Hallux Rigidus


By Doug Milch, DPM

The big toe joint is supposed to be able move up 70 degrees and down 30 degrees for normal walking.  In certain people, the joint can become stiff and painful with attempted motion. The condition is called “Hallux Limitus” or “Hallux Rigidus.”

The medical term for the big toe is the “Hallux.” If the joint moves, but the motion is limited, it is called Hallux Limitus. If it is very stiff and doesn’t move at all, it is called “Hallux Rigidus” demystifying the medical jargon.

When we walk, the first metatarsal is supposed to contact the ground and be in a down position. If the first metatarsal is in an up position, the big toe joint jams. When this mechanical situation occurs with every step, through the years, the joint cartilage surface wears away causing arthritis and a spur forms on the top of the first metatarsal.

Thus, Hallux Limitus and Rigidus are forms of localized arthritis that occur in that specific joint due to the way a person’s foot functions in gait.

Treatment for this condition depends on how long the person has had it and how advanced it is. Conservative treatment consists of different shoes that have a deep toe box and a stiff sole, anti-inflammatories, orthotic shoe inserts, and sometimes a cortisone injection. If the condition does not respond to conservative care, surgery is the next step.

During surgery, the bone spur is removed which is called a cheilectomy procedure.  Sometimes, that is enough to alleviate the problem. If the condition is advanced and the joint surfaces are arthritic, either part of the joint is removed, or a joint implant is used, or the joint is fused.  

Stiff painful big toe joints can be painful and interfere with normal walking activities.

Fortunately, there are treatment solutions to alleviate this painful condition.

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