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Hallux Rigidus


Hallux rigidus, or stiff big toe, is a common degenerative joint disease of the foot. The affected joint is located at the base of the big toe and is composed of two bones: the proximal phalanx (part of the big toe) and the metatarsal bone (long foot bone). Repetitive micro trauma to the big toe is the main cause of this condition. Hallux rigidus is more common in males, athletes, dancers and manual workers.
Regarding symptoms, stiffness and pain on the top of the toe are the hallmark characteristics of this pathology. The big toe develops a big lump on the top which rubs on the shoe wear.
The diagnosis is performed by gathering a medical history, physical examination and requesting imaging studies like X-ray and MRI.
Treatment consist of non-operative and operative.

Non-surgical treatments are usually tried first. These may include changes in lifestyle or footwear, or the use of shoe padding to limit further damage. Physiotherapy might be useful in some cases. For pain management, analgesic and anti-inflammatory medications, injections, coldpacks or combination of the above may be used.
Surgical treatments vary, depending on how far the arthritis has progressed. For a patient who does not present joint degeneration, a cheilectomy (bone spur removal) or an osteotomy (surgical break of the bone) of the proximal phalanx and/or metatarsal bones may be performed. When the disease has advanced to the point that the cartilage has been lost, an arthrodesis (joint fusion) will be proposed. In an arthrodesis, the big toe joint is fused transforming a stiff painful joint into a pain free stiff joint. Other surgical options are resection or interpositional arthroplasty or joint replacement.