Have you suddenly developed pain in your big toe joint? This may be a sign of a condition called, hallux rigidus. In this diagnosis you hear two words, hallux and rigidus. Your hallux is the great toe and rigidus means stiff or rigid, just like it sounds. Unlike a bunion that's on the side of your big toe joint and may or may not be painful, in hallux rigidus the pain is on top of your big toe joint.
The pain progresses from being occasional to more constant when walking, going up and down stairs, or participating in sports activities such as golf.
Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis—the kind that results from wear and tear—often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus. Hallux rigidus occurs as a result of wear-and-tear injuries, which wear down the articular cartilage, causing raw bone ends to rub together.
In other cases, it is associated with overuse, especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often must stoop or squat. Hallux rigidus can also result from an injury, such as stubbing your toe. Or it may be caused by inflammatory diseases, such as rheumatoid arthritis or gout.
- A bump, like a bunion or callus, that develops on the top of the foot.
- Pain in the joint when active, especially as you push-off on the toes when you walk.
- Pain and stiffness aggravated by cold, damp weather.
- Stiffness in the big toe and an inability to bend it up or down.
- Swelling around the joint.
In the early stages the great toe seems to move OK but as it progresses the joint becomes more and more rigid. Through the clinical exam and X-rays your podiatrist can determine how far this condition has progressed. When we catch this condition early, it's called hallux limitus because the range of motion of the joint is limited. At that point the problem can be controlled with custom orthotics. If the condition is not treated, it will eventually progress to hallus rigidus which may or may not respond to conservative treatment. That's why it's critical to get this condition treated early.
- Orthotics are used to control the biomechanics of the foot and the pain.
- Pain relievers and anti-inflammatory medications can reduce swelling and ease the pain. Note: Please consult your physician before taking any medications.
- Applying ice packs or soaking the foot in contrast baths (alternating cold and hot water) may also help reduce inflammation and control symptoms for a short period of time.
- A stiff-soled shoe with a rocker or roller bottom design and possibly a steel shank or metal brace in the sole can help alleviate the symptoms. These types of shoes add greater support when walking and reduce the amount of bend in the big toe. eg. Hoka
When damage is more severe, a surgical procedure will be necessary. In selecting the procedure or combination of procedures for your particular case, Dr. Berg will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level and other factors. The length of the recovery period will vary depending on the procedure or procedures performed.
Other Causes of Big Toe Pain
While hallux rigidus is a common cause of big toe pain, so is gout--a painful inflammatory condition. Learn more about gout here!