Hallux Rigidus Treatment

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Hallux Rigidus?

Hallux rigidus, also known as stiff big toe, is a medical condition characterised by arthritis in the metatarsophalangeal (MTP) joint at the base of the big toe. The articular cartilage within this joint undergoes damage, leading to increased stress upon loading the joint. This can lead to a stiff and painful big toe.

The condition tends to develop gradually, often beginning with mild pain and stiffness, particularly during activities such as walking or standing for prolonged periods. As it advances, the range of motion in the big toe becomes increasingly limited, affecting gait and potentially causing strain on other areas of the body​​.

Causes of Hallux Rigidus

The development of hallux rigidus can be attributed to several factors:

  • Wear and Tear
    Hallux rigidus is often caused by wear and tear on the articular cartilage. Deterioration causes the raw bone ends to rub together, causing damage within the joint. This happens over time, often as a result of ageing.
  • Injury
    Trauma or injury to the toe can also lead to hallux rigidus. These injuries may damage the cartilage, exacerbating the wear and tear process. Previous injuries can also increase stress on the MTP joint, thereby heightening the likelihood of developing the condition.
  • Bone Spurs
    Overgrowth or spur formation on the top of the bone may occur, restricting the toe’s ability to bend properly during walking.
  • Certain Types of Foot Anatomy
    Anatomical differences may predispose some individuals to the condition.

Symptoms and Signs

The symptoms and signs of hallux rigidus are diverse and tend to evolve as the condition progresses.


  • Stiffness in the Big Toe: The primary sign of hallux rigidus is stiffness in the big toe, leading to a limited ability to bend it up or down.
  • Pain in the Joint: Individuals often experience pain in the big toe joint, especially when pushing on the toes during walking. This pain can vary in intensity, and at times, it may be felt deeper within the toe.
  • Swelling Around the Joint: Swelling is commonly observed around the affected joint, indicating inflammation.
  • Development of Bumps: Bumps resembling bunions or calluses may develop on the top of the foot, indicative of changes in the joint structure.
  • Range of Motion Loss: As the condition worsens, there is a noticeable loss in the range of motion of the big toe, affecting normal foot movements​​​​.

Diagnosis

The process of diagnosing hallux rigidus involves a combination of clinical assessment and imaging.

  • Medical Review: Diagnosis typically begins with a comprehensive review of the patient’s medical history, including any previous foot injuries or conditions.
  • Physical Examination: A thorough physical examination is conducted, to inspect the foot for bone spurs, assess swelling, and evaluate the range of motion in the toe joint. The foot specialist also checks how much the toe can bend without causing pain.
  • X-ray Imaging: An x-ray is often used to confirm the diagnosis and assess the extent of joint damage. It can reveal the presence of bone spurs and the degree of joint space narrowing, which are indicative of hallux rigidus.

Non-Surgical Treatment Options

There are several non-surgical approaches to managing hallux rigidus, aimed at alleviating pain and improving joint function.

Orthotic Devices

Foot specialists may suggest using custom-made orthotic inserts or specially designed footwear. This can provide better support and distribute pressure more evenly across the foot, easing stress on the big toe joint​​​​.

Physical Therapy

Physical therapy may aid in enhancing joint flexibility and strength, which could help in reducing symptoms and possibly delay the need for more invasive treatments.

Pain Relievers and Anti-Inflammatory Medications

Over-the-counter medications can be effective in reducing pain and inflammation in the affected joint.

Corticosteroid Injections

These injections can provide temporary relief by decreasing inflammation and pain in the joint.

Platelet-Rich Plasma (PRP) Therapy

This treatment involves using a patient’s blood, rich in growth factors, to promote healing and pain reduction in the affected area.

Surgical Treatment Options

When non-surgical treatments are insufficient in managing hallux rigidus, surgery may be considered. The choice of surgical procedure depends on the severity of the condition and the patient’s overall health.

Cheilectomy

This procedure involves the removal of bone spurs and part of the metatarsal bone to create more space for the big toe to bend. It is usually considered for mild to moderate arthritis.

Arthrodesis (Joint Fusion)

In cases of severe arthritis, arthrodesis may be performed. This procedure involves removing the damaged cartilage and fusing the bones of the joint. While this results in a loss of motion in the joint, it can help alleviate pain.

Arthroplasty (Joint Replacement)

This procedure removes the damaged bone in the MTP joint and replaces it with a spacer made of donor tissue or synthetic material. This allows for some movement in the joint.

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Prevention Strategies

Though completely preventing hallux rigidus might not always be feasible, adopting certain strategies can help reduce the risk or slow the progression of the condition.

  • Maintain a Healthy Weight - Keeping a healthy weight minimises stress on the feet and toes, which can be beneficial in preventing joint issues.
  • Wearing Appropriate Footwear to Minimise Injury Risk - Wearing shoes with good arch support, sufficient room for the toes, and avoiding footwear that puts excessive stress on the big toe (like high heels) can help reduce the risk.
  • Regular Exercise and Toe Flexibility - Engaging in exercises that maintain toe joint mobility and overall foot health can be helpful. This includes regular stretching and strengthening of the toes and feet.
  • Rest and Avoid Overuse - Rest the joint after intense physical activities and avoid activities that excessively stress the big toe joint, such as certain high-impact sports.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    What Happens If Hallux Rigidus Is Left Untreated?

    When left untreated, hallux rigidus may progress, potentially leading to increased pain, stiffness, and limitations in movement. These symptoms can affect daily activities and mobility. Timely consultation with a foot specialist can help manage the condition to reduce the risk of these complications.

    Can Hallux Rigidus Be Cured?

    While hallux rigidus, a form of arthritis, cannot be completely cured, its symptoms can be managed through various treatment methods. Depending on the severity, management can range from conservative methods like physical therapy and orthotics to surgical interventions. Early diagnosis and treatment can improve outcomes and quality of life.

    How Can I Exercise My Big Toe to Help Treat Hallux Rigidus?

    Exercises aimed at maintaining or improving flexibility and strength in the big toe can be beneficial. These may include toe stretches, toe lifts, and resistance exercises. Consult a foot specialist for a tailored exercise regimen that safely addresses your individual needs.

    How Do You Massage a Hallux Rigidus?

    Massage therapy can help alleviate some symptoms of hallux rigidus by improving circulation and reducing stiffness. Techniques may include gentle manipulation and rubbing of the toe and foot area. Seek guidance from a foot specialist to ensure the massage technique is appropriate for your specific condition.

    Can Hallux Rigidus Spread?

    While hallux rigidus itself is a form of localised arthritis and does not spread, it can lead to complications in other parts of the body if not treated. It may lead to compensatory gait changes, potentially causing stress and discomfort in other foot areas, ankles, knees, and hips. Consult a foot specialist for help in managing the condition and preventing secondary complications.