HALLUX RIGIDUS

What Is Hallux Rigidus?

A disorder of the joint located at the base of the big toe. It causes pain and stiffness, and with time it gets increasingly harder to bend the toe. The word “Hallux” refers to the big toe, while “Rigidus” indicates that the toe cannot move.

A cheilectomy is a surgical procedure performed to treat hallux rigidus, a condition characterized by stiffness and limited range of motion in the big toe joint. The goal of a cheilectomy is to alleviate pain and improve joint function by removing bone spurs and other obstructions that restrict movement in the joint.

Foot Specialists define Cheilectomy as an operation of the metatarsophalangeal (MTP) joint, where the big toe bends and attaches back to the foot. The procedure involves a surgeon making an incision on the skin and removing excess bone with the aid of orthopedic tools that cut away at the bone spurs.

Generally, the bone spurs form at the top of the joint, but surgeons can remove bone spurs on the sides of the joint during cheilectomy surgery as well. 

Orthopedic surgeons or podiatrists perform this outpatient foot surgery under local anesthesia as either an open surgery or as a minimally invasive procedure with a smaller incision.

What Are The Reasons For A Cheilectomy?

Common factors associated with bone spurs of the big toe include:

• Arthritis: A degenerative condition of the cartilage. Over time, the cartilage wears down, exposing the joint bone. Bone spurs can then form over these exposed areas.
• Trauma: Such as stubbing or spraining your toe.
• Repetitively pounding your foot, such as during sports, can lead to small bone fractures and joint inflammation. A condition described as turf toe can develop. Eventually, these issues can cause the growth of bone spurs around the injured toe.

A consequence of arthritis in the big toe, Hallux rigidus, often preceded by hallux limitus, a lesser form of arthritis in the big toe where the joint stays somewhat stiff, but not as painful as with hallux rigidus.

Often, before considering a cheilectomy, patients can manage the pain and inflammation of hallux limitus and hallux rigidus by applying alternating heat and ice, taking anti-inflammatory medication, and/or wearing orthotic shoes. When these measures do not work, you may discuss surgery with your Foot and Ankle Specialist.

Symptoms of Hallux Rigidus

Hallux rigidus is a condition that affects the big toe joint, leading to stiffness and limited range of motion. The symptoms of hallux rigidus can vary in severity, and they tend to worsen over time. Here are some common symptoms associated with hallux rigidus:

Pain: The most common symptom of hallux rigidus is pain in the big toe joint. Initially, you may experience pain only during certain activities, such as walking, running, or bending the toe. As the condition progresses, the pain may become more persistent, even when at rest.

Stiffness: Stiffness in the big toe joint is another hallmark symptom. You may find it difficult to bend the toe or experience resistance when trying to move it. The stiffness can make activities like walking or pushing off the ground challenging.

Limited range of motion: As the condition progresses, the range of motion in the big toe joint decreases. You may find it difficult to flex or extend the toe fully. This limitation can affect activities that require toe movement, such as walking, running, or squatting.

Swelling: Inflammation and swelling around the big toe joint can occur, especially after prolonged or vigorous activity. The swelling may contribute to increased pain and further restrict the toe’s range of motion.

Difficulty with footwear: Hallux rigidus can make it challenging to find comfortable footwear. The restricted motion and joint enlargement may cause shoe discomfort, especially in the area around the big toe joint. You may need to wear shoes with a wide toe box or modify footwear to accommodate the condition.

Development of a bony bump: Over time, a bony bump, known as an osteophyte or bone spur, can develop on the top of the big toe joint. This can be seen or felt as a hard, bony prominence. The bone spur may contribute to joint stiffness and impede normal movement.

Treatments for Hallux Rigidus

The treatment for hallux rigidus, a condition characterized by stiffness and limited range of motion in the big toe joint, depends on the severity of symptoms, the extent of joint damage, and the individual’s activity level. Here are some common treatment options:

Nonsurgical treatments:

a. Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help alleviate pain and reduce inflammation. However, it’s important to consult with a healthcare professional before taking any medication.

b. Footwear modifications: Wearing shoes with a wide toe box and low heel can provide more room for the toes and reduce pressure on the affected joint. Stiff-soled shoes or rocker-bottom shoes may also be beneficial as they help to decrease the stress on the big toe joint.

c. Orthotic devices: Custom-made shoe inserts or orthotic devices can help support the arch, improve foot alignment, and offload pressure from the big toe joint.

d. Physical therapy: Specific exercises and stretches can help improve joint flexibility, strengthen surrounding muscles, and maintain range of motion. Physical therapy may also involve modalities such as ultrasound or electrical stimulation to reduce pain and inflammation.

Joint-preserving procedures:

a. Cheilectomy: This surgical procedure involves removing bone spurs and other obstructions that limit joint movement. Cheilectomy aims to increase the joint space and improve range of motion.

b. Osteotomy: In cases where there is significant joint deformity or misalignment, an osteotomy may be performed. This procedure involves cutting and reshaping the bones to improve joint function.

c. Joint fusion (arthrodesis): In advanced cases with severe joint degeneration and pain, joint fusion may be considered. This procedure involves removing the damaged joint surfaces and permanently fusing the bones of the big toe joint. Although fusion eliminates joint motion, it can provide pain relief.

d. Joint replacement (arthroplasty): In some cases, especially for older patients or those with less demanding activity levels, joint replacement surgery may be an option. This involves removing the damaged joint surfaces and replacing them with artificial implants.

The choice of treatment depends on factors such as the severity of symptoms, activity level, and individual preferences. It’s important to consult with a healthcare professional, such as a podiatrist or orthopedic specialist, to determine the most appropriate treatment plan for your specific case of hallux rigidus. They can assess your condition, provide an accurate diagnosis, and recommend the most suitable treatment options to alleviate pain and improve function.