Arthritis Symptoms of the Big Toe (Hallux Rigidus)

Hallux rigidus is the medical name for arthritis that occurs at the base of the big toe. The joint at the base of the big toe is called the first metatarsophalangeal joint, or MTP joint. This is the junction of the long bone of the forefoot (front of the foot) and the bone of the big toe.

Because of the way the foot moves, this joint is especially prone to developing arthritis. In fact, hallux rigidus, or big toe arthritis, is the most common site of arthritis in the foot.

Symptoms

The most common symptom and the most common reason to seek medical attention for this problem is pain around the base of the big toe. This pain is worsened with activity, especially running or jumping.

Other common symptoms include swelling at the base of the big toe, a lump next to this joint due to bone spur formation, and calluses from the abnormal shape of the toe.

The symptoms are typically worsened when the big toe has to bend upwards, as is the case when you are walking up a steep incline or running. When the toe is forced upwards, the bone spurs that have formed are pinched together, causing pain and inflammation.

Footwear and activity modifications can help significantly relieve symptoms. Wearing firm-soled shoes that prevent motion at the base of the big toe will help relieve symptoms.

Diagnosis

The diagnosis of hallux rigidus is made by testing the mobility of the MTP joint, usually comparing it to the opposite foot to see how much motion is lost at the joint.

X-rays can determine how much of the joint cartilage has worn away and may show whether bone spurs have formed in this area. Determining the extent of arthritis will help guide treatment.

Treatment

The first steps of treatment are choosing the right footwear and reducing inflammation.

These include:

• Wearing stiff-soled shoes: Stiff-soled shoes limit motion at the base of the big toe. When buying shoes, look for types with a less-flexible sole that will prevent the arthritic joint from bending.
• Inserts: Alternatively, inserts can be made for your existing footwear. For example, adding a "Mortons extension" to an orthotic will make the hard part of the orthotic extend along the big toe, it will reduce the motion in the joint to alleviate the pain
• Adding a rocker bottom to shoes: A rocker bottom is a curved sole that can be added to your footwear. The rocker-bottom, much like the bottom of a rocking chair, helps the foot smoothly transition from the heel to the toe while walking. This modification also limits the movement of the arthritic toe joint.
• Anti-inflammatory medications: These medications will help to decrease pain and swelling in areas of inflammation. If the oral medications are not sufficient, an injection of cortisone may also be considered. Injections of cortisone into the big toe can be painful because there is not much space for the medication to be injected (compared to a knee or shoulder), but the relief is often rapid and can be long-lasting.

Is Surgery Necessary?

Surgery is sometimes the best treatment for hallux rigidus, especially if conservative measures are not effective. Surgery is rarely the first step in treatment, and generally, people should try simple steps before moving on to more invasive treatments.

The two most common surgical procedures are called a cheilectomy or an arthrodesis (fusion). And a joint replacement might be considered as well.

A Keller procedure is a cheilectomy that's done to remove the bone spurs from this area. This procedure often helps if the bone spurs are limiting joint motion.

With a cheilectomy, the bone spurs are removed. The advantages of this procedure are that it has a quick recovery and provides pain relief. However, the joint is still arthritic, and the spurs can return. While the pain caused by limited motion may be improved, pain coming from worn-out cartilage may remain. And within 15 years the toe may float at some level.

A more extensive surgery called a joint fusion may be necessary. A fusion eliminates much of the pain, but it will cause the toe to be permanently stiff.

Less often, a joint replacement is necessary. An advantage of a joint replacement is that it allows motion to remain. But after about 15 years, another joint replacement or a different procedure is usually needed.