hallux rigidus

Figure 1: Decrease joint space/arthritis great toe joints

There are a number of reasons that you may experience painful big toes. The three most common are all related to abnormal function of the big toe joint. Those are:

    1. Bunions (enlargement of the big toe joint)
    2. Hallux Rigidus (arthritis of the big toe joint).
      “Hallux” means big toe. “Rigidus” means rigid joint.
    3. Functional Hallux Limitus (jamming of the big toe joint).
      “Limitus” means a limited amount of motion. “Functional” means that it happens during function or while walking, but there is not necessarily any permanent damage to the joint.

What is Hallux Rigidus?

Hallux rigidus means “stiff big toe joint”. This condition is a type of “wear and tear” arthritis in which the joint surfaces at one of the joints in your big toe begin to both wear away and develop extra bone, called osteophytes or ‘spurs’, that further limit motion. This joint is very important because it has to bend significantly with every step you take.

Hallux rigidus only gets worse over time. The earlier it is treated the easier it is to eliminate your pain and help you avoid surgery. Often correctly prescribed foot orthotics will eliminate pain and help reduce further damage.

Symptoms of this Hallux Rigidus include pain in the toe when you are active (especially as you push off with your toe), swelling, a loss of motion in the joint and bone spurs on the top of the joint. Walking may become painful. As you change the way that you walk because of pain, you can develop pain in your knees, hips and lower back.

Diagnosis of hallux rigidus is usually done by physical examination and x-ray. X-rays will show the location and size of any bone spurs that have formed, as well as the degree of damage to the joint itself.

How did I get Big Toe Joint Arthritis?

Your big toe undergoes a tremendous amount of stress when you are walking. Forces that equal twice your body weight (more when running) pass through your foot on every step. Your big toe, along with the ‘ball’ of your foot, was designed to bear much of that force.

If you have a foot where the arch of your foot collapses too much, as in the case of flat feet (also known as over-pronation) your big toe is unable to bend normally. This causes the joint of your big toe to jam along the top of the joint and even partially dislocate with every step. Over time, this leads to arthritic changes, cartilage damage and the formation of spurs.

In addition, hallux rigidus can be caused by or made worse by trauma, carrying too much weight and anatomical deformities of the foot.

How is Hallux Rigidus treated?

orthotics for hallux rigidus

Figure 2: As seen here, orthotics for hallux rigidus should conform closely to the arch of the foot.

Foot Orthotics: The correct custom made orthotic will reduce or eliminate your pain by restoring more normal motion to the big toe joint, preventing jamming of that joint and effectively releasing the big toe, allowing it to move and function properly. A very specific orthotic prescription, based on the best evidence in the medical literature, allows us to treat the cause of your pain rather than just the symptoms. With the correctly prescribed orthotic, harmful joint stresses can be reversed, allowing affected tissues to heal and joint function to be improved. In this way the orthotic provides both primary treatment and preventative care by working to restore normal function and range of motion to your big toe.

In order to best improve function of your big toe joints, research has shown that orthotics must be made from non-weightbearing casts of your feet with the foot held in the position that provides the best function of the big toe joint. In addition, the orthotic itself must conform very close to the arch of the foot.

Proper orthotics can be the most effective way to treat big toe pain and prevent surgery. Because hallux rigidus gets worse over time you should not wait to be evaluated. For a complete evaluation of whether orthotics can help your big toe problem, make an appointment today to see us in our Seattle office.

Anti-Inflammatory Treatment: This may include ice and anti-inflammatory medications. These may provide some temporary relief and ease the pain of inflammation, but are not helpful in addressing the underlying cause of your condition.

Footwear: We will provide you with recommendations for specific shoes that will act to reduce pressure on the big toe. A stiff-soled shoe with a rocker or roller bottom may be recommended to help you walk and lessen the bend in the big toe. A shoe with a wide toe box may also help relieve pain. We can even help you find high heel shoes that work best for patients with big toe pain. Weight loss can also be important in reducing hallux rigidus pain.

Surgery: In cases that do not respond to conservative measures, we may recommend surgery. At the Foot and Ankle Center of Washington surgery is always a last resort, but there are times where it is necessary for pain relief. There are a few common surgeries that are performed depending on the degree of arthritic changes. Removal of the bone spurs, joint fusion, and complete joint replacement can be performed. These procedures are not without risks and often the disease continues to progress after a temporary period of pain relief. Also, operative measures performed on one foot may cause problems on the other foot due to the extra load. We will provide you with complete and detailed information so that you can make an informed decision.

Don’t let your big toe pain get worse. Early treatment can prevent future problems. Call today for an appointment in our Seattle office.

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