Hallux Rigidus (Arthritis in Toes) - Treatment & Surgery

If every step is agony, a degenerative disorder (arthritis) in the big toe joint may be the cause. Arthritis makes your big toe stiff and causes pain in your foot.

Overview

We’ll help you get back on your feet again

Pain while walking? Problems rolling from heel to toe? Limited mobility? Our specialists at Schoen Clinic are highly experienced in treating foot complaints. After receiving an accurate diagnosis, you’ll get precisely the right treatment from us.

Hallux Rigidus Symptoms

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.

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. Many patients report their mother or father experiencing similar changes.

Symptoms: These are the symptoms of Hallux Rigidus

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.

Diagnostics

Diagnosis: How we determine toe arthritis

To achieve a diagnosis, our specialists thoroughly examine your joint. This also involves x-raying your foot.

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. In the later stages, you will feel pain during all movements.

X-ray images clearly demonstrate Hallux Rigidus

For an accurate diagnosis, we also capture x-ray images of your foot under stress. In these x-ray images, we can see how much your joint space has narrowed. Bony outgrowths can also be observed easily. If we suspect any rheumatic disorders or gout based on these x-ray images, we may also recommend a blood test.

Hallux Rigidus Treatment & Surgery

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. The right shoe is great at 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 outgrowths, and joint inflammation and swelling.

An insert with a stiff sole serves 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, stopping 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 aren’t 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.

Surgical treatment methods

Hallux Rigidus: treatment with surgery

Various surgeries are available to preserve your joint. These include arthroscopy of your joint, removing painful bony outgrowths (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 outgrowths are removed. However, because we can’t rectify the causes of your arthritis, it will progress in spite of surgery.

Removal of painful bony outgrowths (cheilectomy)

We can improve your movement and alleviate your symptoms by extracting the bony outgrowths and removing 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. 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’ll be able to put your full weight on your foot without limitation, even while playing sports. The rolling movement is largely taken over by the big toe end joint.

Additional surgical options as required

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

Specialists

Mr Ali Abbasian

Consultant Orthopaedic Surgeon MBBS FRCS(Tr&Orth)

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Mr Kumar Kunasingam

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

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Mr Stefan Weitzel

Consultant Orthopaedic Surgeon MD FRCS(Eng) FRCS(Tr&Orth)

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Dr Roger Wolman

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

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