Understanding Hallux Rigidus
Osteoarthritis of the big toe is one of the most common conditions of the foot and ankle. The big toe, referred to as the first metatarsophalangeal or MTP joint, is made of two bones, a phalanx and metatarsal.
The big toe joint plays an important role in walking as it bends with every step you take. When suffering from osteoarthritis, the MTP joint becomes stiff and painful, which may change the way you walk and activities you can perform. The medical term to describe this loss of motion is Hallux Rigidus. It is a degenerative disease that can affect people of all ages but most common in people over the age of 50.
In a normal joint, the bone surfaces are covered in cartilage, a tough protective cushion that allows the joint to move easily. Overtime, due to wear-and-tear, trauma or joint mechanics, cartilage begins to wear down, causing the bone surfaces to rub together. As a result of the cartilage damage, the joint space narrows and osteophytes or bony outgrowths begin to form. In the early stages of the disease, the cartilage damage and osteophyte formation typically occur on the top of the metatarsal head, therefore causing pain while walking or pulling the toe back. As the disease progresses, the more cartilage damage occurs, spreading throughout the joint and eventually resulting in complete overgrowth, and a stiff joint.
The symptoms of hallux rigidus include:
- Joint tenderness
- Swelling and inflammation around the joint
- Difficulty wearing shoes due to bone spur development (overgrowths)
- Dull pain in other areas of the body (hip, knee, lower back) due to changes in the way you walk
When diagnosing hallux rigidus your surgeon will look for reduced range of motion, especially while pulling the toe up (dorsiflexion) and try to feel for any osteophyte formation. X-rays are the most common method to determine the severity of the disease and determine which treatment options may be best for you.
Before considering surgery there are always non-operative treatments such as:
- Shoe modifications
- Cast immobilization with a reduction in activity
- Anti-inflammatory drugs
- Physical therapy
- Local injections