Hallux Rigidus: Throw the kitchen sink at it

hallux rigidus

Hallux rigidus simply means the big toe (“hallux”) joint is rigid (“rigidus”). There is some variability in the use of the term, “hallux rigidus” as some apply it to a joint that is rigid with no motion available and others apply the term to a joint that still has some motion but is less than the normal amount required for gait. Osteoarthritis of the big toe joint is the most common reason for hallux rigidus and some use the term ‘hallux rigidus’ to mean osteoarthritis of the big toe (first metatarsophalangeal) joint.

The typical symptoms of hallux rigidus are increasing pain and stiffness in the big toe joint, especially doing activities that require the joint to flex or bend more. There is a gradual loss of the range of motion of the joint which make it harder to walk properly. There is often swelling and inflammation around the joint. Eventually bone spurs develop around the joint, further restricting motion.

The big toe joint is a very important joint for gait, so its loss of motion can have significant impact. As we walk or run and the back heel comes off the ground, the big toe joint has to move to allow our heels to come up. If that joint does not move, then compensations are going to be caused at other joints to get that motion to allow us to move forward. This motion at other joints could be excessive and become painful. The change in gait from the hallux rigidus can be compensated in many other parts of the body and become painful because of that.

Treatment of Hallux Rigidus

The typical approach to hallux rigidus is: pain relief and restricting motion of the joint.

  • Pain relief. Depending on how painful it is, relief of that pain may be needed. This could be as simple as applying ice packs or the use of anti-inflammatory drugs or it may be the use of injections into the joint.
  • Restricting motion of the joint. As movement of the joint is painful, then it makes sense to limit that force that is trying to move the joint. This can be done with the use of footwear that have a rocker motion built into them (eg MBT; Hoka running shoes). Sometimes a rocker can he added to the outside of the sole on a shoe. With these rockers the foot rocks over it and there is less demand on the joint to bend. Full length rigid carbon insoles in the shoes are also used to stiffen the forefoot area, so less motion occurs at the joint. Padding can be used to create a Morton’s extension for hallux rigidus – this could use podiatry felt as a short term measure or added to a foot orthotic with a material such as EVA for the longer term.

In addition to the above, exercises to strengthen the muscles around the joint may have a long term benefit. Mobility exercises and stretching out the range of motion of the joint may help give a small improvement and mostly help prevent the restriction in motion progressing.

If the above conservative approaches do not help there are surgical options for hallux rigidus as a a fusion of the joint (arthrodesis), a removal of the bone spurs that are restricting the motion of the joint (cheilectomy) or an implant such as the Cartiva.

Forum Questions and Discussions on Hallux Rigidus

Hallux rigidus or osteoarthritis?
What are best men’s dress casual shoes for hallux rigidis?
Type of carbon insole for big toe arthritis ?
Failed Cheilectomy
Hallux Rigidus both feet
Hallux Rigidus Orthosis
Gait changes following cheilectomy for hallux rigidus
Classification of Hallus Rigidus

Personal Opinion on Hallux Rigidus

For most people I go with the Hoka running shoes and the rigid carbon plates. The Hoka shoes with the rocker type action in the forefoot makes it easier for the body to move forward over the foot and the rigid carbon plates restrict motion of the big toe joint to give some symptomatic relief.


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