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Arthritis of the big toe (hallux rigidus)

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It literally translates as ‘stiff big toe’, and it’s one of the most common causes of pain in the forefoot. Read on to find out if your pain is caused by hallux rigidus, and what you can do about it.

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What is hallux rigidus?

Hallux rigidus is a type of arthritis affecting the main big toe joint, in the ball of the foot (the first metatarsophalangeal joint, or MTPJ)

Arthritic diseases – of which there are many types – lead to inflammation in the joints.

Big toe arthritis often leads to a bony lump developing on the top of the joint.

It’s very common, even among younger people.

What are the symptoms of hallux rigidus?

This type of arthritic toe causes joint pain and swelling, and can limit movement. The toe might become crooked.

Some people feel pain only when they are walking, others can feel it even without movement. It might cause you to walk on the outside of your foot, which then causes other problems.

It often feels particularly stiff and painful when you try to turn your toe upwards. In some cases the affected toe starts to bend downwards and it becomes difficult to put it flat onto the floor.

The bony lump that appears on the top of the joint can rub on your shoes and feel uncomfortable.

What are the causes?

There is still uncertainty about what exactly causes arthritic diseases, but in this case it’s likely to be due to wear and tear from walking.

Walking is good but it does put the body under stress! Each step sends a force equal to twice your body weight through the toe joint.

Injuries, infection or other medical conditions can also lead to the development of an arthritic toe, and different feet anatomies can increase stress on the joint.

Click here to find out more about Wimbledon Clinics’ programmes for injury prevention and return from injury.

Or call Wimbledon Clinics now on 0208 944 0665 or email [email protected]

What are the treatment options?

  • Shoes

Your choice of shoe can help to alleviate the symptoms of hallux rigidus.

Going for a stiff sole (like those found in hiking boots) or a curved, rocking sole, is effective because it prevents the joint from bending while walking. You can get a “rocker bar” for the sole of your shoe, which protects the toe from flexing sharply as you move through the foot.

Slip-on shoes should be avoided because they only stay on the feet by being tight over the toes, which will worsen the pain.

  • Insoles

Insoles for your shoes – also known as inserts or orthotics – can help take the pressure off by redistributing the weight and reinforcing the shoe.

  • Activities

One way to make life more comfortable is to adjust the activities and sports you participate in. Going cycling, swimming or using a rowing machine, for example, is better for your arthritic toe than running or jumping.

  • Pain relief

Some people take painkillers or anti-inflammatories but they are not advisable for long-term use. Steroid injections can also be helpful but only as a temporary measure.

  • Surgery

There are some very effective procedures for hallux rigidus, although it’s still generally viewed as a last resort for most people. The severity of arthritis in the joint determines which is the best option.

A cheilectomy is offered when only the upper part of the joint is affected (see the section below). It’s possible to have the bone at the base of your big toe reshaped, which is sometimes done at the same time as a cheilectomy.

A relatively new procedure, called a Cartiva implant, is offered to selected patients. It involves using a spacer to push the bones apart and prevent painful rubbing.

If the whole joint is damaged there are other options to consider, depending on the age and circumstances of the patient, such as fusion of the joint.

Will a cheilectomy cure my hallux rigidus?

A cheilectomy is the surgical removal of the bony lump (also called a ‘spur’) that develops on the top of the big toe’s main joint.

The surgeon will also flush out any free-floating debris that may be causing stiffness and immobility.

For most people (around 85%), a cheilectomy significantly reduces their pain and improves joint movement.

The operation is often offered to people who are experiencing early arthritis of the big toe, when the joint is not yet too badly affected. But if the arthritis is more severe, it may not be the best course of action.

Other operations are available for hallux rigidus – a foot and ankle specialist will be able to take you through the options, based on your individual circumstances.

Some people do need another operation further down the line, if the condition progresses.

How long does cheilectomy recovery take?

The cheilectomy recovery period can take quite a while.

After the initial few days, when your foot will need to stay elevated, you will need to avoid walking too far for a couple of weeks.

Physiotherapy can begin one week after the operation. A gradual build-up of exercises extends the range of motion in the joint.

When you can return to work very much depends on the kind of job you have. If you can get to work and it involves sitting down and being able to put your foot up most of the time, you could probably return within three weeks. Something more physically demanding -such as a heavy manual job – could take up to three months.

Most people can expect to be able to drive again after four weeks.

As for a full return to contact or impact sports, every situation is slightly different, but most people return to their previous activities within six months.

Find out more about Wimbledon Clinics’ programmes for injury prevention and return from injury.

If you think you may have an arthritic toe and need advice and specialist treatment, then contact us today and we’ll put together a clear strategy for treatment and recovery, so you can be back to your best as soon as possible.

 Call us on: 0208 944 0665 or email us at: [email protected]

Foot and ankle specialist: Matt Solan