What is hallux rigidus?
Hallux rigidus is arthritis affecting the base of the big toe (1st MTP) joint and is a relatively common condition.
“Hallux” is the Greek word for toe and “rigidus” means it is stiff.
What causes Hallux Rigidus?
There are many different reason a person develops arthritis of any joint. Some arthritis is hereditary (runs in families) but excess weight, damage to the joint or overuse can cause arthritis.
What problems/symptoms does it cause?
Pain, swelling and stiffness are the main problems experienced. Activities may be limited due to these symptoms.
The surface covering of the ends of the joints are damaged so instead of gliding smoothly over each other like ice on ice, they rub and catch.
Extra bone is formed around the joint as part of the arthritis process. This extra bone and the pain in the joint limits movement.
How is it diagnosed?
The diagnosis is made on the history given and the examination. An xray confirms the diagnosis.
What is the treatment for hallux rigidus?
The treatment can be either surgical or non surgical
- Wearing shoes with stiff soles reduces the bend of the great toe and may help reduce symptoms.
- Avoiding activities that make the problem worse.
- Pain killers – simple paracetamol and anti inflammatory medication if allowed.
Fusion (arthrodesis/stiffening) of the joint at the base of the big toe is a permanent solution to the problem and is very effective.
The operation is performed as a day case procedure. A general anaesthetic is required.
Worn cartilage and bone is removed from either side of the joint. The ends of the bones of the joint are “freshened” and then held together with plates or screws. The screws are buried and do not usually need to be removed. The body thinks the bones are broken and heal.
A special shoe is worn for 6 weeks afterwards.
People walk normally once they have recovered from surgery and many are able to run and play sports.
Because worn cartilage is removed during the operation, the toe will be shortened by a small (approx. 0.5cm) amount.
90% of people who have this operation are very pleased with the result.
It is important to remember that the base of the big toe is permanently stiffened & high heeled (>2 inches) shoes cannot be worn after surgery.
The small risks of surgery are:
- Infection (1-2%)
- The bone not joining up (1-2%)
- The bone joining in an imperfect position (2-3%)
- Sensitivity or numbness related to the skin incision (2-3%)
The risk of these problems are higher in people who smoke, have diabetes or poor circulation. Some of these complications may necessitate further surgery.
How long does recovery take?
The foot usually takes 12 weeks to fully recover from surgery.
The toe will be immobilized for 6 weeks following surgery while the bone heals. During this time you will walk on your heel or use a special shoe. You cannot drive (except if it is your left foot and you have an automatic car).
The foot may be swollen for up to 12 weeks following surgery.