Anatomy of the Great Toe

The great toe, or hallux, plays an essential role in balance and walking by bearing a significant portion of body weight during movement. The first metatarsophalangeal (MTP) joint, located at the base of the big toe, allows the toe to bend upward and downward, making it crucial for proper foot function. When arthritis develops in this joint, it results in a painful and stiff condition known as hallux rigidus.

Symptoms of Hallux Rigidus

• Stiffness in the big toe, particularly during upward movement (dorsiflexion).
• Pain and swelling around the first MTP joint.
• A feeling of warmth or inflammation in the joint.
• Crepitus (cracking or grinding sensation) during movement.
• Difficulty with walking or engaging in physical activities.
• Pain that worsens with impact activities, such as running or jumping.

How is Hallux Rigidus Diagnosed?

A diagnosis of great toe arthritis is made through a combination of clinical examination and imaging. The key components of the diagnostic process include:

• Physical Examination: The physician will evaluate the range of motion in the big toe, checking for stiffness, pain, and crepitus.
• X-rays: X-rays of the foot are essential to assess joint space narrowing, spur formation, and the degree of cartilage loss. In some cases, further imaging such as an MRI may be needed.

How is Hallux Rigidus Treated?

Treatment for great toe arthritis focuses on reducing pain, preserving joint function, and improving mobility. Non-surgical options are typically attempted first, with surgical treatment reserved for more severe cases.

Non-Surgical Treatment

• Lifestyle and Activity Modification: Patients are encouraged to reduce high-impact activities like running and jumping. Lower-impact exercises, such as swimming, cycling, and walking, are recommended to maintain fitness without exacerbating the condition.
• Weight Management: Losing weight can reduce stress on the toe joint, alleviating some of the pain associated with arthritis.
• Walking Aids: Devices such as walking sticks can help redistribute weight away from the affected toe joint.
• Medications: Anti-inflammatory medications (e.g., ibuprofen) and pain relievers (e.g., paracetamol) may be used to manage symptoms.
• Physiotherapy: Physical therapy may help maintain joint mobility and strengthen the surrounding muscles, potentially slowing the progression of stiffness.
• Orthotics and Shoe Modifications: Custom orthotics (shoe inserts) and modifications to footwear can help redistribute pressure and reduce pain when walking.
• Steroid Injections: In some cases, corticosteroid injections may provide temporary relief from pain and inflammation, though the duration of relief varies.
• Biological Injections: Injections of agents like glucosamine, PRP (platelet-rich plasma), or stem cell products have been explored, but they have not shown significant benefit in treating hallux rigidus. These are not commonly recommended in current practice.

Surgical Treatment

When non-surgical treatments fail to provide sufficient relief, surgery may be considered. The goal of surgery is to reduce pain, improve function, and correct deformities in the joint.

Debridement: This procedure involves “cleaning up” the joint by removing bone spurs and inflamed tissue, which can help restore some range of motion and reduce pain.

Osteotomy: In some cases, an osteotomy (cutting and realigning the bone) is performed to correct the joint’s alignment and relieve pressure.

Joint Arthroplasty (Cartiva Implant): This procedure involves the insertion of a gel-like implant (such as the Cartiva implant) into the joint, acting as a spacer to maintain joint space and preserve movement.

Arthrodesis (Joint Fusion): For severe cases where other treatments have failed, joint fusion may be necessary. In this procedure, the bones of the joint are permanently fused using plates and screws to eliminate pain, but this also results in a loss of motion in the joint.

Post-Surgical Care After surgery, patients will need a recovery period of several weeks. Weight-bearing is typically restricted initially, followed by a gradual return to activity under the guidance of a physiotherapist. Full recovery can take several months, and physical therapy is often required to restore strength and mobility.

Prevention of Hallux Rigidus

Preventing great toe arthritis involves taking measures to protect the joint from injury, maintaining a healthy weight, and wearing supportive footwear. Avoiding high-impact activities that place excessive stress on the big toe joint can also reduce the risk of developing arthritis.

Summary

Great toe arthritis, or hallux rigidus, is a degenerative condition affecting the first MTP joint, leading to pain, stiffness, and reduced mobility. While non-surgical treatments such as lifestyle modifications, orthotics, and medications can help manage symptoms, surgical intervention may be necessary in severe cases. Early diagnosis and treatment can help prevent the progression of the condition and improve long-term outcomes.