Hallux Rigidus (Big Toe Arthritis)

What is Hallux Rigidus (Big Toe Arthritis)?

Hallux rigidus (HR) or ‘Big Toe Arthritis’ is a condition characterised by stiffness and limited movement in the joint at the base of the big toe, known as the great toe metatarsophalangeal joint (MTPJ). Typically caused by arthritis or wear and tear of the cartilage lining the joint, big toe arthritis can also result from previous injuries or underlying medical conditions such as gout. While its exactcause may sometimes remain unknown, it often develops with age.

hallux rigidus big toe arthritis image of inflammation and xray

 

Hallux rigidus can manifest in varying degrees of severity, ranging from mild stiffness to significant limitation of movement. In its mildest form, individuals may experience occasional discomfort and stiffness in the big toe joint, particularly during activities that require bending the toe. As the condition progresses, stiffness and pain may become more pronounced, affecting daily activities such as walking, standing, and even wearing shoes. Severe cases of hallux rigidus may result in complete loss of movement in the big toe joint, leading to significant disability and impairment of quality of life.

The extent of joint damage can also vary among individuals with hallux rigidus. In some cases, the cartilage within the MTPJ may show early signs of wear and tear, with minor irregularities and roughening of the joint surfaces. In more advanced stages, the cartilage may become severely eroded, leading to the formation of bony spurs (osteophytes) and deformity of the joint. These bony spurs can cause pain and discomfort, particularly when they rub against surrounding soft tissues or press against tight-fitting shoes.

The primary cause of hallux rigidus is arthritis, which leads to the deterioration of the cartilage within the MTPJ. This can result from wear and tear over time, previous injuries to the joint, or underlying medical conditions like gout. However, in some cases, the exact cause may remain unidentified. While the exact cause of hallux rigidus may sometimes be unclear, it often develops gradually over time, particularly as people age and the joint undergoes natural degenerative changes.

  • Stiffness and Pain: Hallux rigidus commonly manifests with stiffness and pain in the metatarsophalangeal joint (MTPJ) of the big toe. This stiffness can vary in severity and may be particularly noticeable during the initial steps after periods of rest.
  • Impaired Mobility: Individuals with hallux rigidus often experience difficulty walking, especially when engaging in activities that require bending the toe, such as pushing off during walking or running. The limited range of motion in the affected joint can significantly impact mobility and gait, leading to altered walking patterns and discomfort.
  • Discomfort During Activity: Engaging in physical activities that involve flexing the big toe, such as climbing stairs or squatting, may exacerbate symptoms of hallux rigidus. The pain and stiffness in the MTPJ can hinder movement and make it challenging to perform daily tasks or participate in recreational activities.
  • Formation of Osteophytes: Over time, bony spurs, known as osteophytes, may develop around the affected joint in response to the degenerative changes associated with hallux rigidus. These osteophytes can cause additional pain and discomfort, especially when pressure is applied to the area, such as when wearing tight-fitting shoes. The presence of osteophytes can further restrict movement and exacerbate symptoms, impacting the individual’s quality of life.

Foot Anatomy

The foot’s anatomy is intricate, comprising bones, ligaments, tendons, muscles, and cartilage, all playing pivotal roles in its function.

In the context of hallux rigidus, particular attention is drawn to key structures around the great toe metatarsophalangeal joint (MTPJ). The first metatarsal bone and proximal phalanx (phalanges) interact at this joint, crucial for maintaining alignment and enabling movement.

Cartilage within the MTPJ ensures smooth movement, but in big toe arthritis, cartilage deterioration leads to inflammation and stiffness.

"Palmer - Drawing Bones and joints of the foot - English labels" by Beckie Palmer, © StatPearls Publishing LLC, license: CC BY

Treatment & Surgery Options

In its mildest form, big toe arthritis may not need operative treatment. Non-operative management focuses on relieving pain and reducing stress on the affected joint. Lifestyle modifications, weight loss, and the use of walking aids can help alleviate symptoms. Pain relief medications and appropriate footwear, including shoes with stiff insoles or a rocker bottom, may also be recommended. In some cases, cortisone injections can provide temporary relief from inflammation.

Surgical intervention may be considered if conservative measures fail to provide adequate relief.

 

  • MTPJ Debridement +/- Osteotomy:

In mild cases, joint debridement involves trimming affected surfaces and washing out debris, often combined with osteotomy for realignment. Advanced cases may require additional procedures like resection and soft tissue insertion to provide long-term relief.

 

  • MTPJ Replacement:

Artificial joint replacements have shown mixed results in treating HR, with concerns about long-term reliability. While newer implants offer potential, their efficacy remains uncertain, and many surgeons do not recommend this approach.

 

  • MTPJ Arthrodesis (Fusion):

Considered the “gold standard” for moderate to severe HR, arthrodesis involves removing remaining cartilage and fusing bones together. While providing significant pain relief, it limits joint mobility and may require lifestyle adjustments.

The choice of surgery depends on factors like arthritis severity, patient age, and functional demands, requiring consultation with a skilled surgeon to determine the most suitable treatment approach.

 

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Downloadable info sheets related to Hallux Rigidus (Big Toe Arthritis)

These notes from OrthoSport Victoria are for educational purposes only and are not to be used as medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.

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