Arthritic Conditions: Big Toe Arthritis (Hallux Rigidus)

Hallux limitus vs. hallux rigidus: what's the difference? 

Osteoarthritis of the big toe joint is a progressive disease. The early stage of big toe arthritis is called hallux limitus, a condition where the motion of the big toe joint is limited.

As the disease progresses, the condition develops into hallux rigidus when the joint is rigid and unable to move.

What are the symptoms of hallux rigidus and hallux limitus?

Because hallux rigidus and hallux limitus are stages of the same problem, they have some similar symptoms. However, there are some different symptoms as the arthritis progresses.

Hallux limitus symptoms include:

• Discomfort and pain in the joint of the big toe during physical activities, notably when walking or pushing off the ground

• Swelling commonly occurs around the joint, accompanied by a reduced range of motion, making bending the toe challenging.

• Discomfort that occurs when the weather is damp or cold.
• A feeling of "tightness" in and around the joint.

Hallus rigidus symptoms include:

• Constant big toe joint pain, even when at rest.
• Irritation when the big toe joint is moved up and down.

• Bone growths such as bunions or spurs might appear at the top of the joint, which can cause further irritation when they rub against shoes.

• Difficulty wearing shoes, especially high heels.
• A callus under the big toe due to increased pressure.

Eventually, even walking becomes difficult, causing limping, pain in other parts of the foot, discomfort in the knee and hip, and weight gain due to decreased exercise.

What are causes and risk factors of hallux limitus and hallux rigidus?

The root cause of hallux limitus/rigidus is big toe arthritis, but there are some behaviors that can lead to premature cartilage deterioration and symptoms of arthritis. These include:

• Wearing High-heel or poorly fitted shoes 
• Squatting for long periods of time
• Stubbing the big toe
• Poor running technique
• Overuse during high-impact activities that involve repeated pressure on your toes.

Other risk factors for hallux rigidus include normal wear-and-tear brought on by age and genetic factors. Some inherited foot shapes or deformities can contribute to or cause big toe arthritis. Some of these include:

• Pronation: When the foot rolls outward at the ankle, it makes you use too much of your inner foot when walking. This causes excessive weight and pressure on the big toe joint and the soft tissue surrounding it.
• High arches: If you have high arches, walking puts too much weight on the bottom of the foot. This forces excessive weight on the toe joint, causing compression, deterioration, and tearing in the joint.
• Elevated big toe: This causes excessive downward pressure and force on the big toe with every step.
• An abnormally long big toe: This increases stress on the big toe joint, especially if you are wearing high heels or shoes that are too tight. The joint cartilage becomes pinched between the big toe and the metatarsal (foot bone), causing premature wearing and deterioration of the cartilage.

How is hallux limitus and hallux rigidus diagnosed?

The foot and ankle orthopedic surgeons at the University Foot and Ankle Institute use several methods to determine if a patient has big toe arthritis.

During the examination, our specialist will assess the mobility of the metatarsophalangeal (MTP) joint and determine the specific areas of pain. The presence of bone spurs, which are often associated with this condition, will also be evaluated. To further assess the degree of joint deterioration and the size and location of any bone spurs, standing X-rays, which allow weight to be placed on the foot, are usually conducted. Additional imaging tests such as MRI and CT scans are generally not required to diagnose hallux rigidus.

Non-surgical treatments for hallux rigidus

While non-surgical treatment options for big toe arthritis are limited, some that have been found to be effective therapies for many of our patients include:

Shoe modifications 

• • Wider shoes with a larger toe box can take pressure off the inflamed big toe joint and reduce pain.
  • Stiff-soled shoes can help limit the motion of the big toe. We sometimes recommend rocker-bottom soles to take off some pressure as well.

Shoe inserts 

Custom orthotics made specifically for your feet can take the pressure off the big toe and redistribute it through the rest of the foot.

Nonsteroidal painkillers

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and Alleve may be recommended to reduce pain and inflammation. Remember, never take these medications without having food in your stomach, as they can cause dangerous GI side effects.

Steroid injections

Injections of catabolic steroids (corticosteroids) into the joint can reduce inflammation and scar tissue. This type of injection often brings temporary relief.

Joint fluid injections 

Several injections over many weeks of a normal joint fluid substitute (sodium hyaluronate) can increase the lubrication of the joint, often decreasing pain.

Stem cell treatment 

A revolutionary new technique using stem cells from your own body may be used to help with cartilage repair. The stem cells are taken from your bone marrow and concentrated at the time of the visit. The concentrated stem cells are then injected into the toe joint and may help repair cartilage damage.

Surgical options for hallux rigidus

While we always try to use non-surgical treatments, they are limited. Unfortunately, conservative treatments aren’t always effective. At UFAI, we have many effective surgical options to consider when necessary.

Arthrosurface

Arthrosurface is UFAI's preferred surgical solution for hallux rigidus. The Arthrosurface is a metal partial joint replacement that has a quicker recovery than other great toe surgeries and brings pain relief and improved motion in the joint. UFAI’s patients are on their feet immediately and in sandals just five days post-procedure.

The Arthrosurface procedure replaces the area of missing cartilage at the metatarsal head with a titanium implant so the joint alignment and function stay intact and essentially normal. This treatment has proven to be quite successful with cartilage degeneration of the big toe and ankle.

The result: our doctors are able to retain your joint’s natural range of motion with this minimally invasive outpatient procedure. Often, patients experience immediate relief.

