Stiff Big Toe (Hallux Rigidus)
What is a Stiff Big Toe?
A stiff big toe, also called hallux rigidus, is a form of degenerative arthritis affecting the joint where the big toe (hallux) attaches to the foot. The toe typically becomes stiff at the base and is sometimes called a “frozen joint”.
Degenerative arthritis is a medical condition characterized by the chronic breakdown of cartilage in the joints leading to painful inflammation and stiffness.
Why and How a Stiff Big Toe Happens
A stiff big toe occurs when the smooth articular cartilage covering the end of the big toe bones is damaged or lost. This results in:
- Narrow joint space
- Rubbing of the raw bone ends
- Formation of bone spurs on top of the bones
- Eventual non-flexion of the big toe
Causes
The main causes of a stiff big toe can include:
- Abnormal foot anatomy
- Injury to the foot and/or big toe
- Overuse and/or wear and tear
- Family history (genetic factor)
- Certain medical conditions (for example, arthritis or gout).
Risk Factors
Anyone can develop a stiff big toe. However, the condition tends to affect people between the ages of 30 and 60 and is more common in women.
Signs and Symptoms
Symptoms of stiff big toe start out mild and gradually worsen over time. The early signs and symptoms include:
- Pain and stiffness at the base of the big toe
- Pain and stiffness that is aggravated by cold or damp weather
- Swelling and inflammation in and around the joint
- Difficulty bending the big toe
As the condition progresses, there can be advanced symptoms such as:
- Pain during inactivity
- Formation of a hard bump at the top of the foot
- Total inability to bend the big toe
What if the Condition is Left Untreated?
If left untreated, a stiff big toe may lead to:
- Limping, and pain in the knee, hip, or lower back
- Painful standing and/or walking
- Permanent loss of big toe motion and disability
Diagnosis
Your doctor will first physically examine your foot or big toe and test their range of motion. An X-ray of the foot or the big toe may be ordered to identify the degree of damage.
Treatment
Nonsurgical management can be the first-line treatment for a stiff big toe, especially if the condition is diagnosed early. It may include the following:
- Soaking the affected foot alternatively between cold and warm water
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs)
- Avoiding high-impact activities such as running
- Undergoing physical therapies including ultrasound therapy
- Wearing shoes that offer plenty of room for the toes
- Avoiding high-heeled footwear
These treatments may help decrease the symptoms and relieve pain to some extent but cannot stop the condition from progressing. Your doctor may choose to prescribe corticosteroid injections for additional relief.
Failure of nonsurgical interventions may prompt surgery. There are various types of surgeries available to treat stiff big toe. However, the doctor may take into consideration the severity of the condition, activity type or level and patient age before choosing the type of surgery. They include:
- Cheilectomy: Performed in combination with another procedure called osteotomy, it
- Involves shaving of bone spurs and removal of part of the big toe bone.
- Treats mild to moderately damaged stiff big toe.
- Preserves the joint and maintains stability and motion.
- Interpositional arthroplasty:
- Involves the removal of damaged bone and placing a spacer between the bones to minimize contact. Treats moderate to severe stiff big toe.
- Preserves joint motion, relieves pain and can be easily converted to fusion if it fails.
- Arthrodesis (joint fusion):
- Involves removal of damaged cartilage and creates fusion of bones (with screws, plates or pins) to enable them to grow together.
- Treats a severely damaged big toe and provides long-term pain relief.
- However, the movement of the big toe may be permanently restricted.
- Arthroplasty:
- This is joint replacement surgery and entails replacing one or both sides of the joint with an artificial component made of plastic or metal.
- Comes with a few risks such as infection, implant failure and soft tissue instability.