Stiff toe joint (Hallux Rigidus)

Hallux Rigidus is a disorder of the joint located at the base of the big toe. The joint is covered with an articular cartilage (a slick, shiny covering at the end of the bone). If this covering is injured, it begins wearing out or gets degenerated. Hallux Rigidus is therefore, a form of degenerative Arthritis. In the degeneration process, bone spurs gets formed around the joint. The spurs or bony outgrowths may restrict the motion in the joint, especially the ability of the toe to bend upward when the foot is moved upward. This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Since Hallux Rigidus is a progressive condition, the toe's motion decreases as with time. This calls for immediate non surgical or surgical treatment, as per the severity of the condition.

CAUSES

According to the doctors, the condition begins with an injury to the articular cartilage lining the joint, such as from stubbing the big toe. The injury sets in motion a degenerative process that could last for years before the actual symptoms start showing.

Other causes of Hallux Rigidus are faulty functioning (bio mechanics) and structural abnormalities of the foot that can lead to Osteoarthritis in the big toe joint.

Genetic factors may also lead to Hallux Rigidus. While in other cases, it is associated with physical activities or jobs that increase the stress on the big toe, especially among workers who have to repeatedly stoop or squat.

SYMPTOMS

Early signs of Hallux Rigidus are:

• Pain or stiffness in the big toe while walking, standing, bending etc.

• Pain or stiffness worsened during cold or damp weather.

• Problems while physical activities like running and active outdoor sports.

• Swelling and inflammation around the joints.

DIAGNOSIS

Physical examination may normally help in diagnosis. However, X Rays or MRI scans are often required to understand the extent of the degeneration and bone spur formation.

TREATMENT

•  Initial treatment begins with anti-inflammatory medications to control the pain, swelling, heat, and redness of the degenerative Arthritis. These include oral non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

• Properly designed shoes reduce the bending of toe while walking. It will also help to mitigate the problem. Injections of corticosteroids also reduce inflammation and pain. A rocker type of sole allows the shoe to take some of the bending force, and may be combined with a metal brace in the sole to limit the flexibility of the sole of the shoe and reduce the motion needed in the MTP joint.

• Ultrasound or other physical therapies also provide temporary relief.

• Custom Orthotic devices are recommended to improve foot function.

In severe cases, surgery may be required. This is done after considering the extent of the deformity based on X Ray and MRI findings, age of the patient, the activity level and other associated factors. The length of the recovery period will vary, depending on the procedure performed.