Pain in the big toe joint is a common presenting complaint to our office. There are many different problems which can contribute to pain in this area of the foot, including trauma, bunions, arthritis, gout and sesamoiditis. This month, I would like to focus on a condition called hallux rigidus. I personally have this condition and underwent surgery for it less than six weeks ago.
Hallux rigidus is, simply put, a stiff big toe joint. This becomes a problem over time because as a normal part of human gait, motion in the big toe joint is required. Our body will attempt to compensate for it through other joints and alternating the way we walk. In spite of this, however, a significant amount of stress is still passed through this stiff joint. This, over time, will cause jamming, arthritic changes (wearing out of the cartilage), bone spurs on the top of the joint, and sometimes, loose pieces of bone at the top of the joint. This condition often makes certain shoes intolerable, normal walking is painful, and unfortunately, the problem is usually slowly progressive: it just gets worse and worse.
Diagnosis is pretty straightforward and is based on the history of the problem and a physical examination. X-rays are used to provide further information and to help direct treatment. Some general treatments for hallux rigidus include wearing wider toe-box shoes, stiff soled shoes and custom orthotics with certain accommodations to off-load this joint. Anti-inflammatory medication, when tolerated, is usually helpful and reduces the pain and swelling in the joint. Surgery is a good option for many people; it can be used to clean up the joint, realign the joint, replace the joint, or fuse the joint. The surgical procedure is decided upon based on many factors and is tailored to the individuals needs. In most cases, walking in a special shoe right after surgery is permitted. Only in the case of joint fusion is an extended period off the foot required.
Hallux rigidus is easily treatable to reduce symptoms. Earlier treatment usually yields better results, and can slow the progression over time. If you have pain in your big toe joint, get it checked out and find out what you can do to protect this joint from future and further damage. We make a conscientious effort to not employ a cookie-cutter approach to these problems, but to treat everyone as an individual and tailor the treatment approach as needed.
We welcome your call at the Foot and Ankle Institute of Valencia. For more information, please call 661-260-1180.