Hallux rigidus
This condition is osteoarthritis (wear and tear) of the joint at the base of the big toe. It presents with pain, swelling, stiffness, crepitus (a crunchy sensation when the joint is moved) and bony spurs (osteophytes). The pain is due to the inflammation within the joint, the worn out bone ends moving against each other and the bone spurs. The joint becomes thickened and bulky. The spurs ‘jam’ against each other when the toe is bent up to its limit and painfully stretch the tissues when it is bent down. They can press inside the shoes causing redness or even ulceartion of the skin. Hallux rigidus can also cause the big toe swing onto the second toe if the joint wears out unevenly.
The severity of the arthritis is checked on Xray but the type and level of symptoms is highly variable for a given amount of arthritis. In some feet the joint almost seizes up with almost no pain at all. The situation canalso stay the same for many years. Decisions about treatment should be based on current symptoms rather than the xray appearence or on fears for the future.
The mainstay of initial treatment is nonoperative. Simple painkillers and anti-inflammatories (taken under supervision from your family doctor) can reduce the pain in the big toe. Shoes deep and wide enough to accomodate the bump and insoles to stiffen that part of the toe can help significantly. Injections into the joint are useful in certain cases to reduce acute inflammation and prevent further stiffness, however their effects can be shortlived. Removal of the bump (cheilectomy) can help reduce pain and to increase the movement in the joint. If the cartilage in the joint is severely worn out then fusion (permanent stiffening) of the joint is indicated. Joint replacements for the big toe are not as reliable as replacements for other joints and, therefore may only be suitable in a very small number of cases.
