Do you have a stiff or painful big toe joint?  A common problem with the big toe is a disorder called hallux rigidus. Hallux or the big toe and rigidus which means stiff. This is a condition where the ball of the foot or first metatarsophalangeal joint develops arthritis. Arthritis in this case is related to cartilage breakdown at the joint that leads to bone spur formation that limits the mobility of the joint.

 

Early on patients have stiffness bending the joint at extreme ranges of motion, such as toe off while running. In advanced cases, the joint can lose most if not all of its mobility. In hallux rigidus the bones surrounding the joint form large bone spurs that can not only limit the motion, but can rub on shoes causing irritation.

 

Early hallux rigidus can be treated with topical antiinflammatories and special inserts in the shoes that make the sole of the shoe stiffer to prevent painful motion across the joint. Some patients undergo corticosteroid injections which can be a medium term effective solution for pain relief. Medium severity hallux rigidus can be treated with a procedure called a cheilectomy where the impinging or colliding spurs are removed, allowing the joint to cycle more freely.

In late cases where the cartilage is destroyed and the joint is very stiff, patients typically undergo a first metatarsophalangeal arthrodesis or fusion procedure where the arthritic joint is removed and the metatarsal and proximal phalanx are fused or heal together. This is a very effective procedure to limit pain and to restore function. Often patients will ask if this procedure will limit function. The procedure is to improve function and reduce pain. Many studies have shown that patients following fusion of this joint can jog, ski, hike, cycle, swim, and even continue yoga.