#condition - Foot & Ankle

Big Toe Arthritis (Hallux Rigidis)

What is Hallux rigidis and what causes it?

Hallux rigidus is arthritis or ‘wear and tear’ of the main joint of the big toe.

In most people there is no definite cause. The fact that the joint bears significant stress during walking must play a role. Occasionally, it relates to an injury or another medical problem such as gout or an infection.

What are the common problems?

Common symptoms pointing to the diagnosis are pain in the big toe around the joint. This usually occurs when walking, but can also be present at rest and at night. Stiffness of the big toe is common and the ability to turn the big toe upwards is usually lost.

A bony bump (“osteophyte”) may develop on top of the joint, which you might be able to see and feel. This is your body’s natural response to the worn joint. The bump may rub on shoes. We sometimes call this a dorsal bunion. (X-ray below, shows the bump on the bone)

To compensate for the painful big toe some people tend to walk on the side of the foot The problem tends to develop early in life, and in most people it gradually deteriorates without pain over many decades. In about 20-25% of people the joint becomes progressively more stiff and/or painful and treatment may be required.

What are the treatment options?

Treatment always begins with conservative (non-surgical) treatment. I recommend staying active if possible (good for general health), and wearing sensible shoes.

You can take simple pain killers, if the pain is bad and interfering with your life. Your GP will be able to oversee this aspect and ensure the prescribed medication is safe. The toe is usually most painful when it is bent upwards and it can be helpful to stiffen the sole of your shoe so that it does not bend whilst walking. Your orthotist will be able to advise you, and will often manufacture a small rocker (curve) to the sole of the shoe with a rigid extension to control big toe movement. The rocker helps reduce the amount of work your big toe needs to do during walking.

If the toe remains very painful, it may be worth injecting some steroid mixed with local anaesthetic into the joint. This reduces the inflammation and the injection can be given in the outpatient clinic. The toe may be more painful for a few days after the injection and if improvement occurs you will notice this within a few weeks. The duration of improvement is variable from none at all, to the occasional patient who is cured.

Failing the above, surgery is indicated and can follow a number of different directions.

What are the surgical options?

These include a cheilectomy, which involves removing the bony lump on the top of the toe which may be causing the pain, through to a fusion (permanent joining) of the big toe joint.