Hallux Rigidus is a common cause of big toe pain. Symptoms include a stiff big toe with swelling and inflammation in the joint, and pain, particularly when walking. This toe injury can be caused by a direct impact or from overuse. Repetitive stress on the toe, such as when the foot overpronates or when the toes are dorsiflexed (like in a rugby scrum) can bring on this injury.
Initial symptoms include pain and stiffness at the base of the big toe called the MTP joint, especially when walking. Swelling and inflammation may also be present. As the condition gets worse the patient may also experience loss of movement and walk with a limp. Eventually, pain is felt even when resting and the top of the joint will be tender to touch. Bone growth on top of the joint may occur. Pains in the lower back, hips, or knees may result due to changes to walking patterns.
The Hallux is the Latin word for the big toe and rigidus literally means rigid or stiff. The big toe is important in walking and running as it dorsiflexes (bends back) during the push-off phase of the gait cycle.
In Hallux Rigidus, the movement in the joint at the base of the big toe gradually decreases. Initially, the term Hallux Limitus is often used and the term rigidus is used later as the movement becomes considerably reduced. It is a form of degenerative arthritis although is often initially confused with a bunion.
The condition can cause lots of further problems, especially with walking, as we require at least 60 degrees of dorsiflexion at the MTP joint for a normal walking pattern. If this is not available, compensations are made elsewhere, for example, the ankle, knee, and pelvis.
It can be caused by either a traumatic injury or through overuse. Overpronation or where the foot rolls inwards too much increases the stress on the joint. Repetitive weight bearing in a dorsiflexed position such as when walking up mountains or driving forward in a rugby scrum or similar can be a factor.
Other causes include traumatic injury such as stubbing the big toe causing cartilage damage in the joint. A hypermobile 1st metatarsal bone or bone which has too much movement can also cause the big toe to stiffen over time. Rheumatoid arthritis which is inflammatory wear and tear of the joint, as well as Gout which is a form of arthritis caused by excessive uric acid in the joint, can also cause Hallux Rigidus.
Treatment of hallux rigidus is usually conservative, starting with a period of relative rest. Avoiding painful activities and substituting swimming or cycling may be necessary. This should allow pain and inflammation to reduce and normal movement return.
Anti-inflammatory medications may be prescribed. Always check with a Doctor before taking medications as some such as Ibuprofen should not be taken by asthmatics for example. A doctor may also prescribe a Corticosteroid injection.
Any contributing biomechanical factors such as overpronation should be corrected. Physical therapy may be employed to try to increase the range of motion at the joint using.
X-rays may display degeneration and excess bone growth at the MTP joint. In extreme cases, surgery may be required to remove bony growth on top of the joint, or even a total arthroplasty (joint replacement) can be done.