What is Hallux Rigidus?
Hallux rigidus means “big toe doesn’t move.” This is a condition that results in the big toe being stiff and often painful. The big toe joint or metatarsal phalangeal joint is the joint affected. There are stages of problem and it can be quite severe. The longer this toe condition is present the more severe the joint damage becomes.
What are the symptoms of Hallux Rigidus?
Often in the early stages of the disease the joint just won’t bend when standing. This stage is usually asymptomatic. There is no joint damage and the toe does not hurt. The toe moves normally when sitting. Later on as the joint wears out because it is not functioning properly it gets sorer. The joint also loses the range of motion it once had. Usually a normal joint will move up at least 65 degrees and down about 15 degrees. When the joint only moves about 40-50 degrees upward then the condition is called Hallux Limitus (“big toe only move a little”). This is when the toe usually starts to hurt. Also patients may notice a bump on the top of the toe joint. This is a spur that forms on the toe of the metatarsal, further limiting the amount of motion the toe has. This condition gradually continues until the spurs and cartilage loss is so severe that no joint space or motion remains. Sometimes the patient will experience a sudden increase in pain. Often that is the spur on the joint fracturing.
What non-surgical options are effective for Hallux Rigidus or Limitus?
Arch supports or custom orthotics can be helpful early in the disease. Shoe gear modifications like loose shoes in the toe box or a stiffer sole or more support. Custom shoe modifications like a rocker bottom soled shoes can also help. Injections in the joint can calm down the joint inflammation and give temporary or long term relief of pain. Ice and medications can help calm the joint down as well. Often these solutions are simply not satisfactory because of shoe gear demands or being ineffective. The problem with all conservative care is the joint continues to deteriorate. This usually means more severe pain. This is not always true, however. I have seen patients where the condition is so severe that the joint stops moving completely and stops hurting. I have also seen patients with joint disease and joint movement that does not really hurt at all. Who knows why?
What other problems go along with Hallux Limitus?
Frequently there is a callus that forms on the bottom of the big toe. This can be a particular problem with patients with diabetes as this location is the most common location for a diabetic foot ulcer. Because the foot is not functioning properly the rest of the body can pay a price as well. Hip, knee, and back pain can also result from hallux rigidus. Gait changes such as a shuffling or non-propulsive gait can result. This condition in the foot is rarely isolated. There is usually (not always) some other foot mechanical problem that goes along with this condition.
Is surgery an option for Hallux Rigidus or Limitus?
Surgery can be a life saver for these patients. Procedure selection is important but in general surgical success rates in Hallux Rigidus is over 90 percent in most studies.
If surgery is necessary how long is the recovery?
In general the surgery requires 1 week with the foot up most of the time and the use of a protective boot for about a month. Normal activities and shoes are usually possible after that. The foot usually feels normal after about 4 to 6 months, although it does vary from patient to patient.
Our patients often choose to have the surgery in the office under local anesthesia. This can save them thousands of dollars.
What are the surgical risks?
All surgery has risks. Infection, numbness, loss of correction, recurrence of problem and even loss of toe or limb are possible. In general complications in foot surgery occur about 5-10 percent of the time. This does not mean the surgery won’t be successful it usually just means the recovery will be longer and extra care may be involved.
Bottom line: Patients with hallux limitus don’t need to suffer. There is relief available. Call our Pleasanton office at 830-569-3338 or schedule an appointment online to get the treatment and relief that your toes deserve!