Hallux Rigidus
Overview
The “hallux” is the big toe and “rigidus” implies stiffness or restricted range of motion. This is because of arthritis developing in the main joint of the big toe. It is a very common problem and often happens in both feet. Thankfully, it does not spread to other joints of the foot. Most patients note stiffness and pain, especially if they wear a higher heel or if someone stands on their foot. It tends to be slowly progressive and associated with swelling. Snug firm footwear can become too painful to wear.
Non-Surgical Treatments
It is always easier to change your shoe rather than your foot – so wide fitting, deep toe-box shoes often provide significant relief. Likewise, flat stiffer shoes are more appropriate. Occasionally, an orthotic to provide further stiffness to the shoe will help. These orthotics need to be made for your foot by a trained orthotist. They typically have a carbon fibre section under the big toe, to reduce movement of the big toe with walking.
Surgical Treatments
Hallux Rigidus can cause two types of pain. The first is Impingement Pain where bone impinges on bone and stretches the capsule of the joint, causing sharp, darting and intermittent pain. This is best managed by removing the proud bone about the joint (this procedure is called a ‘Cheilectomy’ – or tidy-up of the joint).
The second type of pain is “arthritic pain”, secondary to bone rubbing on bone. This type of pain necessitates a fusion procedure, which involves an operation to get one bone to grow onto the other, to stop any movement and thus stop painful bone rubbing on bone. Some surgeons are trying newer joint replacement options to preserve motion; these are not yet fully proven to be effective over the long-term.
Fusion surgery for Hallux Rigidus is successful in 90% of patients. Complications include non-union (where one bone does not grow onto the other), mal-union (the bones have joined, but in a sub-optimal position), nerve irritation and wound infection. It takes 6 weeks for the fusion to happen, hence crutches and a special post-operative shoe are necessary during this time. The big toe will be shorter by a few mm after the fusion operation, but this has no consequences other than the appearance of your foot. The shortening always looks more dramatic if your second toe is naturally longer than your big toe.
