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Diseases & Conditions

Hallux Rigidus

(Also Called 'Stiff Big Toe')

Hallux rigidus literally means "stiff big toe," which is the main symptom of the disorder. Hallux rigidus is a form of degenerative arthritis, which can cause pain and stiffness in the metatarsophalangeal joint (the joint where your big toe—the hallux—joins your foot).

Because hallux rigidus is a progressive condition (gets worse over time), the toe’s motion decreases as time goes on, making walking or even standing painful. The pain and stiffness may get worse in cold, damp weather, and the joint may become swollen and inflamed. A bump, like a bunion or callus, often develops on the top of the foot and makes wearing shoes difficult.

Hallux rigidus is the second most common disorder of the big toe, after hallux valgus (bunions). Hallux rigidus occurs in adolescents and adults and is most common in people between the ages of 30 and 60.

What causes hallux rigidus?

There is no single cause of hallux rigidus. It may develop because of overuse of the joint, such as in workers who have to stoop and squat or athletes who place a great deal of stress on the joint. It may occur after an injury, such as stubbing the toe or spraining the joint (called "turf toe" in athletes). In some people, hallux rigidus runs in the family and comes from inheriting a foot type or a way of walking that may lead to this condition. Osteoarthritis (wear and tear arthritis) and inflammatory diseases such as rheumatoid arthritis or gout are other possible causes of hallux rigidus.

How is hallux rigidus diagnosed?

Your doctor can diagnose the condition by testing the range of motion of the joint—how far the toe can bend up and down. X-rays can show if there are any abnormalities in the bone or bone spur development.

How is hallux rigidus treated?

Early treatment of hallux rigidus usually includes the following measures:

  • Wearing appropriate shoes with plenty of room for your toes. Some patients find that shoes with very stiff soles relieve pain. Women should avoid wearing high heels.
  • Placing pads in your shoe to limit movement of your big toe
  • Avoiding high-impact activities, such as jogging
  • Taking non-steroidal anti-inflammatory medications, such as ibuprofen, to help relieve the pain and reduce swelling in your big toe. Your doctor may recommend corticosteroid injections into the joint.

If pain and stiffness continue, surgery may be necessary. Shaving the bone spur (cheilectomy) may help relieve the pain and preserve joint motion. Sometimes it may be necessary to cut the bone (osteotomy) is order to realign or shorten the big toe.

A procedure called interpositional arthroplasty has been successful in younger patients with hallux rigidus. In this procedure, a "spacer" of donor tissue is placed between the ends of the joints to relieve pain. If the condition is severe, joint fusion (arthrodesis) may be the best option for long-lasting pain relief.

Complications can occur with any type of surgery, but are not frequent after surgery for hallux rigidus. Complications may include infection, joint stiffness, progression of the arthritis, recurrence of the deformity, and persistent swelling.

The recovery time after surgery depends on the procedure:

  • After cheilectomy, a special shoe is worn for about two weeks, but swelling may last for several months.
  • If an osteotomy is done, swelling usually goes down in six to eight weeks, but healing can take up to three months.
  • After joint fusion, a cast or boot is worn for about three to six weeks and crutches are used for two to six weeks.

Generally, you will be able to return to work between four and eight weeks after surgery, depending on the type of job you have, your activity level, and your response to surgery.

Can hallux rigidus be prevented?

While there is no definite way to prevent hallux rigidus, you may be able to slow its progress by doing exercises to keep the joint mobile, resting the joint when it becomes painful, and wearing good-fitting shoes that have enough space around the toes.

If you develop symptoms of hallux rigidus, contact your doctor. Early diagnosis and treatment can help ensure successful treatment.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/28/2010…#14665