This page describes the condition of Hallux Rigidus and the approach to this condition adopted by Mr Bowyer. Other surgeons may use variations on the techniques, for instance with regard to post-operative management. It is important that you understand what your own surgeon intends to do, and how you will be treated after the procedure.
Hallux rigidus (sometimes also called hallux limitus) is a painful loss of motion of the big (first) toe, particularly when extending (lifting up) the toe. This is usually due to arthritic degeneration of the joint at the base of the big toe.
Common Signs and Symptoms
- Pain when extending (lifting up) the first toe, including when trying to stand on your tiptoes or push off, such as when running or jumping
- Tenderness of the top of the joint at the base of the first toe
- Redness, swelling, and warmth over the top of the base of the big toe (occasionally)
- Foot pain, stiffness, and limping
Arthritis of the big toe that causes bone spurs protruding from the bones that make up the joint at the base of the toe, which results in pinching of the soft tissues between the bony spurs as the toe is extended (lifted up).
This condition is usually curable with appropriate treatment, although often surgery is required to prevent the problem from recurring.
Injury to other areas of the foot or ankle due to abnormal walking associated with trying to avoid the pain of toe motion with normal walking.
General Treatment Considerations
Initial treatment consists of rest from the offending activity and medications and ice to help reduce inflammation and pain. Wear stiff-soled shoes with a wide toe area to help reduce bending of the big toe and pressure on the top of the first toe. Occasionally an orthotic provided by a podiatrist, incorporating a modification such as a “kinetic wedge” may help reduce pressure on the big toe and eliminate the symptoms. However, stiff shoes may affect athletic activity and womens shoes are often not suitable for this approach to treatment. A cortisone injection into the arthritic joint may also be beneficial, particularly if there has been an acute flare-up of pain.
If these treatments are not successful, surgery may be necessary. Surgical options include removing the arthritic bony spur (dorsal cheilectomy), sometimes combined with cutting a bone in the toe to change the arc of motion (Moberg osteotomy). An alternative approach is fusion of the joint (totally eliminating all motion in the joint at the base of the big toe, arthrodesis), but keeping the middle joint freely moving. These options will often alleviate the symptoms, allow most footwear to be worn, and allow walking without a limp.