Big Toe Joint, Hammer Toe & Bunionette Problems:
Hallux Rigidus Treatment [Exercises, Inserts and Surgery?]
Hallux Rigidus Treatment is possible without surgery! Exercises don’t work great, but sometimes the right shoe and inserts make most pain DISAPPEAR!
- Big toe joint pain can be improved with a few simple treatment changes.
- We are foot doctors & we see this problem get better almost every day.
- The goal is to solve this problem without medication or surgery if possible.
So, let’s GO!
- Do you have a stiff big toe? This might mean that there is arthritis developing within your big toe joint.
- If you have a slight decrease in motion, this is called hallux limitus.
- If the big toe joint does not bend at all, this is called hallux rigidus.
- This does mean that there is destruction of your cartilage within the joint.
- As the joint keeps getting more and more damaged, it starts to develop a very large spur on the big toe joint.
- It is possible to also have a bunion in the big toe joint arthritis.
- It is possible to have sesamoiditis and big toe joint arthritis.
- It is possible to have a turf toe and big toe joint arthritis, although little bit less likely.
So, click on the gallery to see a description & full size photos!
Click on pictures for full size & descriptions:
Causes of Big Toe Joint Pain:
- A bunion is the beginning of the dislocation of the big toe joint.
- The official term is subluxation, this is when the first metatarsal phalangeal joint starts to come out of the joint.
- This usually means the big toe joint is starting to point towards the second toe, this forces the second toe to rise over the big toe if it gets bad enough.
- This can contribute to forming a second toe hammer toe, as well as making the second, third, fourth, and fifth toes spread towards the outside of the foot.
- You can also develop a bunion to your fifth toe, this is called a tailor’s bunion, or a tailor’s bunionette.
- A turf toe injury is the hyperextension of the first metatarsal phalangeal joint, also known as a big toe joint sprain.
- There are many tendons and ligaments and bones on the bottom of your big toe joint.
- If you strain the tendons and ligaments, these can take many weeks or many months to heal.
- If you ever watch professional football, or soccer, this is a very common sports injury when the big toe plants into the ground and all your body weight transfers over.
- There are two bones underneath your big toe joint called your sesamoids bones. These are the tibial sesamoid and the fibular sesamoid.
- If the big toe joint becomes disrupted, such as in a bunion these can become dislocated sesamoids.
- In sports such as basketball where there is a lot of pressure put on the big toe joint, this can lead to inflammation of the sesamoid bones. This is called the sesamoiditis.
- If your sesamoiditis gets really bad, it is also possible to get a broken sesamoid, or sesamoid fracture.
- It can be a good idea to see a podiatrist if you do have a broken or fractured sesamoid bone.
- Arthritis means that the cartilage is missing from your joint, this then prevents normal joint motion. Eventually as the damage keeps getting worse, the bone starts to crack, cause severe pain and eventually develop bone spurs and uneven bone at the site.
- In your big toe joint when you start to lose some motion, this is called hallux limitus. Eventually this starts to lose complete motion and this is now called hallux rigidus. This means that your big toe joint is rigid and unable to move.
- There are four stages to hallux rigidus,progressing from no arthritis to complete fused arthritis.
- Hallux rigidus and big toe joint arthritis essentially mean the same thing.
- This is a very common problem that we see especially in people who are on their feet all day, or have broken their toe in the past.
- Flat feet can be caused by many different things, and flat feet result in many different problems.
- The more your foot flattens, the more abnormal pressure is put onto your big toe joint. This can lead to abnormal pressure causing a dislocation also known as a bunion, or jamming of the cartilage which can lead to big toe joint arthritis or hallux rigidus.
- Flat fee are very complicated topic, as you can have a bunion in a high arched foot as well, but generally it is the act of over pronation that causes your big toe joint to receive pressure and become agitated.
- Controlling flat fee with more support has more pros than cons for sure.
Hallux Rigidus Symptoms:
- Pain at the base of the big toe during walking.
- A giant callus develops on the inside of the big toe joint.
- Stiffness in the MTP joint.
- Swelling and inflammation may be present.
- As the condition progresses the patient may experience:
- A considerable loss of motion in the MTP joint.
- Pain even when resting.
- Pain on touching the top of the joint.
- Additional growths of bone may be felt here.
- A limp.
- Pains in the lower back, hips, or knees due to changes to walking patterns.
What is Hallux Rigidus?
The Hallux is the Latin word for the big toe and rigidus literally means rigid or stiff. The big toe is important in walking and running as it dorsiflexes (bends back) during the push-off phase of the gait cycle.
In Hallux Rigidus, the movement in the joint at the base of the big toe (the metatarso-phalangeal or MTP joint) gradually decreases. Initially the term Hallux Limitus is often used and the term rigidus is used in the later stages as movement becomes considerably reduced. It is a form of degenerative arthritis although is often initially confused with a bunion.
The condition can cause lots of further problems, especially with walking, as we require at least 60 degrees of dorsiflexion at the MTP joint for a ‘normal’ walking pattern. If this is not available, compensations are made elsewhere, for example the ankle, knee and pelvis.
