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Hallux Rigidus. Stiff Big Toe?

The most common site of arthritis in the foot is at the base of the big toe, and its incidence is increasing as the population ages. Having mobility in our big toe joint is especially important because it needs to bend with every step we take; a stiff big toe can lead to pain and difficulty walking. Those who repetitively and excessively load the big toe joint may be at a heightened risk for joint degeneration.

Hallux limitus is the gradual loss of joint range of motion in conjunction with joint degeneration, which can progress to hallux rigidus. Hallux rigidus is typically defined as a complete loss of joint motion - a degenerative process in which the joint surfaces in your big toe joint begin to wear away and develop extra, joint-limiting bone. These little excess growths of bone are called osteophytes or more commonly "bone spurs".

In general, hallux limitus and rigidus is more prevalent in females than males, and is more likely to affect both feet as opposed to only a single foot.

A stiff big toe is commonly seen in athletes: especially runners, due to the repetitive nature of running as well as the excessive load placed on the joint. Sports that put athletes at a heightened risk of a condition called turf toe (a sprain of ligaments around the big toe joint from hyperextension), such as football, soccer, wrestling, dance and gymnastics, also put athletes at a heightened risk for later developing hallux limitus / rigidus. Prolonged squatting, such as a catcher's position in baseball or gardening, that place the toe in a fully extended position is also higher risk of later developing hallux limitus / rigidus.

It's believed that the most common cause of hallux rigidus is trauma, that can be an acute trauma (such as dropping something on your toe) or repetitive microtrauma (such as the repetitive nature of sports or work). Excessive pronation, or fallen arches is also a risk factor to developing hallux limitus / rigidus since extra stress is placed on the big toe joint as the pressure is shifted towards your midline.

(Typical) Symptoms:

Early stages of hallux limitus may present as swelling, pain, and limited range of motion. As the degenerative arthritis worsens general enlargement and thickening of the big toe joint occurs along with tenderness along the top of the joint line and with loss of joint mobility. Sometimes a bony prominence (osteophyte) can be seen on the top of the big toe joint, which can make wearing certain shoes difficult. The big toe is typically painful and aggravated with active (especially with the pushing off during walking or doing exercises such as lunges).

Conservative Care Options:

Hallux limitus is often successfully treated conservatively through a combination rest, anti-inflammatory drugs, injections, joint manipulation and physical therapy, proper footwear and orthotics. Hallux rigidus follows the same treatment plan but since it's further along in it's degenerative progress more aggressive forms of treatment may be required from improved pain.

Appropriate footwear and orthotic devices play a significant role in helping minimize the pain and in preventing further joint degeneration. The goal of an orthotic device is to improve the postural position of the foot to unload the big toe joint of excessive stress, essentially helping to move the pressure away from the big toe joint to elsewhere where it can be better tolerated.

When selecting footwear is to important to look for shoes with a wide, square toe box to allow for adequate room for toes and to avoid friction. A low heel (less than 1") is beneficial in reducing the stress placed on the ball of the foot. It is especially important to avoid stitching over areas where bones and joint are prominent as stitching doesn't stretch and can easily irritate a tender area. A stiff soled shoe with a toe spring (the rise or curve upward of the sole at the forefoot) or rigid rocker soled shoe reduces how much the foot needs to bend during push off and helps with forwards propulsion.

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