Hallux Rigidus

Hallux rigidus

Hallux Rigidus is a common cause of stiffness, pain, and inflammation of the joint at the base of the big toe. Here we explain the symptoms, causes, and treatment.

Symptoms

What is Hallux rigidus?

Causes

Treatment


Hallux rigidus symptoms

  • Initial symptoms include pain and stiffness at the base of the big toe (called the MTP joint)
  • Pain is worse when walking.
  • Your big toe may also be swollen and inflamed.
  • As it gets worse, you may also experience loss of movement in the joint, or walk with a limp.
  • Eventually, you will feel pain in the toe continuously.
  • The top of the MTP joint will be tender to touch.
  • You may notice a lump over the joint, where new bone growth has occurred. X-rays may require to identify degeneration in the joint, or excess bone growth.
  • Eventually, lower back, hip, or knee injuries may result due to changes in the way you walk.

What is Hallux rigidus?

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) as you run or walk.

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.



What causes a stiff big toe?

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. As a result, over time, repetitive weight-bearing in a dorsiflexed position makes it more likely to occur.
  • Activities such as when walking up mountains or driving forward in a rugby scrum require large forces to be transmitted through the MTP joint in a dorsiflexed (bent upwards) position.
  • Traumatic injury such as stubbing your big toe causes damage to the cartilage within the joint.
  • A hypermobile 1st metatarsal bone is one which has too much movement. Over time this can also cause your big toe to stiffen.
  • Rheumatoid arthritis, which is inflammatory wear and tear of the joint.
  • Gout is a form of arthritis caused by excessive uric acid in the joint, can also cause Hallux rigidus.

Treatment for stiff big toe

Treatment of hallux rigidus is usually conservative, which means without surgery.

  • Rest. Avoiding painful activities such as walking, running and jumping. Instead, substitute swimming or cycling if possible until symptoms settle down. This should allow pain and inflammation to reduce and normal movement return.
  • A doctor may prescribe anti-inflammatory medications such as Ibuprofen. Always check with a doctor before taking medications as some, such as Ibuprofen should not be taken by asthmatics.
  • 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.

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.

Related articles

  • Forefoot and ball of the foot pain

    Forefoot pain includes injuries to the long metatarsal bones in the foot, inside, outside and under the ball of the foot. Here we explain the…

  • Foot biomechanics

    Foot biomechanics is the study of how the foot moves during the gait cycle. You wouldn't build a house without getting the foundations right, and…

  • Toe pain

    Here we explain the common injuries which cause sudden, or gradual onset toe pain. Gradual onset or chronic toe pain The following injuries cause gradual…

  • Choosing the best running shoes

    Choosing running shoes, as every runner knows, is fundamental to any training regime and subsequent competitive performance. For runners , selecting a new set of…

  • Foot arch pain

    Here we explain causes of midfoot pain. Pain in the middle of the foot can develop gradually through overuse, or suddenly following direct trauma such…

  • Overpronation

    Overpronation is often recognised as a flattening or rolling in of the foot but it is not quite as simple as that. If you overpronate,…

  • Gout

    Gout is a form of arthritis caused by a build-up of uric acid within the body, which is a waste product of metabolism. It is…

Scroll to Top