Hallux Rigidus - Big Toe Joint Arthritis

What is Hallux Rigidus?

This is a very common problem and means arthritis in the main joint (metatarsophalangeal joint) of the big toe.  Hallux is taken from the Greek for big toe and rigidus means stiff or rigid.

What are the symptoms?

As the name implies the big toe joint becomes stiff and inflexible. Unfortunately, this is often accompanied by pain which can severely limit activities. In some people the pain is so severe that even walking short distances can be difficult. The pain is commonly worse when the toe bends upwards (dorsiflexion). Swelling around the joint is common and is a result of fluid, from inflammation, and new bone formation.  The new bone tends to form prominent spurs over the top of the joint- these can rub on shoes and in severe cases may even ulcerate through the skin. Early on in the disease process the pain tends to only come on with certain activities such as running. Over time it may become painful even when resting.

What causes big toe arthritis?

In the majority of people Hallux rigidus occurs spontaneously and there is no underlying reason or cause. In some people there may be certain precipitating factors such as

• Previous trauma such as a cartilage injury or fracture involving the big toe joint. Many of these are missed injuries and the symptoms from arthritis often only develop years after the injury.
• Generalised osteoarthritis- some people are affected by wear and tear arthritis (osteoarthritis) in many joints. People with this condition often have involvement of the big toe joints.
• Inflammatory arthritis- people with rheumatoid arthritis and other types of inflammatory arthritis often have widespread joint disease and the big toe joints are frequently affected.

How is it diagnosed?

The diagnosis is generally fairly straightforward. A single consultation with a Consultant Orthopaedic Foot & Ankle Surgeon and routine standing x-rays of the foot tend to be all that is required. The X-rays are used to look for associated foot problems such as arthritis elsewhere, the overall alignment, bone spurs and the severity of the arthritis. Very occasionally in younger patients when a cartilage injury (osteochondral defect) is suspected an MRI scan may be needed.

Can it get worse?

Hallux rigidus can occur at any age- even during adolescence. In some people the symptoms remain stable and do not worsen but in most the arthritis progresses. The timescale for any progression is difficult to predict but may be years.

How can it be treated?

If you have no pain, discomfort or other symptoms then you do not need any treatment. If you are having symptoms such as pain, swelling, stiffness or rubbing then there are several treatment options.

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