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Hallux Rigidus

■ ■ ■ Description

Hallux rigidus is a painful loss of motion of the big (first) toe, particularly when extending (lifting up) the toe. This is usually due to arthritic spurring of the joint at the base of the big toe.

■ ■ ■ Common Signs and Symptoms
  • Pain when extending (lifting up) the first toe, including when trying to stand on your tiptoes or push off, such as when running or jumping

  • Tenderness of the top of the joint at the base of the first toe

  • Redness, swelling, and warmth over the top of the base of the big toe (occasionally)

  • Foot pain, stiffness, and limping

■ ■ ■ Causes
  • Arthritis of the big toe that causes bone spurs protruding from the bones that make up the joint at the base of the toe, which results in pinching of the soft tissues between the bony spurs as the toe is extended (lifted up)

■ ■ ■ Risk Increases With
  • History of previous toe injury, including “turf toe”

  • Long first toe, flat feet, and other big toe bony abnormalities

  • Arthritis of the big toe

  • Tight shoes with narrow toe box

  • Family history of foot abnormalities

  • Gout and rheumatoid and psoriatic arthritis

■ ■ ■ Preventive Measures
  • Wear wide-toed shoes that fit well.

  • Tape the big toe to reduce motion and prevent pinching of the tissues between the bone.

  • Maintain appropriate conditioning:

    • Foot and ankle flexibility

    • Muscle strength and endurance

■ ■ ■ Expected Outcome

This condition is usually curable with appropriate treatment, although often surgery is required to prevent the problem from recurring.

■ ■ ■ Possible Complications
  • Recurrence of symptoms; increasing symptoms such that the pain may become constant

  • Prolonged healing time if not appropriately treated or not given adequate time to heal

  • Inability to compete due to pain 

  • Injury to other areas of the foot or ankle due to abnormal walking associated with trying to avoid the pain of toe motion with normal walking

■ ■ ■ General Treatment Considerations

Initial treatment consists of rest from the offending activity and medications and ice to help reduce inflammation and pain. Wear stiff-soled shoes with a wide toe area to help reduce bending of the big toe and pressure on the top of the first toe. However, stiff shoes may affect athletic activity. Padded donut pads help reduce pressure on the top of the big toe. Occasionally an arch support (orthotic) may help reduce pressure on the big toe and eliminate the symptoms. Rarely, a short trial of casting or bracing the foot and ankle is attempted. A cortisone injection into the arthritic joint may also be beneficial. If these treatments are not successful, surgery may be necessary. Surgical options include removing the arthritic bony spur, cutting a bone in the foot to change the arc of motion (allowing the toe to extend more), or fusion of the joint (totally eliminating all motion in the joint at the base of the big toe).

■ ■ ■ Medication
  • Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

  • Topical ointments may be of benefit.

  • Pain relievers may be prescribed as necessary by your physician. Use only as directed and only as much as you need. These are usually only prescribed for postsurgical pain.

  • Injections of corticosteroids may be given to reduce inflammation.

■ ■ ■ Heat and Cold

  • Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

■ ■ ■ Notify Our Office If

  • Symptoms get worse or do not improve in 2 weeks despite treatment

  • After surgery you develop fever, increasing pain, redness, swelling, drainage or bleeding, or increasing warmth

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects)

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