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Hallux Rigidus

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Hallux rigidus is a disorder where the big toe becomes increasingly stiff. “Hallus” refers to the big toe, and “rigidus” indicates that it is rigid and cannot move. The joint at the base of the big toe is called the metatarsophalangeal, or MTP joint, and is one of the most common sites to develop foot arthritis. Every time a step is taken, the MTP joint has to move, if it becomes stiff, walking is difficult and painful. This stiffening is usually due to normal wear-and-tear or from an injury to the joint which makes the cartilage to break down. As the cartilage breaks down the ends of the bone rub together causing pain and bone spurs to develop. Hallux rigidus can be a disabling condition, since the big toe is essential for many movements, even simply standing. The condition is degenerative, meaning it gets progressively worse over time as the joint because frozen in place.

Hallux Rigidus Causes

Hallux rigidus occurs as a result of structural abnormalities of the foot causing osteoarthritis of the joint at the base of the big toe. People who have fallen arches or rolled-in ankles are more susceptible to hallux rigidus. It is unknown why hallux rigidus affect some people and not others but it is normally found in people between the ages of 30-60. Hallux rigidus may be caused by an injury to the toe or from normal wear-and-tear. People with a foot deformity or people who have a family history of it are also at risk of developing the condition.

Hallux Rigidus Symptoms

The most common symptoms for hallux rigidus are:

  • Pain in the big toe joint while walking, especially when patients push-off of something with their foot. Pain may still be present while resting in severe cases
  • Swelling and inflammation around the joint
  • A bump that looks like a bunion or a callous on top of the foot (although bunions are different from hallux rigidus)
  • Stiffness in the big toe and the inability to move it up or down
  • Aggravated symptoms with cold or damp weather
  • Difficulty wearing shoes if bone spurs develop
  • Limping

Diagnosis

The orthopedist will conduct a physical examination of the foot to determine the range of motion of the big toe. An x-ray can evaluate the extent of damage present and pinpoint any other abnormalities, such as bone spurs.

Hallux Rigidus Treatment

Nonsurgical treatment is used to manage hallux rigidus in earlier stages, before the development of possible bone spurs which are more difficult to manage. Treatment may prevent or postpone the need for future surgery, with the following methods:

  • Shoe modifications. A larger “toe box” allows more room for the toe. Supportive soles may also be suggested. Your surgeon may also recommended custom orthotic devices to improve foot function
  • Medication. NSAID medicines may help reduce pain and inflammation
  • Injections. Corticosteroids injected in the MTP joint to help reduce pain and inflammation
  • Physical therapy

If nonsurgical methods prove ineffective, then surgery may help reduce or eliminate the painful symptoms of hallux rigidus. There are three main surgeries that can be used to correct this problem, cheilectomy, arthrodesis, and arthroplasty. Cheilectomy – Doctors recommend this surgery when there is mild or moderate damage done to the MTP joint. The surgery involves making an incision on the top of the foot so they can remove any bone spurs and a portion of the foot bone to allow more room for the toe to bend. Arthrodesis – When the damage to the cartilage in the MTP joint is severe enough doctors will fuse the bones together. Surgeons do this by removing the damaged cartilage then use medical pins, screws or plates to fix the joint into a permanent position. By doing this the bones start to grow together and the toe will not be able to be bent at all. This is the best way to reduce pain in cases with severe damage. Patients have to wear a cast for the first six weeks following surgery and will not be able to wear high heels. They may also have to wear a shoe that has a rocker-type sole. Arthroplasty – This is a joint replacement surgery is normally done with older patients who have fewer functional demands on the feet. Doctors remove the joint surfaces and an artificial joint is implanted to relieve pain and preserve joint motion.

Risks

Like with any surgery there are risks involved:

  • Infection
  • Damage to the surrounding nerves
  • Damage to the blood vessels
  • Damage to the joint
  • Blood clots
  • Difficulty healing
  • Failure to relieve symptoms
  • Death

There are a few different treatment methods to heal hallux rigidus. If you're looking for long-lasting relief, it's time you visited West Medical. We care about our patients, and we're happy to thoroughly assess your condition to provide you with the best possible treatment option. If you are interested in learning more about hallux rigidus causes, symptoms, and treatment in Los Angeles and throughout Southern California, please call our West Medical offices at (855) 690-0565 and one of our representatives will be happy to address any of your questions, comments, or concerns.

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