Big toe arthritis (Hallux Rigidus)

Big toe arthritis or ‘Hallux rigidus’ is a condition occurring at the joint where your big toe attaches to your foot called the 1st Metatarsal phalangeal joint (1st MPJ). The term ‘Hallux Rigidus’ is latin for ‘Rigid big toe’.

The hallux plays a big role in foot function. Approximately 60% of bodyweight will pass through the big toe during the push off phase of the gait cycle. It has a windlass ‘winch’ mechanism to aid the foot’s forward propulsion. The hallux also plays an important role in static and dynamic balance.

As with other forms of arthritis, Hallux Rigidus is a progressive disease, meaning it worsens over time. In the early stages, when the joint is still mobile, it is called ‘Hallux Limitus’. The joint movement becomes more limited over time until it may eventually become stiff and immobile.

This limitation in movement of the big toe can cause other parts of your lower extremity to compensate when you walk or run, placing increased strain on joints and tissues over time.

Symptoms

Whilst the joint is mobile, the main symptoms of Hallux Limitus are pain and stiffness in the big toe. The pain is mainly felt when the foot is active and the joint is moving such as when walking, running, or climbing stairs. There may be swelling and inflammation around the joint and symptoms may be worse if the weather is cold or wet.

Later stage symptoms may include:

• Bony lumps which may cause footwear problems

• Altered gait may cause symptoms in the knee, hip or lower back

• Pain in the toe when resting

Causes

Potential causes include:

• · Acute injury to the toe

• · Family history

• · Inflammatory disease (gout/rheumatoid arthritis)

• · Overuse of the big toe through sport or occupation

• · Foot structure & anatomy

Treatment

Non-surgical treatment may include:

• Shoe modifications – the toe is usually more painful when bent upwards during walking, so a stiffer sole or a ‘rocker sole’ helps to reduce the joint movement whilst walking. Shoes with a large toebox puts less pressure on the toes and high heels or pointed toe shoes should be avoided.

• Custom orthotics – can be helpful particularly if the problem is caused by abnormal foot biomechanics

• NSAIDS – such as ibuprofen can help reduce pain and inflammation

• Corticosteroid injections – If the pain is affecting daily living, small amounts of corticosteroids may be helpful

• Exercise plan – mobility and strengthening exercises

• Weight loss and lifestyle changes

Surgery

Surgery is only carried out if other treatments fail and the condition is causing lots of pain and affecting daily living. Joint fusion is one procedure, where the joint is fixed into a slightly elevated position to allow you to rock through the toe for more comfortable walking.

At Ayres Health, our MSK podiatrist Andrew helps many people with big toe arthritis as it is a common condition. If you have pain in the big toe joint, book a musculoskeletal podiatry appointment or a free discovery session to meet Andrew and discuss how he may help you.