Hallux Rigidus

Prevention and Treatment of Hallux Rigidus

Hallux rigidus is easier to treat if it is identified in the very early stages. Therefore, if you experience any stiffness in the big toe that does not go away after two or three days, consult your primary care physician or a foot health professional.

In some cases, taking a non-steroidal anti-inflammatory medication, if tolerated, will relieve pain and swelling. Icing may also help. Wearing shoes with a larger toe box and avoiding high heel shoes often helps reduce pressure in the area, as does wearing padded socks. However, these steps only help symptoms; they don’t halt the progression of the condition.

Modifications to footwear can help. Placing a custom orthotic with a Morton’s extension (an orthotic in which rigid material extends under the first toe to the tip of the toe) into the shoe of the affected foot can help to alleviate pressure under the big toe, as does adding a rocker sole to the bottom of the shoe of the affected foot. Either one can make it easier to walk or run without pain.

Footwear accommodations can also be made for hallux limitus. These include the use of custom orthotics to reduce pressure under the big toe during ambulation, and the use of rocker soled shoes, which help compensate for lost range of motion.

Treatment often involves surgery. Three types of surgery are most commonly used:

  • In the early stages, when damage is not severe, a procedure called a “cheilectomy” may be recommended. In this surgery, any bone spurs (and possibly a portion of the first metatarsal bone) are removed so that the toe has more room to function.  Recovery make take several months, but at least two studies (http://www.ncbi.nlm.nih.gov/pubmed/14630834, http://www.ncbi.nlm.nih.gov/pubmed/25981441) showed high success rates for the surgery.
  • When damage to the metatarsophalangeal joint (MPJ) is severe, a procedure called “arthrodesis,” or fusing bones together, may be performed. Any damaged cartilage is usually removed and a pin, screws, or plate is inserted to hold the joint in position. After surgery, the bones will eventually grow together. This surgery results in loss of the ability to flex the big toe, but according to the American Academy of Orthopaedic Surgeons (AAOS), it is a reliable remedy for pain. Recovery periods vary, but often last three months or more, and rocker sole footwear may be required for walking after the surgery.
  • Less active people who don’t put too much demand on their feet may be candidates for arthroplasty (joint replacement surgery), in which the surfaces of the joints are removed and an artificial joint implanted. A recent study showed clear clinical benefits and high patient satisfaction with this type of surgery.

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