reduce pain and improve function. Options include:

• Wide-fitting footwear.
• Shoes with a stiff sole.
• Rocker-bottom shoes to reduce the amount the big toe needs to bend.
• Insoles or carbon-fibre inserts.
• Activity modification.
• Physiotherapy and exercises.
• Painkillers or anti-inflammatory medication where appropriate.
• An injection into the joint in selected cases.

These treatments can significantly improve symptoms but do not reverse the underlying arthritis.

When might surgery be considered?

Surgery may be considered when pain continues despite appropriate non-operative treatment and is significantly affecting your quality of life.

The operation depends on the severity of the arthritis and how much of the joint remains healthy.

What might surgery involve?

Possible procedures include:

Cheilectomy: removal of bone spurs and part of the damaged joint surface to improve movement.

Osteotomy: altering the position or shape of the bone to reduce pressure through the joint.

Fusion (arthrodesis): removing the damaged joint surfaces and fixing the bones together. This is commonly used for more advanced arthritis and provides reliable pain relief.

Joint replacement: in selected patients, the damaged joint can be replaced to preserve some movement.

What is recovery like?

Recovery depends on the procedure performed. Some operations allow relatively early walking in a special heel weight bearing shoe, whereas fusion and more extensive procedures require a longer period of protection while the bone heals, often 6 weeks .

Swelling can persist for several months.