Hallux ridgus (stiff big toe) is a degenerative condition affecting the big toe (hallux) also known as the metatarsophalangeal (MTP) joint at the base of the toe. It results in pain and restriction of movement (rigidus). The changes in the joint are essentially those of osteoarthritis, with loss of cartilage, formation of osteophytes at the joint margin (spurs) and changes in the bone (hardening or sclerosis). The lining of the joint can become inflamed (synovitis), and the ligaments holding the joint together become thicker and stiffer.

Causes

Hallux Rigidus may be the result of wear and tear or a past traumatic injury to the big toe that has led to damage of the articular cartilage, which provides cushioning and allows smooth movement and flexibility of the big toe. The bones may rub against each other causing pain and the development of bone spurs that further restrict toe movement. Hence, the toe becomes stiff and walking is painful. In addition, poor foot alignment such as a flatfoot or bunion can create stress to the MTP joint and lead to Hallux Ridigus. The condition usually occurs between 30 and 60 years of age and may be more common with certain types of foot anatomy which place more stress on the MTP joint.

Non Operative Treatment

In the early stages of osteoarthritis your GP or medical physician will probably start you on the most common non-operative treatment including pain killers (paracetomol or panadol osteo) and anti-inflammatories if tolerated and not contraindicated. Ice and contrast baths (alternating hot and cold water soaks) can help temporarily reduce inflammation and pain. Changing your footwear to one with a broader toe area and a stiff or rocker-bottom sole may help reduce pressure on the toe.

Surgery

Following consultation and review, if osteoarthritis has progressed and other interventions have not succeeded, surgical intervention for treatment may be recommended. As with all surgeries, it comes with some risks and should be left as a last resort. 

Cheilectomy

Cheilectomy is usually recommended for patients who have mild to moderate Hallux Rigidus. It involves removing the bone spurs and a portion of the big toe bone allowing more room for the toe to move. The underlying disease process may progress and require a conversion to an arthrodesis or arthroplasty in time. It is a relatively simple procedure with no need for postoperative immobilisation.

Find out more about Cheilectomy.

Arthrodesis

Fusing the big toe MTP joint (arthrodesis) in a functional position is often recommended when damage to the cartilage is severe. Similar to an ankle fusion, the damaged cartilage is removed and pins, screws and/or a plate is used to fix the joint in a permanent position. Over time the bones will grow together and there is no motion at the MTP joint, however you can still move the adjacent joints and most patients report excellent or good pain relief and return to function.