Hallux Rigidus
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.
Early signs and symptoms include:
- Pain and stiffness in the big toe during use (walking,
standing, bending, etc.)
- Pain and stiffness aggravated by cold, damp weather
- Difficulty with certain activities (running, squatting)
- Swelling and inflammation around the joint
As the disorder gets more serious, additional symptoms
may develop, including:
- Pain, even during rest
- Difficulty wearing shoes because bone spurs (overgrowths)
develop. Wearing high-heeled shoes can be particularly difficult
- Dull pain in the hip, knee, or lower back due to changes
in the way you walk
- Limping, in severe cases

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. Your podiatric foot and ankle
surgeon can determine the cause of your hallux rigidus and
recommend the best treatment.
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 usually required to determine how much arthritis is
present as well as 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.
Supplements such as glucosamine-chondroitin sulfate and some
vitamins and minerals may also be helpful.
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?
In some cases, surgery is the only way to eliminate or reduce pain.
There are several types of surgery that can be undertaken to treat
hallux rigidus.
These surgical procedures fall into two categories:
Some procedures reconstruct and “clean up” the joint. The
surgeon removes the arthritic damage from the joint as well as
any accompanying bone spurs and then alters the position of
one or more bones in the big toe. 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 patients age, occupation and activity level.
Your podiatric surgeon is trained to select a surgical procedure
best suited to your particular condition and needs.
If surgery is performed, the length of the recovery period will
vary, depending upon the procedure or procedures performed.
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