Hallux rigidus (Arthritis in toes)

Getting you back on your feet again

Are you experiencing pain while walking, limited mobility, or problems rolling from heel to toe? If every step is agony, a degenerative disorder, like arthritis in the big toe joint, may be the cause. A tell-tale sign of arthritis is stiffness, so if you have it in your toes it can make your big toe stiff and cause pain in your foot.

Our specialists at Schoen Clinic are highly experienced in treating all aspects of foot complaints. With an emphasis on accurate diagnosis, our experts will diagnose the precise condition and offer the appropriate treatment. We will provide you with the best possible outcome, ensuring you get exactly the right treatment to improve your quality of life.

Toe arthritis – What is it?

Arthritis of the big toe joint (Hallux Rigidus) occurs due to joint degeneration. This leads to bony outgrowths, often on top of the joint, as well as a narrowing of the joint space. The first sign of toe arthritis is often pain in the joint, combined with reduced mobility.

Symptoms of Hallux rigidus: What to watch out for

A stiff toe severely limits movement, mainly in the instep direction. Bony outgrowths will cause you pain, particularly while wearing closed shoes. Swelling or reddening may occur. Those affected often also try to go easy on their big toe joint without realising, and roll their foot over the outstep. But your foot isn’t built for this type of strain, and reacts with pain.

Early symptoms include:

  • Stiffness
  • Pain in the big toe during movement
  • Swelling or inflammation
  • Difficulty carrying out strenuous activities, like squatting or running

Further symptoms can develop as the condition deteriorates:

  • Pain at all times, even during rest
  • Pain in other areas, like the knees, hips or back (due to a change in how you walk)
  • Shoes become difficult to wear
  • Limping

A stiff toe severely limits movement, mainly in the instep direction. Bony overgrowths will cause you pain, particularly while wearing closed shoes and swelling or reddening may occur. Those affected often also try to go easy on their big toe joint without realising, and roll their foot over the outstep. However, your foot is not built for this type of strain and pain can result.

Causes: How does Hallux rigidus occur?

Typically, joint degeneration is a disorder that occurs in the later stages of life but young people can also be affected, for example, after injuries. Studies have also shown that arthritis can be inherited, with many patients reporting their mother or father experiencing similar changes.

Diagnosis: How we determine toe arthritis

As with many conditions, the earlier the diagnosis, the easier it is to treat. To achieve an accurate diagnosis, our specialists thoroughly examine your joint. This also involves X-raying your foot.

X-ray images clearly demonstrate Hallux Rigidus

Taking X-ray images of your foot under stress assists in obtaining an accurate diagnosis. In these X-ray images, we can see how much your joint space has narrowed and bony overgrowths can also be observed easily. If we suspect any rheumatic disorders or gout based on these X-ray images, we also conduct a blood test.

Clinical examination of Hallux Rigidus

During the examination, a bony upward bulging of the joint will be observed. This is often reddened due to it rubbing against the shoe. Sometimes, an inflammatory bursa may have formed as well. In the early stages, only forceful movements of your toes in the instep direction will be painful and in later stages, you will feel pain with all movements.

We tailor treatment to your symptoms

In general, in the early stages of the disorder, we can greatly alleviate your symptoms through conservative measures and eliminate the need for Hallux Rigidus surgery. Wearing the right shoes is great for providing significant relief. There are a wide variety of Hallux Rigidus shoes available which will let you walk again with ease.

Hallux rigidus: Treatment without surgery

The goal of conservative treatment is to reduce the stress on your joint, the pressure on the bony overgrowths, and joint inflammation and swelling.

An insert with a stiff sole will serve to transfer the rolling movement of your foot to the sole of your shoe. Your big toe then bends upwards less when you roll your foot, helping to stop the pain.

Adjusting the sole of your shoe using a so-called rocker sole can also help. This is a rounded piece of rubber that is glued to the outside of the sole of your shoe. It reduces the flexibility of the sole around the big toe joint, making rolling movements in the shoe easier.

One proven method, particularly with sports shoes, is to hollow out the sole underneath the big toe and fill the cavity with very soft material. During rolling movements, your big toe is immersed in the soft material and pressed less in the instep direction.

