Stiff Big Toe (Hallux Rigidus)

Stiff big toe can effect your balance.

The function of the toes, especially the big toe, is to help us balance, and to propel us forward during walking or running. One of the most common complaints is "Hallux Abducto Valgus", better known as a Bunion. American research has indicated that women suffer from bunion deformities 4 to 6 times more frequently than men. However, a complaint that can also cause pain at the big toe joint which, according to research, is actually more common among men than women, is Hallux Rigidus.

Hallux Rigidus, “stiff big toe,” is a commonly occurring condition of degenerative arthritis (a wearing out of surfaces) affecting the big toe joint. The condition results over time from constant wear and stress or from an injury to the joint. The result of the condition is pain, swelling, and/or restriction of movement; eventually the sufferer will stop bending the joint when transferring weight to the other foot, as in walking or running. Women will probably have to stop wearing shoes with high heels.

Stiff Big Toe

Two problems result from Hallux Rigidus: pain and stiffness (loss of motion). Walking is painful and difficult, since the Metatarso-Phalangeal Joint cannot move enough to allow the foot to “roll through” while walking.

In most cases, there is no definite cause of this condition. Because of the tremendous stress put on this small joint over time (a force equal to twice one’s body weight), eventually the joint simply begins to wear out. It can affect fairly young people, even as young as teenagers.

Hallux Rigidus can also result from an injury or as a complication of another medical condition, such as Gout or infection.  It can also result from mechanical or anatomical problems in the foot and ankle, excessive pronation (rolling in) of the ankles, as well as toe deformities, which increase the stress on the joint.

Recent endoscopic findings have also attributed a reduced range of motion (ROM) as the big toe joint secondary to damage at the tendon of the Flexor Hallucis Longus tendon as it runs adjacent to the Sesamoids that are like little knee caps that run underneath the big toe joint in little groves called Cresta, which are positioned underneath the Distal Condyle of the 1st Metatarsal Shaft. The damaged, frayed tendon slips in between the Sesamoid and Cresta effectively “jamming” the movement of the joint. 

A physical examination and effective medical history will often determine the presence of Hallux Limitus However, to fully evaluate the condition we may take x-rays to determine the degree of the deformity and assess the changes that have occurred.

Hallux Limitus is progressive and will usually get worse over time until the big toe fuses by itself. This can take many years and is usually a painful process forcing the patient to reduce their activity levels. Once Mr Edwards has evaluated your big toe joint, a treatment plan can be developed that is suited to your needs.

As a form of degenerative arthritis, treatment may begin with anti-inflammatory medication to alleviate the pain, inflammation, however long-term use of this type of medication for the treatment of Hallux limitus is not indicated.

As with Bunion deformities, there are several types of surgical procedures available to treat Hallux Rigidus, depending on the severity of the case.

Advancements in endoscopic technique can now offer hope to those patients who have been recommended fusion of the affected big toe joint as the only treatment option. “If we catch the process early enough, we can literally enter the joint, repair the damage and come out leaving the patient mobile after a fews days of rest with a positive long-term prognosis”. Mr Stefan R Edwards FNZCPS.

So, if you suffer from a painful big toe joint, you don’t have to put up with it. Early treatment is recommended to help avoid irreparable damage at the big toe joint surface. 

The exact aetiology of Hallux Limitus is unknown however genetic predisposition plays a significant role in this condition. That being said Mr Edwards has observed certain environmental factors that can help reduce the risk and manage those case that suffer from this condition.

It is crucial for those patients who suffer from Gout to continue the use of their prevention medication if they are to avoid irreparable damage to their big toe joints. If they do suffer a “gouty attack”, keep the joint still and take anti-inflammatory medication ( as indicated by their family doctor) and if needed, request a consultation with a consultant Rheumatologist to help organise a long-term treatment management plan.

If you suffer from Gout, prevention is far better than cure.

For those who do not suffer from Gout, other non-invasive measures can be taken to help reduce the risk of Hallux Limitus.

These include:

  • Take fish oil, 4 tablets a day or eat raw oily fish eg. Salmon.
  • Take Chondroitin as prescribed.

Remember. Early diagnosis and treatment increases your chance of successful treatment.

For further advice or to make an appointment, please contact one of our professional team, our numbers and contact details are listed on the Contact page.