Hallux Rigidus

Hallux Rigidus Treatment: *Exercises, Inserts and Surgery* What is Best?


Hallux Rigidus Treatment is possible without surgery! Exercises don’t work great, but sometimes the right shoe and inserts make most pain DISAPPEAR!




What are the Symptoms of Hallux Rigidus?


  • 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.



Hallux Rigidus treatment includes biomechanics, orthotics and surgery.



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 painful bump on big toe
Hallux rigidus is usually a very painful bump on the top of the big toe joint.



What Causes a Hallux Rigidus Deformity?


  • 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.
  • Gout.



A big toe joint spur is hallux rigidus
Hallux rigidus is a big spur on top of the big toe joint, in this X-ray you can imagine how it prevents the big toe joint from bending upward at all.


Hallux Rigidus 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.



A rigid insert that slides into your shoe will prevent painful jamming of your big toe joint. If you can tolerate this in your shoe, it should make the majority of your pain go away very quickly. This works great for people who are on their feet all day long.



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.



Hallux Rigidus surgery before and after
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.


Hallus rigidus surgery preoperative, big toe spur
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.





Big toe joint spur following surgery, intra- operative
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.


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.