Hallux Rigidus

by / Wednesday, 06 March 2019 / Published in Arthritis, Bracing, Orthopedic

Hallux Rigidus (HR) is is a type of degenerative arthritis involving the joint located at the base of the big toe. HR causes pain and stiffness in the joint, which progressively worsened with time. It can be a very disabling condition as it makes it very difficult and painful to walk, stoop down, climb up or even stand. It is not to be confused with bunions which are mildly painful and somewhat disfiguring. In its early stage when the rigidity is mild, it is often referred to as Hallux Limitus. At the other end of the spectrum, when entirely rigid, it is practically a frozen joint.

The common causes of HR include structural abnormalities of the foot that can result in osteoarthritis in the big toe joint. This is typically seen with patients with fallen arches or excessive pronation of the ankles. In some cases, it is familial given the similar structural issues in the foot with a familial/genetic origins. HR is also associated with overuse, seen in people involved in activities with stooping or squatting or if there has been an injury to the big toe. Furthermore, it can be precipitated by rheumatoid arthritis or gouty arthritis.

Earlier diagnosis and appropriate management minimizes the chance of complications, such as development of bone spurs

Clinically, it presents with pain and stiffness in the big toe during walking, standing, bending, etc., which is worsened by cold, damp weather. There may also be swelling and inflammation around the joint. As the condition worsens, there is pain even during rest, and rigidity worsens to cause a frozen joint with no motion at all. There may also be limping.

Earlier diagnosis and appropriate management minimize the chance of complications, such as the development of bone spurs. The diagnosis is clinical, based on history and careful foot examination, but x-rays are performed to determine the degree of arthritis, bone spur development, etc.

Early diagnosis leads to early treatment, which is conservative, to begin with, and comprises of shoe modification (stiff or rocker-bottom soles), orthotic devices, painkillers/anti-inflammatory agents (NSAIDs, or corticosteroids if needed), and physical therapy. However, In some cases, surgery is necessary. There are multiple surgical approaches available for HR treatment, with the goal of providing relief from severe pain and stiffness.

Arthrodesis is a process in which the bones are fused together and is recommended when the damage to the articular cartilage is severe. It involves removal of the cartilage and using pins, screws, or a plate to fix the joint in a permanent position. This leads to eventual fusion of the bones across the joint. It causes permanent immobility at the joint but is the surest way of achieving complete pain relief Following surgery, the patient has to wear a cast for the first six weeks, followed by using crutches for about another six weeks. Joint replacement surgery is considered in patients with severe HR. It is a major surgical procedure but it provides relief from pain and there is full joint motion after recovery.