What Is Hallux Rigidus & What You Should Do About It

Your big toe has been a bit creaky and sore for a while, but lately it has become just plain stiff and you want to figure out what's going on. If this sounds familiar, it's time to make an appointment with a medical professional. You might have hallux rigidus or “Stiff Big Toe,” a form of degenerative arthritis.

The Basics ---

• A big toe that has gone from creaky and sore to just plan stiff might be suffering from hallux rigidus, a form of degenerative arthritis that is best addressed early.
• Typically caused by irregular biomechanics or structural problems with the foot, hallux rigidus is a progressive condition that can also be caused by genetics. If you notice pain, swelling, or stiffness in your big toe, it's time to see a podiatrist or foot surgeon for a diagnosis.
• Non-surgical treatments for hallux rigidus include icing, physical therapy, wearing shoes with a wide toe box, and using corrective hallux rigidus orthotics. If a medical professional has diagnosed you with hallux rigidus and advised you to add insoles to your footwear, we recommend Tread Labs Pace Insoles to give you the support your foot needs to correct any biomechanical issues that are placing pressure on the joint of your big toe.

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What You Need To Know ---

What Causes Hallux Rigidus?

Typically, hallux rigidus is caused by irregular biomechanics or structural problems with the foot. Over time, the big toe metatarsophalangeal, or MTP joint, may become arthritic. This can occur through repeated pressure due to other foot abnormalities, like fallen arches, which put additional weight on the joint.

Hallux rigidus may also have a genetic component. So, if it runs in your family, that may be part of the cause. Other potential causes include excessive squatting or other activities that place continual pressure on the big toe joint, contributing to the disintegration of the surrounding cartilage.

Medical conditions like gout or rheumatoid arthritis can also contribute to the development of Stiff Big Toe, which is most common in people between the ages of 30 and 60 years of age.

What Are the Symptoms of Hallux Rigidus?

If you've experienced discomfort, rigidity, or swelling in your big toe while walking, squatting, bending, climbing stairs, or during other activities, these could be early symptoms of hallux rigidus.

The symptoms may be exacerbated during damp or cold weather. Eventually, as the condition progresses, you may experience pain even when you’re off your feet.

You may begin to limp while walking or feel hip, knee, or lower back pain. These symptoms are signs that your body is attempting to compensate for the loss of flexibility and balance.

You could even develop painful bone spurs, caused by the friction of your bones rubbing together when the surrounding cartilage wears away.

Diagnosis, Treatment & Modifications

Diagnosing hallux rigidus involves a visit to a podiatrist or foot surgeon—preferably before the condition has progressed to full rigidity or before a bone spur has developed. Your practitioner will examine the flexibility of your big toe by moving it in different directions.

If arthritis or a bone spur is suspected, the doctor may order a series of X-rays to examine the extent of damage to the area before deciding on the best course of treatment.

Nonsurgical Hallux Rigidus Treatments

• Applying ice to the affected toe to help reduce swelling and pain
• Wearing shoes with a wide toe box to alleviate pressure on the toe joint
• Using corrective hallux rigidus insoles to improve functionality and support proper biomechanics while walking
• Alternating between ice and hot water soaks for 30 seconds at a time
• Physical therapy
• Anti-inflammatory drugs to help with big toe pain and swelling
• Steroid injections at the site to reduce inflammation and big toe pain

Surgical Hallux Rigidus Treatments

The following are some surgical treatments that may be required to help correct more serious cases of Stiff Big Toe:

Cheilectomy

If your hallux rigidus is moderate-to-severe, your doctor may recommend removal of any spurs and/or a portion of the bone. This will help the joint to move more freely. A cheilectomy for hallux rigidus involves creating an incision along the top of the foot to provide access to the bone, which is then surgically cut.

Post-surgery, your big toe will require months of healing time, and you'll need to wear a special sandal with a wooden sole for at least two weeks after your procedure. Patient outcomes following cheilectomy are generally positive and effective for the long-term.

Arthrodesis

For extreme cases of hallux rigidus, your foot surgeon may need to do a bone fusion. This is accomplished through a surgical incision and removal of the damaged cartilage, followed by the insertion of pins, a plate, and screws to affix the toe joint into the proper position.

Although you will be permanently unable to move the toe joint after your surgery, the pain, bone spurs, and swelling associated with the condition will eventually subside.  

You will be in a cast for at least six-weeks post-surgery, and you’ll need crutches for another six weeks after that, so you’ll need to plan for a lengthy recovery. Because your toe will be unable to bend after the fusion, you will have to wear flat heels and may require a rocker sole on your footwear.

Arthroplasty

Joint replacement surgery may be an option to restore flexibility to the toe and reduce chronic pain and swelling. Usually, this procedure is only recommended for elderly patients whose mobility needs are less demanding than younger patients.

How Do Hallux Rigidus Orthotics Help?

Stiff Big Toe is often a result of pressure placed on the joint due to biomechanical issues with your feet. Insoles for hallux rigidus are designed to correct such issues can be helpful.

When you're looking for insoles to relieve arthritis pain in your big toe, you'll want to make sure you find ones that have firm, medical grade support. Soft, foam insoles won't give your feet the support they need to align your ankles, knees, and hips. Aligning your body properly takes pressure of your big toe joints. 

Check these boxes when you're shopping for hallux rigidus orthotics:

• The contours of the insoles should mimic the contours of your feet. Your arch should be fully supported throughout.
• Soft, cushy insoles might feel comfortable to start, but they are not going to help align your body by correcting biomechanical issues. Only firm support can do that.
• Durable materials that hold up, like open-cell polyurethane foam instead of EVA.

When To See A Podiatrist For Hallux Rigidus

Like most progressive conditions, the best time to seek treatment for hallux rigidus is early on. Speak to your doctor if you notice pain, swelling, or stiffness in your big toe or if activities that require toe flexibility become difficult.

With a proactive approach to foot wellness, you may be able to avoid foot surgery and a lengthy recovery. With proper shoes and the use of supportive hallux rigidus orthotics, you can remediate the discomfort and reduce the cartilage and joint damage of this condition.

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