Hallux Limitus/Rigidus, sometimes called “stiff big toe” is a form of degenerative arthritis that causes pain, stiffness and inflexibility in the joint at the base of the big toe. ‘Hallux’ is the word for big toe and ‘rigidus’ refers to stiffness that often limits the toe’s range of motion.
This condition can be very difficult to manage and live with since the big toe is used constantly for support in walking, stooping down, climbing up and standing. Hallux rigidus and bunion deformity are often confused. These conditions involve the same joint but are very different and involve different treatments.
As a progressive condition, hallux rigidus gradually decreases the range of motion in the big toe. The initial stage that fairly limits toe motion is called ‘hallux limitus.’ Gradual progression, however, leads to increased stiffness until the end stage, ‘hallux rigidus’ is potentially reached.
Hallux rigidus often develops from structural deformities and abnormal function, or biomechanics of the foot. These complications may lead to osteoarthritis in the big toe joint. Osteoarthritis develops from “wear and tear” in people with foot deformities that change the function of their big toe and foot. Examples of deformities include fallen arches or excessive pronation (rolling in) of the ankles.
Genetic factors sometimes contribute to the development of hallux rigidus. Patients may inherit a foot type that is more likely to lead to this condition. Overuse is another common cause of hallux rigidus, as jobs or activities that require excessive stooping or squatting may increase the stress on the big toe. Injury, such as stubbing the toe, may result in this disorder.
Rheumatoid arthritis, gout and other inflammatory diseases also place patients at increased risk. Dr. Radovic can determine the cause of hallux rigidus and recommend a treatment plan for each individual patient.
Initial signs and symptoms may include:
Symptoms may worsen or new symptoms may arise as hallux rigidus progresses, including:
Patients who seek treatment in the initial stages of the condition are more likely to benefit from non-surgical treatments. Hallux rigidus becomes more difficult to manage if patients prolong professional treatment until a bone spur develops.
To diagnose hallux rigidus, Dr. Radovic will examine both feet and manipulate the toe to test its range of motion. X-rays are often ordered to determine the extent of arthritis and to evaluate any bone spurs or other deformities that may have developed.
Early treatment is often the best way to prevent or extend the need for surgical repair. The following are some non-surgical options for mild to moderate cases of hallux rigidus:
Shoe modifications. Wearing shoes with a large toe box reduces pressure on the toes. Dr. Radovic may also recommend shoes with stiff or rocker-bottom soles to increase support.
Orthotic devices. Custom orthotic devices, or shoe inserts may provide additional support and improve foot function.
Medications. Ibuprofen, aspirin or other oral non-steroidal anti-inflammatory drugs (NSAIDs) may reduce pain and inflammation.
Injection therapy. Injections of corticosteroids may be applied directly to the area of concern to reduce pain and inflammation.
Physical therapy. Rehabilitation exercises or ultrasound therapy may be recommended in conjunction with other treatments to temporarily relieve pain and inflammation.
Surgical treatment is sometimes the only method of reducing or relieving pain. Several different surgical procedures are available for treating hallux rigidus. Dr. Radovic will consider a number of factors when choosing the suitable procedure or combination of procedures for a patient, such as age, activity level and the extent of deformity based on x-ray results. Patients should expect variable recovery periods depending on the type of procedure or procedures performed.