What is it?
Hallux Rigidus is a latin phrase which means "stiff big toe". The joint at the base of the big toe degenerates prematurely. The cause is unknown. The condition is not related to and does not predict degenerative joint problems in other parts of the body. The toe becomes painful for three reasons. first, a "spur" forms on the top of the joint that causes pain due to shoe pressure and blockage of movement. Second, the toe becomes so stiff from arthritic degeneration that it does not give or flex up during the "push off" phase of walking. Third, arthritis in the joint itself can lead to aching discomfort.

Treatment:
It is important to realize that no form of treatment will produce a normal toe. The goal of treatment is to relieve pain. A stiff soled shoe or insert to limit push off stress and a shoe with a deep toe box to relieve shoe pressure is the only type of non-surgical treatment. Most patients report very little relief with this treatment. Surgical options include removing the bone spur, removing the spur and part of the joint, replacing the joint, and fusing the joint.

Simply removing the excess bone on the top of the joint often provides satisfactory pain relief for many years - especially if the joint surfaces are still in reasonably good condition. The operation is done through a short incision on the top of the toe. A wooden soled sandal is worn for at least two weeks after the surgery. Often the toe and the operative site will be swollen for several months.

When the joint damage is more severe, removing the excess bone as well as part of the joint surface can be done. Post-surgical management is similar to management after simple bone removal. Occasionally a pin may be inserted into the toe for stability and removed during an office visit four to six weeks after the surgery.

Replacement of the joint with a silicone device is not recommended for patients under age sixty five and may eventually compromise other surgical options. Fusion (arthrodesis) requires fixation of the joint with screws or a plate and screws after removal of the joint cartilage. A cast must be worn for at least six weeks after the surgery and crutches are usually recommended for six weeks. This is the most reliable way to eliminate the pain, but most people object to the idea of permanent stiffness. High heeled shoes usually can't be worn with a stiff toe. Most patients who have the fusion are quite satisfied with the pain relief and don't seem to mind the stiffness with most daily activities.