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San Antonio’s Top Hallux Rigidus Specialist 

Hallux Rigidus - Stiff Big Toe

Hallux rigidus is a chronic condition in which the big toe joint becomes stiff and painful. The big toe joint is incredibly important, as it aids in walking, allowing propulsion or push off, and more. When you can’t push off the big toe joint properly, then your body compensates for it in harmful ways. Often, people may shorten their stride, transfer weight to the outside of the foot or lift the leg higher at the hip in order to walk. 

Compensation for hallux rigidus is problematic because compensatory mechanisms involve alterations in your gait, which leads to other issues. For instance, shortened stride involves less hip motion and subsequent stiffness of the hip, low back, and sacroiliac joints. One may also quicken the pace of their walk to make up for the shortened stride, which can lead to fatigue. Further, the transference of weight to the outside of the foot can lead to ankle sprains, stress fractures, forefoot pain, and iliotibial band syndrome which is pain in the soft tissue over the hip joint. 

Hallux rigidus can sometimes be caused by trauma, such as a fracture of the big toe joint that damages the cartilage. More often, it is a chronic condition that occurs due to years of poor joint alignment and mechanics. The big toe joint is designed to move downward and “grab” the ground as one pushes off. If the joint fails to do so or moves upward as one pushes off, a jamming occurs at the joint leading to degeneration, which causes hallux rigidus.

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If you are experiencing stiffness and pain in your big toe, South Texas Podiatry can help.

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Finding Relief from Big Toe Stiffness

Hallux Rigidus Treatment Options

There are four stages of hallux rigidus that treatment methods are based on. These include:

  • Stage 1: Functional Hallux Rigidus -This early stage involves mild loss of range of motion in the joint. Joint changes can be seen on an x-ray which include narrowing of the joint and spurring over the top of the joint. Treatment for this stage involves increasing the big toe joint’s range of motion by repositioning the first metatarsal downward as one pushes off. This is best accomplished with a prescription orthotic designed for that purpose. This custom orthotic may include an external forefoot wedge, a soft forefoot wedge, and a first metatarsal cutout (an orthotic modification designed to allow the big toe joint to drop downward).
  • Stage 2: Early Structural Changes - Stage two hallux rigidus involves a progression from stage one in which more range of motion is lost and there is more evidence of joint enlargement. Radiographs may show spurring on top of the joint, increased loss of cartilage, as well as flattening of the joint surfaces. Treatment for this stage still involves primarily orthotics, but if there is significant spurring on top of the joint, a procedure called “cheilectomy” may be considered. Cheilectomy is a simple procedure that involves a shaving of the bone on top of the big toe joint in an attempt to increase range of motion and relieve pain.
  • Stage 3: Significant Structural Changes - Stage three hallux rigidus involves more significant joint degeneration and loss of range of motion. At this stage, attempts to use an orthotic to increase range of motion are unsuccessful, so non-surgical treatment can be used. Non-surgical treatment typically involves the use of shoes with a distal rocker sole. A distal rocker sole is an orthopedic shoe modification that allows the shoe to roll forward without bending the big toe joint.  Surgical treatment may involve repositioning the cartilage on the big toe joint to have the remaining cartilage function where most of the motion is needed. A joint implant may also be considered, which is basically a spacer or bushing which takes the place of missing cartilage to re-establish motion of the joint.
  • Stage 4: Severe Loss of Range of Motion and Cartilage - Stage 4 hallux rigidus is also known as “end stage” hallux rigidus, as there is little effective motion at the big toe joint, and minimal to no cartilage remaining. Two surgical treatments may be used in this stage:
    • Fusion of the first MTP joint - Fusion eliminates the joint in efforts to eliminate the pain. Fusion involves extended healing, and healing can take 8 to 12 weeks to occur.
    • Total implant arthroplasty -  A total implant arthroplasty is a cartilage replacement. It allows restoration of near normal function to the big toe joint, and healing can occur in a few weeks.

Dr. Davis of South Texas Podiatry emphasizes that it is important to establish the stage of hallux rigidus first, so that the correct treatments can be instituted. If you or a loved one are in need of hallux rigidus repair, the foot pain specialists at South Texas Podiatry can help relieve your pain. Visit our office at 109 Gallery Circle, Suite 119, San Antonio, Texas 78258, or call us at (210) 490-3668 to get more information. 

Frequently Asked Questions

What’s the difference between hallux rigidus and hallux valgus?

Hallux rigidus is a “cousin” of hallux valgus, which is a bunion deformity. Hallux valgus involves a partial dislocation or malposition of the big toe joint in which the joint is crooked, the big toe moving toward  the second toe. The big toe joint is often straight in hallux rigidus, but may appear enlarged or swollen.

Can I prevent hallux rigidus?

While you cannot prevent hallux rigidus from happening, you can slow it’s progress in a few ways. For instance, you can exercise to keep the joint mobile, rest it when you feel pain, and wear good-fitting, supportive shoes with enough space around your toes. 

What are the risk factors for hallux rigidus?

There are a number of factors that could cause hallux rigidus, such as:

  • Overuse of the joint - Such as athletes who overuse it or workers who often squat and stoop down.
  • Injuries - Injuries like stubbing the toe or spraining the joint can contribute to hallux rigidus.
  • Genetics - Hallux rigidus can run in the family, or you could inherit a foot type or way of walking that leads to the condition.

How can I get relief for my foot pain near me?

If you are in need of a foot doctor near San Antonio, Texas, you have come to the right place. South Texas Podiatry offers treatment for hallux rigidus and countless other foot and ankle surgeries. Toe pain can hinder your life activities and your athletic performance. The expert team at South Texas Podiatry will help to relieve your pain so you can get back out there. Visit our office at 109 Gallery Circle, Suite 119, San Antonio, Texas 78258, or call us at (210) 490-3668  to schedule your appointment today!