Hallux Rigidus Surgery: 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.
Hallux Rigidus 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.
Benefits of Hallux Rigidus Surgery
Hallux Rigidus is a condition characterized by stiffness and limited motion in the big toe joint, due to arthritis. If more conservative treatments like medications and physical therapy fail to provide relief to the condition, surgery may be considered. Hallux rigidus surgery has many benefits. We’ve outlined a few of the below:
1. Improved Function of the Joint: Hallux Rigidus surgery can help restore and improve joint function by addressing the underlying causes of stiffness and limited range of motion. This in turn can help with your ability to walk and stand. It will also help you engage in various activities without the limitations imposed by hallux rigidus.
2. Pain Relief: One of the main goals of surgery for hallux rigidus is to significantly reduce and eliminate pain associated with arthritis in the big toe joint. The procedure will aim to remove or address the arthritic changes. This will provide relief from chronic pain and discomfort.
3. An Increased Range of Motion: For moderate severity hallux rigidus, a cheilectomy (which involves removing bone spurs around the joint) can help improve and increase the range of motion at the big toe. In the case of more severe hallux rigidus, a fusion procedure could be performed which can maintain the range of motion at the joint.
4. Correction of Deformities: In some cases, hallux rigidus surgery may involve correcting deformities associated with the condition, such as malalignment of the toe. This can help reduce pressure points as well as improve the overall appearance of the foot
5. Prevention of Further Damage: Surgical intervention can help the progression of hallux rigidus and will prevent further deterioration of the joint. This can be especially important in cases where conservative measures are no longer effective.
It's important to note that the specific benefits of hallux rigidus surgery mentioned above can vary depending on factors such as the severity of the condition, the chosen surgical technique, and individual health considerations. The decision to undergo surgery should be made in consultation with a foot and ankle surgeon who can assess the individual's specific situation and recommend the most appropriate treatment plan based on their needs and goals.
Dr. Kennedy's Articles
- Outcomes after interposition arthroplasty for treatment of hallux rigidus
- Early Failures of Polyvinyl Alcohol Hydrogel Implant for the Treatment of Hallux Rigidus
