Stiff Big Toe (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’s 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 ( hallux rigidus).
Hallux rigidus usually develops in adults between the ages of 30 and 60 years. No one knows why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.
Cause & 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
If you find it difficult to bend your toe up and down or find that you are walking on the outside of your foot because of pain in the toe, see your doctor right away. Hallux rigidus is easier to treat when the condition is caught early. If you wait until you see a bony bump on the top of your foot, the bone spurs will have already developed and the condition will be more difficult to treat.
Your physician will examine your foot and look for evidence of bone spurs. He or she may move the toe around to see how much motion is possible without pain. 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.
Unless the underlying causes of bunions are eliminated, they will only worsen over time. In cases of severe discomfort, a surgical procedure known as a bunionectomy may be performed. The amount of the deformity will determine the surgical technique prescribed.
In the case of small bunions, the bothersome bump may only require shaving to repair the soft tissue in the big toe joint. However, bunions that cause severe pain or discomfort usually require more correction than shaving provides.
In the more severe cases, the technique most often recommended is a procedure that involves breaking and then realigning the metatarsal bone to decrease the toe’s angle of deviation. In both procedures, the bones are correctly repositioned and then stabilized with screws, pins, plates, or wires.
Your orthopedic surgeons use many different surgical procedures to treat bunions. The common goal of these procedures is to realign the joint, relieve pain, and correct deformity.
These procedures include:
- Repair of the Tendons and Ligaments Around the Big Toe
- These tissues may be too tight on one side and too loose on the other, creating an imbalance that causes the big toe to drift toward the others. Often combined with an osteotomy, this procedure shortens the loose tissues and lengthens the tight ones.
Removal of the damaged joint surfaces, followed by the insertion of screws, wires, or plates to hold the surfaces together until it heals. Used for patients with severe bunions, severe arthritis, and when other procedures have failed.
Removal of the bump on the toe joint; used only for an enlargement of the bone with no drifting of the big toe. This procedure is seldom used because it rarely corrects the cause of the bunion.
Removal of the damaged portion of the joint, used mainly for patients who are older, have had previous bunion surgery, or have severe arthritis. This creates a flexible “scar” joint.
The surgical cutting and realignment of the joint. Your orthopedic surgeon will choose the procedure best suited to your condition.
Although this surgery is a relatively simple procedure, the bones and soft tissues involved will usually take approximately three full months to heal. A walking shoe, crutches, or even a wheelchair may be needed to keep weight off the foot during recovery.
When severe bunions occur on both feet, each will require undergoing a separate bunionectomy and recovery period. Having both feet repaired surgically at the same time is strongly discouraged.