Cheilectomy procedure

Cheilectomy removes scar tissue and spurs from the joint to allow a far better range of motion. Physical therapy begins shortly after surgery to facilitate joint movement and prevent scarring and stiffness. Though recovery is rapid with this procedure, it is not recommended for severe arthritis cases.

Hybrid cheilectomy procedure

Another surgical option combines a cheilectomy with a cut in the metatarsal (foot) bone to shorten and lower the bone to prevent jamming by slightly shortening and dropping down the elevated bone leading to the great toe. Recovery is somewhat slower than with traditional cheilectomy because there is a waiting time for the bone cut to heal.

A screw is used to hold the bones together, which allows immediate weight-bearing and early return to shoes compared to procedures without a screw. Patients usually return to full activity after about two months. Physical therapy is also used to decrease stiffness and pain after surgery.

Laxity correction

In some cases, the first metatarsal bone leading to the great toe joint is so elevated and loose that the laxity must be corrected. Surgery is performed by bringing the 1st metatarsal to the ground and fusing it to a bone in the midfoot.

This helps to decrease arch collapse and helps with the normal positioning of the foot. After the first metatarsal has been re-aligned, the great toe joint is cleaned of the scar and spur formation. This procedure is an excellent long-term correction option and addresses the source of an elevated first metatarsal and jamming of the great toe.

Hallux rigidus fusion surgery

In severe cases, we either fuse the big toe joint or add an implant, much like a knee replacement. The great toe arthritis replacement implant option was actually clinically developed with the assistance of our doctors at the University Foot and Ankle Institute.

The great toe joint replacement procedure can replace either the base of the toe or the head of the first metatarsal bone. The benefit of this procedure is the continued movement of the toe and a very rapid return to shoes. The downside is that the implant may not last the rest of a patient's life and may need revision over a lifetime. This type of procedure is best for patients who like to wear high heels.

A fusion of the great toe (arthrodesis) removes all motion from the joint but also removes the pain. This procedure is reserved for severe cases with a great deal of pain and limited to no motion of the great toe joint prior to surgery. Recovery is six to eight weeks in a boot with limited weight on the foot.

Patients typically return to their normal activities with no pain and the procedure is good for a lifetime. After a great toe fusion, patients can usually go back to dress shoes with up to a 2-inch heel, or higher if it is a wedge that is 2 inches total.

UFAI offers the most advanced treatment for big toe joint pain and hallux rigidus

University Foot and Ankle Institute podiatry group is at the forefront of big toe arthritis treatment. We offer a full level of care including conservative treatments, a spectrum of diagnostic imaging MRI and CT scanning services, and dedicated foot and ankle physical therapy and surgical options.

University Foot & Ankle Institute is a nationally recognized expert in the treatment and correction of hallux rigidus. Our podiatrists are at the forefront of treatment and research and committed to offering state-of-the-art big toe arthritis care and assisting in the development of the leading hallux rigidus surgical implant. We regularly teach our techniques to foot surgeons throughout the world

By offering a full spectrum of workup, conservative, surgical, and recovery options, we are truly taking care of you in a state-of-the-art manner without the need to go from place to place.

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Frequently Asked Questions about Hallux Limitus

 

Can hallux rigidus cause knee or back pain?

Hallux rigidus is a condition that primarily affects the big toe joint causing stiffness and limited motion in the joint. It may not directly cause knee or back pain, but there can be indirect factors related to hallux rigidus that might contribute to knee or back pain.

 

Can hallux rigidus cause other problems? 

Some potential issues associated with hallux rigidus are foot deformities like bunions or hammertoes, altered gait (effecting ankles, knees, and lower back), arthritis progression, reduced mobility, or pain and discomfort. If you suspect hallux rigidus, consult with a foot and ankle specialist or a podiatrist near you.

 

Can hallux rigidus cause plantar fasciitis? 

Hallux rigidus is not a direct cause of plantar fasciitis, but the resulting altered mechanics of the condition can indirectly contribute to the development or exacerbation of plantar fasciitis. If you experience symptoms of hallux rigidus or plantar fasciitis, consult with a healthcare professional. 

 

Can you run with hallux rigidus? 

Running with hallux rigidus can be challenging, and whether it's advisable depends on the severity of your condition, your pain tolerance, and the advice of your foot and ankle specialist. 

 

How to prevent hallux rigidus? 

Preventing hallux rigidus involves:

• choosing proper footwear
• maintaining a healthy weight
• paying attention to early foot health symptoms
• avoiding high-impact activities
• proper warm-up, stretching, and strengthening exercises.
• Orthotic devices and regular check-ups where necessary are also helpful.

 

What are the best shoes for hallux rigidus?

Selecting the right shoes for hallux rigidus is crucial to minimize discomfort. A wide toe box, good arch support, cushioning, a slightly stiff sole limiting motion at the big toe joint, a low heel to minimize big toe strain, removable Insoles allowing orthotic inserts, and adjustable laces or straps.

 

Will orthotics help big toe arthritis?

 Orthotic devices can be beneficial for some individuals with big toe arthritis, depending on the type and severity of the arthritis and the specific biomechanical issues associated with the condition. 

 

Do you use the Hemi joint implant for hallux ridigus treatment?

No, we no longer use the Hemi implant. It is obsolete and now we do the Arthrosurface procedure.

 

 

Have a Hallux Limitus question we should add to our FAQs? Please let us know by clicking here.

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