Presentation and symptoms

Hallux rigidus is arthritisthe cartilage wearing down of the joint of the big toe. This causes pain at the base of the big toe which is more pronounced during and after walking. The big toe then becomes stiff, especially when the toe bends upwards, i.e., when taking a step. Some patients will have a “bump” on top of their big toe joint.

Symptoms such as inflammation and pain can flare up from time to time and may even happen during the night. These flare-ups can last several days to several weeks. Regular X-rays are used to diagnosis and monitor this condition.

Hallux rigidus develops slowly and tends to worsen over time. Diagnosis is made by X-ray.

X-Rays: Hallux Rigidus

Comparative radiographs: normal left x-ray and right x-ray showing hallux rigidus.


Treatments of Hallux rigidus

Various treatment options are possible depending on the stage of the condition. However, the cartilage and the big toe joint are not currently able to be reconstructed.

Non-surgical treatments

If you are only experiencing mild pain or no pain at all, it is recommended that you wear shoes that accommodate the bump on the top of your foot and ease any pain flare-ups with painkillers and anti-inflammatories.

For more severe cases, hyaluronic acid injections may be proposed. This involves injecting a gel into the joint which will absorb stress and promote the production of natural joint fluid. However, the effect of each injection is only temporary, therefore, they must be repeated regularly. This can be done at the practice where you had your consultation.

If none of the above measures are helping anymore, surgery should be considered.

Surgical treatments

There are two types of surgery: conservative surgery and arthrodesis. The former aims to alleviate the pain while preserving the joint and its mobility. The latter treats the pain by fusing the joint.

Both of these surgeries can be performed during a short stay in hospital (a few days) or as an outpatient procedure where you will be discharged the same day as the operation.

  • Conservative surgery

    Conservative is similar to bunion surgery. Its aim is to shorten the toe bones by a few millimetres in order to reduce the tension in the joint.

  • Arthrodesis

    Arthrodesis involves fusing the big toe joint. The joint is fixed in a position which will allow you to walk without experiencing any problems.

    To achieve this, the surgeon will remove what is left of the cartilage and fix the joint in the right position using screws. Finally, any bony projections present are also removed. The operation can be performed under general or local anaesthetic and involves making a 5 to 8 cm incision.

    Following the procedure, you must wear a special shoe for four weeks which takes weight off the forefoot. This means that you can walk on the foot immediately after surgery. Your dressings are also to be tended to regularly and pain medication should be taken. Finally, you will have a postoperative consultation with your surgeon to check how your recovery is going.