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Hallux Rigidus - Stiff Big Toe 

Introduction
Your big toes help you maintain balance.  They receive a huge amount of stress each time you walk, stand, squat, or climb stairs. People with degenerative arthritis may develop a condition called hallux rigidus, meaning a “stiff big toe.”  Hallux rigidus occurs when the joint at the base of the big toe wears down, making movement difficult.  Hallux rigidus is a progressive condition, and over time, the toe may become very stiff.  Early treatment is important and may help prevent the need for future surgery.

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Anatomy
Your big toe (hallux) contains two bones (phalanges).  The ends of the bones meet to form two joints, one at its base, and one in the middle of the toe.  The bone ends are covered with protective cartilage.  The cartilage allows the bones to glide smoothly during motion.  The joint at the base of the toe where hallux rigidus occurs is called the metatarsophalagneal (MTP) joint.

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Causes
The exact cause of hallux rigidus is unknown.  Degenerative arthritis causes the protective cartilage in the MTP joint to wear away, causing bone on bone rubbing and stiffness.  Abnormal bone growths (bone spurs) can restrict motion as well.
 
Hallux rigidus most frequently occurs in people between the ages of 30 and 60.  It appears to develop after a trauma, injury, or significant stress.  Researchers do not know why some people develop hallux rigidus and others do not.

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Symptoms
Hallux rigidus causes a stiff and swollen big toe.  The pain tends to become worse during activities.  A bump or callus may develop on the top of your foot. 
 
Hallux rigidus is a condition that gets worse over time.  Eventually, it may be very difficult to move your big toe.  It can affect your ability to walk, stand, and participate in your regular activities.  Your toe may feel painful even when you are at rest.

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Diagnosis
You should contact your doctor if you suspect that you have hallux rigidus.  Early treatment and diagnosis is associated with the best outcomes.
 
Your doctor can diagnose hallux rigidus by reviewing your medical history and conducting an examination.  Your doctor will move your toe to see how far it bends and straightens.  X-rays may be taken to identify arthritis, bone spurs, and other structural abnormalities.

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Surgery
Surgery is recommended when non-surgical treatments fail to relieve symptoms or improve function.  There are several types of surgery for hallux rigidus.  The procedure that you receive depends on the severity and extent of your condition.  Cheilectomy is a surgical procedure used to remove excess bone and bone spurs to allow the toe to bend.  Cheilectomy is most appropriate for mild to moderate cases of hallux rigidus.  The surgery is performed through an incision on the top of the foot.  You will need to wear a rigid sole shoe for a few weeks following surgery.  The procedure is quite successful for relieving pain for most people.
 
Arthrodesis is another type of surgical procedure that is used to secure the toe joint in a permanent fixed position.  Arthrodesis is reserved for severe cases of hallux rigidus.  The procedure involves removing the damaged cartilage, aligning the bones, and securing them with surgical hardware.  Your foot will be placed in a cast for about six weeks, and you will need to walk with crutches during this period.  Over time, the bones grow together and the toe will not be able to bend.
The toe joint may be removed and replaced with artificial implants, in a procedure called arthroplasty.  Arthroplasty is used to restore motion and relieve pain.  It can be a good option for older adults.

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Treatment
Treating hallux rigidus in the early stages can help prevent surgery in the future.  There are a variety of non-surgical treatments for hallux rigidus.  It can help to stop wearing high-heeled shoes, instead wearing stiff soled shoes with a large toe box.  Custom orthotics can help relieve pressure and improve foot function.  Over-the-counter anti-inflammatory medications, such as ibuprofen, can help reduce pain and swelling.  For more severe symptoms, your doctor may inject the toe joint with steroid medication.  Physical therapy exercises may be recommended with non-surgical or surgical treatments to increase motion and restore function.

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Recovery
Recovery from hallux rigidus depends on the severity of your condition and the treatment that you receive.  Recovery is individualized, and your doctor will let you know what to expect.

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Prevention
You should contact your doctor if you develop symptoms of hallus rigidus.  Cases that are diagnosed and treated early are associated with the best outcomes.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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