The average person takes over 5000 steps per day, and by the age of 50 years old, you have walked almost 75000 miles. With each step you take, you put up to two times your body weight upon your feet. One problem that can develop that affects the great toe joint is hallux rigidus. This condition is recognized when there is decreased motion in the joint. The symptoms are gradually progressive and increased in severity with increased activity, many times making it difficult to walk up and down stairs, squat or even walk or run without discomfort.
Hallux rigidus is an arthritic condition often leading to pain and stiffness within the joint located behind the big toe. Arthritis is often described as a wearing out or erosion of the cartilage between the joints. With increased motion within the joints, there’s a gradual increase in the amount of erosion, causing greater damage within the joint. Nobody knows the exact cause of hallux rigidus, but once the process has begun, there is a gradual increase and difficulty in bending the toe. Usually it is more difficult to bend the toe in an upward direction as the problem advances.
Some early signs and symptoms of hallux rigidus include:
As the disorder progresses, other symptoms including pain while at rest, limping or the inability to wear certain shoes will become more noticeable.
There are many theories which may contribute to the formation of hallux rigidus or arthritis within the great toe joint. Some of these causes may include an imbalance in your foot structure and foot function, also known as biomechanics. Other times there can be a traumatic incident, something as simple as jamming your toe, which may have occurred and caused localized inflammation within the joint. Most people with flat feet or low arches are more susceptible to developing hallux rigidus deformity. With increased activities and motion within the joint, this inflammation can lead to the arthritic changes previously mentioned. Heredity may also play a part in the development of hallux rigidus deformity, as we inherit certain foot types.
Initially, the most common symptoms include pain and swelling within the joint. The sooner you seek treatment for the condition, the better chance there is to have the ability to remain comfortable and active for many years. However, the longer the condition is present, the greater likelihood there is that there will be damage within the joint and the development of bone spurs or pieces of bone within the joint.
The diagnosis of hallux rigidus is made after a thorough examination by your foot and ankle surgeon which may also include diagnostic x-rays.
If your condition has been diagnosed early enough, nonsurgical treatment may include different types of shoes, oral anti-inflammatory medication or special inserts made by your foot and ankle surgeon to align the foot and allow proper motion. Many times you may have to alter the types of activities in which you participate or to the degree of your participation in an attempt to avoid surgical intervention and to prevent further damage to the joint.
As the condition progresses, at times the only treatment that will eliminate the pain and deformity is surgery. Depending on the severity of your condition, they are different types of surgical procedures which may be performed.
If the joint is not damaged, one procedure may involve “cleaning up and remodeling” the joint in an attempt to increase the range of motion and flexibility of the joint. As there is greater damage within the joint, at times the joint may not be able to be preserved and the possibility of a total joint implant/replacement may be indicated. This will allow continued activity and range of motion within the joint, allowing a more normal lifestyle.
In severe cases, the joint may need to be fused because of the nature of the condition. Your foot and ankle surgeon will determine which procedure is indicated after the examination. Factors which may affect your surgeon’s decision may include your age, overall physical condition, activity level and occupation. The length of recovery will depend on the type of procedure performed.