Hallux Rigidus - Osteoarthritis
Author: Dr. Yvonne Weber

What is Hallux Rigidus - Osteoarthritis?
Hallux rigidus is a condition of the big toe joint. It causes pain, swelling, stiffness and loss of motion over time. Hallux refers to the big toe, while rigidus indicates that the toe is getting more rigid. Hallux rigidus is a form of osteoarthritis, where the joint degenerates over time and bone spur formation. These bone spurs are often a visual bump at the dorsal base of the big toe joint.

This disorder can become very painful and at times disabling over time. Often time patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.

Hallux rigidus is a progressive condition. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called hallux limitus. But as the condition progresses, the toe's range of motion gradually decreases until it potentially reaches the end stage of rigidus, in which the big toe becomes stiff and may loose all motion.

Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to joint degeneration in the big toe joint. This type of arthritis-is due to wear and tear-often develops in people who have defects that change the way their foot and big toe functions. Fallen arches or excessive pronation (rolling in) of the ankles are more prone 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. Hallux rigidus is also associated with overuse, especially among people participating in activities or jobs that increase the stress on the big toe. Hallux rigidus can also result from an injury, such as stubbing your toe known as "turf toe". Hallux rigidus may also be associated with inflammatory diseases, such as rheumatoid arthritis or gout. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment.

Symptoms often start as mild and then can progress over time. Symptons include -Pain and stiffness in the big toe during use (walking, standing, bending, etc.). Swelling around the joint. Obvious joint enlargement. Throbbing at night time. Difficulty wearing some shoes due to bony overgrowth that develops. Hip, knee or lower back pain due to changes in the way you walk due to the pain in the big toe joint.

The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice symptoms. In diagnosing hallux rigidus, the surgeon will examine your feet, check biomechanics and range of motoin of the big toe joint. Digital X-rays help determine status of joint, bone spur formation and foot type.

Nonsurgical Treatment
In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include:
- Shoe modifications Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended
- Orthotic devices Custom orthotic devices may improve foot function
- Medications Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation
- Injection therapy Injections of corticosteroids may reduce inflammation and pain. Stem cell injections and PRP are other options

When Is Surgery Needed?
There are several types of surgery are available to address hallux rigidus. In selecting the procedure, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level and other factors. The length of the recovery period will vary depending on the procedure performed.