Stiff Big Toe (Hallux Rigidus)

Who are Affected by Stiff Big Toe?

Stiff Toe or Hallux Rigidus usually occurs between 30 and 60 years of age. It may be more common with certain types of foot anatomy which place more stress on the big toe joint. Hence, the toe becomes stiff and walking is painful. 

What Are the Causes of Hallux Rigidus?

The condition may occur due to:

• Age related wear and tear
• An injury sustained at the joint between the big toe and the foot (metatarsophalangeal joint). This can lead to loss of the cartilage from the joint which provides a cushioning effect and allows smooth movement and flexibility of the big toe.

The bones may rub against each other causing pain and the development of bone spurs that further restrict toe movement. 

Symptoms of Hallux Rigidus

Pain is present at the base of the first toe especially when pushing off as you walk. It may be associated with swelling around the joint, a bony bump on the top portion of the foot as well as rigidity and inability to bend the toe.

If you find that your toe is painful and stiff causing you to bear weight on the outside of your foot, you might be suffering from hallux rigidus.

It is recommended that you get it evaluated during the initial stages of the disease before any bone spurs develop. 

How is Hallux Rigidus Diagnosed

Your doctor is highly qualified to examine, diagnose, and treat arthritic conditions of the foot such as hallux rigidus. 

Medical History

Your doctor will ask questions about:

• Current symptoms and their severity
• If an injury was sustained
• Your medical history including family or genetic links
• Your current and past medications
• The impact of the problem on your occupation and lifestyle

Physical Examination

Your doctor perform comprehensive physical evaluation that will include:

• Examining the affected area for swelling, pain, bruising or other features
• Assessing your range of motion, walking pattern and other relevant features

Diagnostic Testing

Once your doctor has completed the physical examination further tests maybe required. These tests can help your doctor determine or eliminate possible causes. These can include:

• X-Ray
• Ultrasound (US)
• Computerised Tomography (CT)
• Magnetic Resonance Imaging (MRI)

Once a final diagnosis has been completed your doctor can discuss with you and recommend any treatment options.

Non Surgical Treatment for Hallux Rigidus

Many cases can be effectively treated with conservative therapy which can include:

• Rest: A period of rest may be required during flare-ups of pain (e.g. temporarily stopping sports)
• Pain medication: Paracetamol, Ibuprofen and Nonsteroidal anti-inflammatory medications (NSAIDs) can help to relieve pain or discomfort. Stronger pain medications may also be required. 
• Shoewear Modification: Changing your shoe to one with a broader toe area and a stiff or rocker-bottom sole may help reduce pressure on the toe.
• Orthotics: Custom orthotic devices may help to reduce pain
• Injection Therapies: A corticosteroid injection may be recommended to help reduce inflammation and pain.

Surgical Treatment for Stiff Big Toe

If these non-surgical treatment modalities do not provide relief, then doctor will discuss your surgical options which may include:

• Cheilectomy: Removal of bone spurs as well as a small portion of the bone from the foot to allow more toe movement. It is usually recommended in mild forms of the disease.
• Arthrodesis: Fusing the toe to the foot. It is usually recommended if the cartilage is severely eroded and movement of the toe is very painful.