Hallux Rigidus
Painful stiffness of the big toe joint usually needs standing X-rays and stage-based treatment.
Hallux rigidus is osteoarthritis of the first metatarsophalangeal joint. Patients describe pain on the top or deep inside the big toe joint, loss of push-off, difficulty walking fast, trouble squatting or running, and a growing dorsal bump from bone spurs. My consultation begins with standing X-rays to assess joint space loss, dorsal osteophytes, alignment, and the stage of degeneration. In earlier stages, a cheilectomy often improves motion and reduces painful impingement by removing the dorsal spur and freeing the joint. In end-stage disease, arthrodesis of the first MTP joint remains the most predictable pain-relieving option. I do not routinely recommend joint replacements here, because in everyday practice their results are less predictable than a well-selected cheilectomy or fusion.
Symptoms
- Pain at the base of the big toe during walking or push-off
- Stiffness and loss of toe motion
- Pain when squatting, running, or going uphill
- Dorsal bump from bone spurs over the joint
Conservative treatment
- Standing X-rays to stage the degeneration and identify osteophytes
- Shoe modification with a stiff sole or rocker sole
- Pain control and anti-inflammatories
- Load modification and physiotherapy to preserve function
When is surgery needed?
After standing X-rays, I often recommend cheilectomy in earlier stages to improve motion of the big toe. In advanced arthritis with severe cartilage loss, first MTP arthrodesis is usually the most reliable option. I do not routinely recommend joint implants here because their results are less predictable in the long term.