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Hallux Rigidus (Stiff big toe)

Introduction to Hallux Rigidus (Stiff big toe)

Hallux rigidus can be characterized as arthritis of the main joint of the big toe. It is a wearing out of the joint surfaces. It is called "hallux rigidus" because its main feature is stiffness ("rigidus") of the big toe ("hallux").

Symptoms of Hallux Rigidius

Early signs and symptoms include:

  • Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
  • Pain and stiffness aggravated by cold, damp weather
  • Difficulty with certain activities (running, squatting)
  • Swelling and inflammation around the joint

As the disorder gets more serious, additional symptoms may develop, including:

  • Pain, even during rest
  • Difficulty wearing shoes because bone spurs (overgrowths) develop. Wearing high-heeled shoes can be particularly difficult.
  • Dull pain in the hip, knee, or lower back due to changes in the way you walk
  • Limping, in severe cases

Cause of Hallux Rigidus

In the majority of cases the cause is unknown, the reason for this may be due to wear and tear of the joint which is particularly subject to pressure out due to tremendous stress placed on it during walking. With each step, a force equal to twice your body weight passes through this very small joint.

Contributing conditions such as gout or infection of the toe can lead to this condition. .

An underlying biomechanical condition can also cause this condition. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

In detail, excessive pronation may destabilize the great toe joint. If the foot pronates (or flattens) excessively, there is an increase in pressure under the first metatarsal as the foot rolls in. This force may be considered as an upward pressure from the floor on the inside of the weight-bearing portion of the foot. This pressure beneath the first metatarsal can cause it to elevate, resulting in hypermobility, hallux limitus or hallux rigidus. Simple orthotics such as the Dr Foot Work Insoles can often provide relief.

Long Term Prognosis

Research shows that although the joint remains arthritic and stiff, it tends not to get much worse in the majority of people. Even after 20 years the joint was much the same as it had been when the people who were studied first went to the doctor.

However, in about 20-25% the joint becomes progressively more stiff or painful and treatment may be required.


Hallux Rigidus

Conservative Treatment

  • As a form of degenerative arthritis, treatment begins with anti-inflammatory medication. Other conservative treatments include:
    • Shoes with a larger toe box
    • Rest and ice
    • Use of a toe spacer between the great and second toe
    • Stretching of the foot
    • Avoid high heels
    • Watch your weight
  • You can take simple pain killers for the pain if it bad and interfering with your life. Try parakeet first as side-effects are rare if you stick to the correct dosage. If this does not work your doctor may prescribe stronger pain killers or anti-inflammatory medicines if these are considered to be safe for you.
  • Because the joint is usually most painful when the toe is bent upwards during walking, it sometimes helps to stiffen the sole of your shoe so that it does not bend while walking. If you do this, you may need a small "rocker bar" on the sole of your shoe so that you can rock over this while walking instead of bending your toe up. This can be done for you by an orthotist or chiropodist. One disadvantage of this treatment is that the stiff insole may push your osteophyte up against the shoe.
  • If the toe remains very painful, it may be worth injecting some steroid mixed with local anaesthetic into the joint. This reduces the inflammation inside the joint. The injection can usually be given in the outpatient clinic, although sometimes you may have to come into hospital as a day patient. The toe may be painful for a few days after the injection and any improvement has usually occurred by a week. If your toe is improved by an injection the effect may last for a few days, weeks or months; occasionally the improvement seems to be permanent.

Surgical Treatment

  • If none of the conservative options helps, an operation may be useful. You would need to discuss this with an orthopaedic foot and ankle surgeon by referral from your GP. There are five main operations for hallux rigidus:
  • Either as a separate operation or at the same time as a cheilectomy, the bone in the base of your great toe (proximal phalanx) may be reshaped to make the most of the movement you have left.
  • If the whole joint is involved, there are three main options, depending on the age and activity of the patient:
  • In young fit people, especially those doing heavy jobs, a fusion of the joint would be recommended. This removes the painful joint and stiffens it completely. 95% of people will get rid of their pain. However, the toe is stiffer than before and the choice of shoes is more limited. A few people will go on to get arthritis of the small joint in the middle of the toe after a fusion, but this is not usually troublesome.
  • In retired, active people, a plastic("silastic") replacement of the joint may be offered. This gets rid of the painful joint and, unlike a fusion, keeps some movement. This makes it easier to walk and to choose shoes (though high heels are still not advisable). However, the joint may wear out and if it does the toe may become very inflamed again. This can be difficult to treat and another operation may be needed. This is why replacement is only advised in people who are not very physically active.
  • In an elderly person who walks very little, the simplest operation is simply to cut out the arthritic joint (Keller's procedure) and leave the toe a little floppy. This can be quite successful in people who walk very little. However, in the more active person the toe may become deformed and pain tends to develop in the ball of the foot because of the weak big toe.

Dr Foot Recommends

Dr Foot Pro Hallux Rigidus Insoles (3/4 length) Pair

£ 25.00

Dr Foot Pro Hallux Rigidus Insoles have a 4 degree forefoot 1st metatarsal post to redistribute pressure away from the 1st metatarsal joint, only use these insoles if you have been diagnosed with Hallux Rigidus.

A common cause of hallux rigidus (stiff big toe) is poor alignment of feet (over pronation). The Dr Foot Work Insoles are designed specifically to fit into work boots and shoes. These dynamically engineered functional insoles correct over pronation and provide comfort and relief for people who are on their feet all day. They are not rigid insoles and thus do not use brute force to correct the underlying biomechanical problem.

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"I had a lot of arch problems which was causing leg and pain in my big toe as I neglected to treat the symptoms for such as long time. After I started using these supports I can work all day - on concrete - with hardly any soreness or tiredness. They work! "

Mrs McManus, Surrey UK