The metatarsophalangeal (MTP) joint, located at the base of the big toe, is one of the most common sites of arthritis in the foot. This joint is important because it must bend every time that you take a step. Once arthritis sets in and the joint begins to stiffen, walking can become particularly painful.

When two bones meet and move together, that is called a joint. The ends of the bones are coated in cartilage which is very smooth and allows motion. Eventually, this may cause reactive bone spurs to develop. A prominent spur will develop in the top of the bone and the joint, preventing the toe from bending as much as it needs to when you walk. This results in hallux rigidus - or a stiff big toe.

Hallux rigidus generally develops in adults between the ages of 30 and 60 years old. While there doesn’t seem to be any scientific reason as to why it affects some individuals and not others, it is thought to result from differences in foot anatomy that increase stress on the joint. In addition, some specific injuries to the toe can damage the articular cartilage and cause hallux rigidus.

Symptoms of Hallux Rigidus

• Swelling around the great toe joint
• Pain in the joint when active, especially when walking
• A bump that develops on top of the foot at the joint
• Stiffness in the great toe coupled with the inability to bend it up or down
• Hallux rigidus often looks like a bunion

Diagnosis

If you find it difficult to bend your big toe up and down or you are walking on the outside of your foot as a result of the pain in the toe, you should seek medical consultation right away. Contact your personal physician as soon as you begin experiencing this stiffness, as hallux rigidus is easier to treat when the condition is caught in the early stages of development. If you wait until the development of bone spurs on the top of your foot, then the condition will be far more difficult to treat, though this is still possible with proper skills and techniques.

Your doctor should examine your foot for any evidence of bone spurs as well as the mobility of the toe to see exactly how much movement can be achieved without pain. X-rays will pinpoint the size and location of any bone spurs and the progression of any degeneration within the joint space and cartilage. X-rays are helpful to determine the overall architecture of the foot and to plan surgery or treatment.

Non-Surgical Treatment

Anti-inflammatory medications may assist in reducing swelling and easing the pain of hallux rigidus. Applying ice packs or taking hot and cold baths may also control symptoms and reduce swelling and inflammation for short periods of time.

Your physician will likely recommend wearing a stiff-soled shoe with a rocker or roller bottom design, or even a shoe with a steel shank or metal brace. This type of design supports the foot while walking and also reduces the amount of bend in the big toe. Taping and physical therapy can also be very successful in treating this condition.

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Surgical Treatment of Hallux Rigidus

In severe cases, surgery may be required for treatment. Arthrodesis, cheilectomy, arthroplasty, and cartiva are all invasive methods of relief that may be successful for alleviating hallux rigidus pain. Dr. Warner advises that you always seek surgical intervention as a final option, only after you have investigated non-invasive treatment.

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