Shoes with soft top material and lots of toe room provide your big toe joint with enough space. These shoes often significantly reduce your symptoms, but do not tend to be very fashionable.

Our physiotherapists will be happy to demonstrate different exercise techniques that you can use to improve the movement of your big toe joint, as well as reduce inflammation. Osteoarthritis cannot be remedied through physiotherapy alone.

Anti-inflammatory medications such as Diclofenac and Ibuprofen can also have a positive impact on severe inflammations in the big toe joint. However, these medications should not be taken over long periods of time.

Hallux rigidus: Treatment with surgery

Various surgeries are available to preserve your joint. These include arthroscopy of your joint, removing painful bony overgrowths (cheilectomy) and correcting displacements (corrective osteotomy). We can preserve the mobility of your joint using these procedures, but we cannot remedy arthritis. Therefore, even with surgery, it may be necessary to replace the surface of the joint with artificial tissue, perform ankylosis (arthrodesis) or artificially replace the joint (arthroplasty) at some point. With corrective osteotomy and cheilectomy, your joint may be fused or artificially replaced at any point in the future.

Arthroscopy

In the very early stages, arthroscopy of your big toe joint may alleviate your symptoms. The inflamed inner lining of your joint is stripped away through surgery, and bony overgrowths are removed. However, because we cannot rectify the causes of your arthritis, it will progress in spite of surgery.

Removal of painful bony outgrowths (cheilectomy)

We can improve your movement if it is reduced by under 75% and alleviate your symptoms. To do so, we extract the bony overgrowths and remove the joint area affected by the wear. Just a small cut above the ball of your big toe joint is needed for this procedure. We can also remove the bone edges using minimally invasive methods: through a small “keyhole” made with a bone cutter. After this procedure, it is important that you complete intensive exercises.

Correction of additional displacements

If, alongside osteoarthritis, your first metatarsal bone has shifted to your inner foot, this displacement can be corrected through surgery (displacement osteotomy). In some cases, we can rearrange your joint so that regions with good cartilage are moved into the principal stress zone to relieve strain on regions with poor cartilage.

Implantation of artificial tissue as a placeholder

If your arthritis is already advanced and you want to preserve mobility in your joint, we can insert artificial tissue as a placeholder. Partially elastic materials have been proven to prevent bones rubbing against one another. However, there is still no conclusive evidence of whether ankylosis can be permanently prevented in any patient. The placeholder will still function well over the first five years. Furthermore, no new joint is implanted through this procedure. Typically, there will still be reduced mobility, and the joint will often be somewhat thicker than the healthy joint on the other side.

Ankylosis (arthrodesis)

If your joint has completely deteriorated, we can fuse the big toe joint. This decreases your pain and increases the stress tolerance. In this operation, we remove the deteriorated cartilage from your joint and screw both joint surfaces together. Once the bones have been unified, you will be able to put your full weight on your foot and return to playing sports.

Additional surgical options as required

We may offer other surgical procedures, according to your individual requirements. Our foot surgery specialists can advise on which ones are best for you in a personal consultation.

Hallux rigidus: Our specialists

Our highly experienced foot and ankle specialists diagnose all aspects of foot conditions and provide the most appropriate treatment method for your individual needs.

Dr Roger Wolman

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Rheumatology

Consultant - Sports & Exercise Medicine

Consultant Rheumatology and Sport & Exercise Medicine
MD (Res) FRCP FFSEM
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Mr Ali Abbasian

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon 
MBBS FRCS(Tr&Orth)
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Mr Kumar Kunasingam

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon
BSc(Hons) MBBS(Eng) MRCS(Eng) FRCS(Tr&Orth) DipSEM DipOrth
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Mr Stefan Weitzel

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon
MD FRCS(Eng) FRCS(Tr&Orth)
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Hallux rigidus: Our specialised hospital

Schoen Clinic Orthopaedic and Spinal Hospital is based in the heart of London and is home to some of the finest specialists at the forefront of their fields. Our multidisciplinary team will ensure you receive the best care possible to achieve the optimum outcome from your treatment.

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Authors, 01.07.2020