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1. HALLUX RIGIDUS
What Is Hallux Rigidus?
E ach day, with every step you take,
your big toe bears a tremendous
amount of stress—a force equal to
Hallux rigidus is a disorder of the
joint located at the base of the big toe.
Wearing high-heeled shoes can be
particularly difficult.
• Dull pain in the hip, knee, or
about twice your body weight. Most It causes pain and stiffness in the big lower back due to changes in the
of us don’t realize how much we use toe, and with time it gets increasingly way you walk
our big toe. We tend to take it for harder to bend the toe. “Hallux” refers • Limping, in severe cases
granted, unless a problem develops. to the big toe, while “rigidus” indicates
One problem that afflicts the that the toe is rigid and cannot move. What Causes Hallux Rigidus?
big toe is called hallux rigidus, a Hallux rigidus is actually a form of Common causes of hallux rigidus are
condition where movement of the degenerative arthritis (a wearing out faulty function (biomechanics) and
toe is restricted to varying degrees. of the cartilage within the joint that structural abnormalities of the foot
This disorder can be very troubling occurs in the foot and other parts of that can lead to osteoarthritis in the
and even disabling, since we use the the body). big toe joint. This type of arthritis—
all-important big toe whenever we Because hallux rigidus is a pro- the kind that results from “wear and
walk, stoop down, climb up, or even gressive condition, the toe’s motion tear”—often develops in people who
stand. If you have pain and/or stiff- decreases as time goes on. In its earlier have defects that change the way
ness in your big toe, you may have stage, motion of the big toe is only their foot and big toe functions. For
this condition. somewhat limited—at that point, the example, those with fallen arches or
condition is called “hallux limitus.” excessive pronation (rolling in) of the
But as the problem advances, the toe’s ankles are susceptible to developing
range of motion gradually decreases hallux rigidus.
until it potentially reaches the end In some people, hallux rigidus runs
stage of “rigidus”— where the big toe in the family and is a result of inherit-
becomes stiff, or what is sometimes ing a foot type that is prone to devel-
called a “frozen joint.” Other problems oping this condition. In other cases, it
are also likely to occur as the is associated with overuse—especially
disorder progresses. among people engaged in activities
Normal Function
Early signs and symptoms include: or jobs that increase the stress on the
• Pain and stiffness in the big toe big toe, such as workers who often
during use (walking, standing, have to stoop or squat. Hallux rigidus
bending, etc.) can also result from an injury—even
• Pain and stiffness aggravated by from stubbing your toe. Or it may
cold, damp weather be caused by certain inflammatory
• Difficulty with certain activities diseases, such as rheumatoid arthritis
(running, squatting) or gout. Your podiatric foot and ankle
Limited Motion
• Swelling and inflammation surgeon can determine the cause of
around the joint your hallux rigidus and recommend
the best treatment.
As the disorder gets more serious,
additional symptoms may develop, Diagnosis of Hallux Rigidus
including: The sooner this condition is
• Pain, even during rest diagnosed, the easier it is to treat.
• Difficulty wearing shoes because Therefore, the best time to see a
Rigid Deformity bone spurs (overgrowths) develop. podiatric surgeon is when you first

2. notice that your big toe feels stiff or Most likely, you’ll have to stop the joint as well as any accompa-
hurts when you walk, stand, bend wearing high heels. nying bone spurs, and then alters
over, or squat. If you wait until bone • Orthotic devices. Custom orthotic the position of one or more bones
spurs develop, your condition is likely devices may improve the function in the big toe. These procedures
to be more difficult to manage. of your foot. are designed to preserve and
In diagnosing hallux rigidus, • Medications. Nonsteroidal anti- restore normal alignment and
the podiatric surgeon will examine inflammatory drugs (NSAIDs), function of the joint as well as
your feet and manipulate the toe to such as ibuprofen, may be reduce or eliminate pain.
determine its range of motion. X-rays prescribed to help reduce pain • More aggressive procedures are
are usually required to determine how and inflammation. Supplements used when the joint cannot be
much arthritis is present as well as such as glucosamine-chondroitin preserved. These may involve
to evaluate any bone spurs or other sulfate and some vitamins and fusing the joint, or removing part
abnormalities that may have formed. minerals may also be helpful. or all of the joint and, in some
• Injection therapy. Injections of cases, replacing it with an implant,
Treatment: corticosteroids in small amounts such as is done for the hip or
Non-Surgical Approaches are sometimes given in the affected knee. These procedures eliminate
If your condition is caught early toe to help reduce the inflammation painful motion in the joint and
enough, it is more likely to respond and pain. provide a stable foot.
to less aggressive treatment. If fact, • Physical therapy. Ultrasound
in many cases, early treatment may therapy or other physical therapy The procedure that is used to
prevent or postpone the need for modalities may be undertaken correct hallux rigidus depends on
surgery in the future. That’s why it to provide temporary relief. many factors, including the cause of
is important to see your podiatric the condition and the severity, as well
surgeon when you first begin to When Is Surgery Needed? as the patient’s age, occupation and
notice symptoms. In some cases, surgery is the only activity level. Your podiatric surgeon
Treatment for mild or moderate way to eliminate or reduce pain. is trained to select a surgical proce-
cases of hallux rigidus may include There are several types of surgery dure best suited to your particular
one or more of these strategies: that can be undertaken to treat hallux condition and needs.
• Shoe modifications. Shoes that have rigidus. These surgical procedures fall If surgery is performed, the length
a large toe box should be worn, into two categories: of the recovery period will vary,
because they put less pressure on • Some procedures reconstruct and depending upon the procedure or
your toe. Stiff or rocker-bottom “clean up” the joint. The surgeon procedures performed. ▲
soles may also be recommended. removes the arthritic damage from
This information has been prepared by the Consumer Education Committee of the American College of Foot and
Ankle Surgeons, a professional society of 5,700 podiatric foot and ankle surgeons. Members of the College are
Doctors of Podiatric Medicine who have received additional training through surgical residency programs.
The mission of the College is to promote superior care of foot and ankle surgical patients through education,
research and the promotion of the highest professional standards.
Copyright © 2004, American College of Foot and Ankle Surgeons • www.acfas.org