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Hallux Rigidus: Stiff Big Toe

Hallux Rigidus: Stiff Big Toe

What is Hallux Rigidus?

Hallux Rigidus is a form of degenerative arthritis affecting the big toe joint where the big toe (hallux) attaches to the foot. 1st MTP joint stiffness is common in many athletes as well as in the general population. It is a progressive arthritic condition and can be treated with non-surgical and surgical treatments depending on its severity. Stem cell and growth factor therapy has been shown to be effective in mild to moderate conditions whereas minimally invasive surgery has excellent outcomes for more severe cases.

Why and How a Stiff Big Toe Happens

A stiff big toe occurs when the smooth articular cartilage covering the end of the big toe bones is damaged or lost. This results in: 

  • Narrow joint space 
  • Rubbing of the raw bone ends
  • Formation of bone spurs on top of the bones
  • Eventual loss of motion of the big toe

Causes

The main causes of a stiff big toe can include: 

  • Abnormal foot anatomy
  • Injury to the foot and/or big toe
  • Overuse and/or wear and tear 
  • Family history (genetic factor)
  • Certain medical conditions (for example, arthritis or gout). 

Signs and Symptoms 

Symptoms of stiff big toe start out mild and gradually worsen over time. The early signs and symptoms include:

  • Pain and stiffness at the base of the big toe
  • Pain and stiffness that is aggravated by cold or damp weather
  • Swelling and inflammation in and around the joint
  • Difficulty bending the big toe

What if the Condition is Left Untreated?

If left untreated, a stiff big toe may lead to:

  • Limping, and pain in the knee, hip, or lower back 
  • Painful standing and/or walking 
  • Permanent loss of big toe motion and disability 

Treatments

Nonsurgical management can be the first-line treatment for a stiff big toe, especially if the condition is diagnosed early. It may include the following:

  • Shoe modification: Morton’s plate or Rigid sole
  • Injection Therapy Physical Therapy: steroid injection, Hyaluronic Acid, Platelet Rich Plasma (PRP) + PT regiment. 

Surgical Treatment:

In Office:

For grade 1 Hallux rigidus in which there is just a small bump, Nanoarthroscopy and cheilectomy can be performed in the office. This is determined by the site of the dorsal cheilus (aka the bump at the top of the toe). If not, you will need to go to the OR for a more standard operation. 

In the Operating Room:

***All Operating Room surgeries will incorporate growth factor/stem cell ****

1.  Cheilectomy: 

  • Performed in combination with another procedure called osteotomy.
  • Involves shaving of bone spurs and removal of part of the big toe bone. 
  • Treats mild to moderately damaged stiff big toe.
  • Preserves the joint and maintains stability and motion.

2.  Interpositional arthroplasty: 

  • For more severe cases, joint sparing surgery is preferred over fusion. 
  • IPA is regarded as an excellent procedure for end stage Hallux Rigidus and preserves motion which is critical for the more active patient.
  • Involves the removal of damaged bone and placing a spacer between the bones to minimize contact. Treats moderate to severe stiff big toe. 
  • Preserves joint motion, relieves pain and can be easily converted to fusion if it fails. 

3.  Arthrodesis (joint fusion): 

  • For end stage arthritis of the big toe, in which a cheilectomy or interpositional arthroplasty (IPA) wouldn’t work. 
  • Involves removal of damaged cartilage and creates fusion of bones (with screws, plates or pins) to enable them to grow together. 
  • Treats a severely damaged big toe and provides long-term pain relief. 
  • However, the movement of the big toe may be permanently restricted.

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