Stiff Big Toe (Hallux Rigidus)

The great toe is most important in your normal walking. During the walking cycle it supports 50% of the body’s weight. If it doesn’t function normally, walking can become difficult and painful. Hallux rigidus is the result of worsening arthritis in the metatarsophalangeal joint, the joint space narrows, cartilage deteriorates and pain results. Arthritis can be caused by repeated trauma, rheumatoid arthritis and metabolic conditions.

Initial treatment is modification with orthoses or specialised shoes. This along with activity modification, pain relief and weight loss can delay progression.

If symptoms worsen surgery can be considered. Two of the standard procedures are cheilectomy and joint fusion (arthrodesis). Joint replacement has been made available in recent years. However the outcomes and satisfaction rates are less than ideal and is now not standard practice. The definitive treatment, or gold standard, is arthrodesis.

Cheilectomy

During cheilectomy, bone spurs and osteophytes are removed from the top of the joint to improve the movement and symptoms. Cheilectomy is normally reserved for those with mild to moderate arthritis of the metatarsophalangeal joint. For it to work, the majority of the arthritis, if not all should be located on the dorsal (top) part of the joint.

This localised arthritis is excised, with the hope of pain and stiffness being relieved. One must understand that this does not prevent the progression of arthritis, and fusion may be required in the future.

Arthrodesis (Fusion)

If pain and disease is more severe then arthrodesis is considered. Here, the diseased joint is excised and fused together by a combination of plates and screws. The bone fuses together eliminating pain.

The procedure allows the patient to walk normally and comfortably.

Aftercare

Normally a cast or post operative shoe is used to limit forefoot movement and to facilitate healing. I normally get the patient to be non or partial weight bearing depending on the circumstances. After that time physiotherapy is started to restore normal function and gait.