Hallux Rigidus: causes, symptoms and treatment

Stiff big toe ("Hallux rigidus") in foreground

This is an arthritic problem with gradual destruction of the joint cartilage. The pathology is very debilitating as the big toe is not only used for walking but also for jumping, climbing up and down, even just for standing still.
Patients often go to the podiatrist believing they have hallux valgus.

Hallux rigidus: symptoms

The initial symptoms include:

– pain and stiffness in the big toe during activity

– pain made worse by the cold

– difficulty in some movements (running, squatting)

– swelling and inflammation of the joints; in the advanced stages pain even when at rest can be noticed

– difficulty in wearing certain shoes due to the presence of bone overgrowth appearing on top of the bone (exostosis)

– knee, hip and spinal pain due to mechanical imbalance.

This pathology affects around 2% of the population with a net predominance of men over women between 30 and 60 years of age, causing pain and a gradual loss of movement until the joints become completely rigid.

 Hallux rigidus: causes

The main cause of hallux rigidus is inadequate foot biomechanics or a structural irregularity that gradually leads to arthritic episodes.

For example, patients with flat feet and excessive foot pronation are likely to develop hallux rigidus. In some case the pathology is hereditary in the sense that a particular foot irregularity is passed on that leads to arthrosis.

In other cases, the pathology is to do with overloading or a direct trauma in which the big toe is compressed.

 Treatment of Hallux rigidus

The aim is to reduce the local inflammatory process and to prevent intra-articular degeneration. In milder cases, it may be enough for the patient to take medicine to reduce the inflammation together with physiotherapy as well as reducing the forces that extend the metatarsophalangeal joint achieved by the use of a personalised corrective orthosis and/or suitable footwear, wide and comfortable enough not to create conflict and constraint in the area of the big toe.

Patients that do not find relief from the above described methods and for which an X-ray examination shows hallux rigidus in an advanced stage, with considerable joint pain, restricted movement and mobility and who would like to maintain an active and dynamic lifestyle, can be referred for surgery.