Hallux Rigidus

ExitCare ImageHallux rigidus is a condition involving pain and a loss of motion of the first (big) toe. The pain gets worse with lifting up (extension) of the toe. This is usually due to arthritic bony bumps (spurring) of the joint at the base of the big toe.

SYMPTOMS

  • Pain, with lifting up of the toe.

  • Tenderness over the joint where the big toe meets the foot.

  • Redness, swelling, and warmth over the top of the base of the big toe (sometimes).

  • Foot pain, stiffness, and limping.

CAUSES

Halllux rigidus is caused by arthritis of the joint where the big toe meets the foot. The arthritis creates a bone spur that pinches the soft tissues, when the toe is extended.

RISK INCREASES WITH:

  • Tight shoes, with a narrow toe box.

  • Family history of foot problems.

  • Gout and rheumatoid and psoriatic arthritis.

  • History of previous toe injury, including "turf toe."

  • Long first toe, flat feet, and other big toe bony bumps.

  • Arthritis of the big toe.

PREVENTION

  • Wear wide toed shoes that fit well.

  • Tape the big toe, to reduce motion and to prevent pinching of the tissues between the bone.

  • Maintain physical fitness:

  • Foot and ankle flexibility.

  • Muscle strength and endurance.

PROGNOSIS

This condition can usually be managed with proper treatment. However, surgery is typically required to prevent the problem from recurring.

RELATED COMPLICATIONS

Injury to other areas of the foot or ankle, caused by abnormal walking in an attempt to avoid the pain felt when walking normally.

TREATMENT

Treatment first involves stopping the activities that aggravate your symptoms. Ice and medicine can be used to reduce the pain and inflammation. Modifications to shoes may help reduce pain, including wearing stiff-soled shoes, shoes with a wide toe box, inserting a padded donut to relieve pressure on top of the joint, or wearing an arch support. Corticosteroid injections may be given to reduce inflammation. If non-surgical treatment is unsuccessful, surgery may be needed. Surgical options include removing the arthritic bony spur, cutting a bone in the foot to change the arc of motion (allowing the toe to extend more), or fusion of the joint (eliminating all motion in the joint at the base of the big toe).

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually prescribed only after surgery. Use only as directed and only as much as you need.

  • Ointments for arthritis, applied to the skin, may give some relief.

  • Injections of corticosteroids may be given to reduce inflammation.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • After surgery you develop fever, increasing pain, redness, swelling, drainage of fluids, bleeding, or increasing warmth.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)