Hallux Rigidus Causes:
- Hallux rigidus can be caused by either a truamatic injury, or through overuse.
- Overpronation – increases the stress on the joint.
- Repetitive weight bearing in a dorsiflexed position.
- Traumatic injury such as stubbing the big toe which can cause chondral (cartilage) damage.
- Hypermobile 1st metatarsal.
- Rheumatoid arthritis.
Big Toe Joint Home Treatment Infographic:
Hallux Rigidus Home Treatment:
- X-rays may display degeneration and excess bone growth at the MTP joint.
- Treatment is usually conservative, starting with a period of relative rest.
- Anti-inflammatory medications may be prescibed, or a Corticosteroid injection may be administered.
- Any contributing biomechanical factors such as overpronation should be corrected.
- Physical therapy may be employed to try to increase the range of motion at the joint using mobilisations.
- In extreme cases surgery may be required to remove the bony growth on top of the joint, or even a total arthroplasty (joint replacement) may be used.
- Icing is the single best thing you can do at home.
- This is done for 20 minutes at a time and is safe.
Massage & Ice Products:
- This can reduce the soreness in the arch surrounding the area.
- It is not the most effective treatment for the big toe joint.
- Stick to mostly a icing the big toe joint.
Menthol Based Gels:
- Biofreeze is one of our favorites.
- These gels have been studied to work 2x as long as ice.
- These can work well on the big toe joint.
Removing The Stress:
- The key is to prevent future pain.
Get Great Shoes:
- Properly measure yourself for your shoe using a Brannock Device at a athletic shoe store.
- Or watch out shoe fitting video.
- Getting some extra depth shoes and skip lacing should be enough to avoid putting pressure on the bump.
- Getting a great supportive pair of shoes will make sure that there is pressure removed from your midfoot and top of the foot (big toe joint).
- This is especially important if you have plantar fasciitis or any other type of heel injury.
- Consider shoes combined with a good supportive orthotic for best pain relief!
- The following link will show you what our favorites are.
Get Great Orthotics:
- These are our recommended orthotics.
Get A Great Dynamic Stretch:
- It is possible to stretch on your own, but these products can also really help!
- This takes a lot of pressure off the front of your foot by making your ankle more flexible.
Get A Great Static Stretch:
- These devices are great for stretching while you are resting.
- This can make your ankle more flexible and take pressure off the ball of your foot.
Hallux Rigidus Exercises:
- Hallux rigidus exercises are out there, but to be honest, they will not do anything for you.
- The entire problem with hallux rigidus is that is a bone deformity, not a muscle or ligament problem.
- Hallux rigidus by definition is bone that is almost fused together.
- Short of breaking apart this bone and giving it some room to move, exercises will not do much for you.
- With that said, hallux rigidus can definitely feel better without just jumping straight to surgery, but this means orthotics and good shoes!
Hallux Rigidus Surgery:
- Hallux rigidus surgery is something known as a cheilectomy.
- Hallux rigidus surgery is one of the beneficial and quickest recovery big toe surgeries available.
- The surgery is as simple as simply going into the top of the joint and shaving out the spur.
- With the spur shaved out, the joint can now bend better.
The red portion in this picture is removed in hallux rigidus surgery. This is a very effective surgery with a quicker healing time, the downside is that it takes longer to heal this.
Hallux Rigidus Surgery Recovery Time:
- Hallux rigidus surgery recovery time is usually much quicker than most bunion and big toe surgeries.
- Sutures generally stay in for 2-3 weeks.
- You are able to go back to a good supportive running shoe in approximately 2 weeks.
- Once you are back in a normal pair of shoes it can still ache for a few more weeks, and you will definitely know it as a month or two go by.
- As 1-2 months start to pass you will ideally feel much better than before you have the spur removed and corrected.
Here a big toe spur is visualized intra-operatively. This bump is shaved down intra-operatively with specialized equipment. This then shaved and smoothed until the joint can move normally.
This is a different patient, but the joint looks much more smooth with much better surface alignment of the big toe joint. When the big toe moves up and down it now has an increased range of motion.
Hallux Rigidus Implant Surgery Options:
- There are two real options for implant surgery.
- There is a synthetic filler that is implanted into the joint.
- There are also big metal implants that can be implanted into the joint.
- These can work well for some people, but when they don’t work, things can go really bad.
- The problem with these implants are that you have a foreign substance that is rubbing for years, in many patients this can destroy large chunks of bone and create a very large deficit to this area.
- If you want a quicker recovery – go with the cheilectomy.
- If you want a more permanent one and done surgery, go with the big toe joint fusion.
- A strong option for hallux rigidus surgery, but with a longer healing time is a big toe joint fusion.
- A big toe joint fusion is a longer healing procedure, but the benefit is that it is much more permanent and very unlikely to reoccur in the future.
- This is the recommended surgery to permanently take care of your big toe joint pain.
And don’t forget… GREAT shoes:
Big Toe Joint, Hammer Toe & Bunionette Problems: