This document describes the condition of Hallux Rigidus, which refers to arthritis in the big toe joint causing stiffness and loss of movement. Common causes include faulty foot biomechanics and overuse from certain jobs or activities. Symptoms progress from pain and stiffness with activity to pain at rest and difficulty walking. The management plan involves 3 phases. Phase 1 focuses on decreasing discomfort through heat/ice, stretches, and low-impact exercises. Phase 2 adds exercises to improve pronation and supination. Phase 3 emphasizes proprioceptive exercises. Progression is based on completing exercises with minimal effort and no pain.

1. 1. injury or condition - Hallux Rigidus
a. Hallux rigidus refers to an absence of dorsiflexion at the first
metatarsophalangeal joint due to arthritis.
b. Common causes of hallux rigidus are faulty function (biomechanics) and
structural abnormalities of the foot that can lead to osteoarthritis in the big
toe joint.
i. fallen arches
ii. excessive pronation of the ankles
iii. overuse – especially among people engaged in activities or jobs
that increase the stress on the big toe, such as workers who often
have to stoop or squat.
iv. stubbing your toe.
v. inflammatory diseases such as rheumatoid arthritis or gout
2. Mechanism of injury or etiology -
3. signs and symptoms -
a. Early signs and symptoms include:
i. Pain and stiffness in the big toe during use (walking, standing,
bending, etc.)
ii. Pain and stiffness aggravated by cold, damp weather
iii. Difficulty with certain activities (running, squatting)
iv. Swelling and inflammation around the joint
b. As the disorder gets more serious, additional symptoms may develop,
including:
i. Pain, even during rest
ii. Difficulty wearing shoes because bone spurs (overgrowths) develop
iii. Dull pain in the hip, knee, or lower back due to changes in the way
you walk
iv. Limping (in severe cases)
4. Management plan -
a. Phase 1.
i. goals: decrease the discomfort in your foot.
1. Heat/ice treatment, Ultrasound and Electrotherapy
2. stretches

2. a. Flexion / Extension Stretches: Cross your legs and
hold your big toe with your hand. Then, using your
hand, bend the big toe up and down, holding each
position for 30 seconds.
b. Joint Traction: Cross your injured foot over your
opposite knee and hold your foot with your opposite
hand behind your big toe joint. Use your other hand to
gently pull your big toe away from your foot, as if you
were trying to pull it out of its socket. Hold and gently
rotate your toe in a circular motion.
c. Abduction/Adduction: Spread your toes as wide as
you can, then, press your toes together, holding each
position for 10 to 15 seconds.
3. exercises
a. foot and ankle circles
b. foot and ankle abc’s
c. bike riding
b. Phase 2
i. goals: working on proper supination and pronation
ii. Estimated Length of time of phase: 3 weeks
iii. exercise rehabilitation:
1. sole claps
a. Part I: sit off table or chair with feet off ground. Keep
heels together
b. Part II: While keeping heels together, actively bring soles
of feet together. Return to starting hold for 10-15 sec 3-4
reps
2. Peroneal Stretch
a. Sit in a chair and place one ankle on the knee of your
other leg, the foot of which should be planted on the
floor. Point the toes of your raised foot and then use
your hands to gently rotate your ankle so the sole of
your foot points toward the ceiling. You should feel a

3. stretch down the outside of your lower leg; hold it for
up to 30 seconds then relax and repeat on the other
leg.
3. Short Foot
a. The short foot exercise is recommended by postural
expert Vladimir Janda in his book "Muscle Function
Testing," to build strength, stability and endurance in
the muscles and tendons that support the arch. Sit
with good posture in a sturdy chair with both feet on
the floor, your toes facing straight forward, and your
knees bent to 90 degrees. Inhale, contract the
muscles on the bottom of your right foot and lower
legs to raise the arch of your foot without curling your
toes. This position is called the short foot position.
Hold this isometric muscle contraction for six
seconds, then exhale and relax. Turn your lower leg
slightly outward, inhale and again come to the short
foot position. Hold for six seconds, exhale and relax.
Next turn your lower leg inward, and perform another
isometric contraction for six seconds. Repeat the
identical series of exercises with your left foot.
Reposition your feet an inch farther away from the
chair, and perform repetitions in the straight, outward
and inward ankle positions with both feet. After each
series, inch your foot forward until you perform a total
of five series with each foot. Sliding your feet farther
away from the chair with each rep works the muscles
at slightly different angles.
4. walking the line
5. band marching
c. Phase 3

4. i. goals - Proprioceptive exercises
ii. Estimated Length of time of phase: 5 weeks
iii. exercise rehabilitation:
1. Roll Your Feet and Squish Your Toes into the Carpet
a. Stand with your knees relaxed and feet pointing
straight ahead, hip width apart. Working primarily with
your feet, ankles and body weight, shift to the left so
your left foot rolls to the outside as the right foot rolls
to the inside. Rock back slightly on your heels as you
shift to the right, rolling to the outside of your right foot
and inside of your left foot. Shift your weight to your
toes as you roll back to the left, making a
counterclockwise movement. Do this for 10 reps, then
reverse and do the same motion 10 times in a
clockwise manner.
2. Runners' poses.
a. To do these, stand relaxed with erect body posture,
with your feet roughly under your shoulders. Then,
swing your right thigh ahead and upward until it is
parallel with the floor (your leg should be flexed at the
knee as you do this, so that the lower part of the leg
should be pointing almost directly at the ground, ie, it
should be nearly perpendicular with the ground); as
you swing your thigh ahead and up, simultaneously
bring your left arm forward, as you would do during a
normal running stride).
b. Hold this position for a couple of seconds, while
maintaining relaxed stability and balance, and then
bring your right foot back to the ground and your left
arm back to a relaxed position at your side (that
completes one 'pose'). Perform 14 more pose reps
with your right thigh, and then switch over to the left

5. leg for 15 poses. As you get better at doing this
exercise, gradually speed up the thigh-lift movement
and also elevate the thigh beyond the parallel-with-
the-ground position (so that the exercise eventually
becomes a high-knee-lift pose).
3. criteria to return to sport or activity
d. preform all phase 3 exercises with little effort and no pain
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