Hallux Rigidus

The most common site of arthritis in the foot is at the base of the big toe. This joint is called the metatarsophalangeal or MTP joint. It is important because it has to bend every time you take a step. If the joint starts to stiffen, walking can become painful and difficult.

In the MTP joint, as in any joint, the ends of the bones are covered by a smooth articular cartilage. If wear-and-tear or injury damage the articular cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The result is a stiff big toe, or hallux rigidus. Often there is appearance of a dorsal bone spur, which may looks similar to a bunion. It can be genetic in nature, or caused from injury.

Symptoms

• Pain in the joint when you are active, especially as you push-off on the toes when you walk
• Swelling around the joint
• A bump, like a bunion or callus, that develops on the top of the foot
• Stiffness in the great toe and an inability to bend it up or down

Diagnosis

Examination may show stiffness or pain of the joint. X-rays will show the location and size of any bone spurs, as well as the degree of degeneration in the joint space and cartilage.

Treatment

Nonoperative Treatment
Nonoperative treatments include stiff shoes with wide toe box, orthotics (carbon fiber insert), NSAIDs, and cortisone injection.

Surgical Treatment
Without response to nonoperative measures surgery is considered. Surgical options range from cheilectomy (cleaning of the joint) to fusion of the joint.