Arthritis of the big to joint is referred to medically as Hallux Rigidus. It happens when the joint surfaces become worn or damaged (Osteoarthritis) due to age or injury or medical conditions such as Gout and it can affect part or all of the joint.
The big toe forms an important part of the walking gait and if it becomes arthritic it can affect us in a number of ways.
Most people notice the big toe joint becoming less flexible, losing the ability to turn upwards and it often produces pain with walking.
If the problem worsens, the joint can also be painful at rest or in bed.
This tends to lead to secondary problems when people start to change their walking gait, placing pressure more through the outside (lateral) part of the foot. Foot, leg and knee paint can then start to appear.
What does it look like?
The big toe joint will often appear larger or swollen and can be tender to pressure from touch or shoes. Ridges or “Lipping” may be felt on the edges of the bones as the body tries to naturally fuse the joint.
Medical imaging will usually show damage and wear to the articular surface of the bones.
Does this only affect older people?
No. Hallux Rigidus can also present in younger people, usually due to injury but it may even be genetic when the cause is unknown.
How bad will it get?
In some people, it causes nothing more than a stiff big toe but research suggests that about 25% of people have enough pain when walking or even at rest to warrant medical intervention.
Controlling weight is important as the big toe joint suffers twice your body weight when walking.
Does Hallux Rigidus need surgery?
Treatment options vary;
Painkillers may help with occasional pain.
We often advise patients to find footwear with very rigid soles so that the big toes does not get forced upwards.
Orthotics can also be used to limit the force on the joint and rocker bars added to footwear to allow a more natural walking gait.
Patients are advised to use footwear with plenty of room in the toe box so that the joint is not coming into contact with the upper of the shoe.
Injections of steroid and local anaesthetic can help reduce inflammation and patients report relief anywhere from a few days to a few months.
Surgery is often used as a last resort but there are a number of surgical options available from trimming the damaged areas (cheilectomy) to fusion of the joint, where the metatarsal and tarsal bones are physically joined together.
Patients with fused big toe joints often require orthotics to offload the stress which is placed on the second and third joints which are generally not used to bearing such pressure.
Replacement joints are available but this procedure is very rarely carried out in the UK.