Besides hallux valgus, hallux rigidus is another common painful condition affecting the metatarsophalangeal joint of the big toe. Hallux rigidus differs from hallux valgus in that the there is no medial deviation of the toe. Instead, it is characterised by restricted motion and periarticular bone formation which protrudes dorsally.
Why is hallux rigidus painful?
The basic pathologic entity in hallux rigidus is that of degenerative arthritis. With time and further degenerative bone formation, increased bulk around the metatarsophalangeal joint leads to significant discomfort with constricting footwear.
What are the treatment options?
Hallux rigidus does not have a cure itself since there is no treatment to reverse osteoarthritis but the painful symptoms can be managed. It is the residual motion in the joint that causes pain when we walk.
Hence the various conservative treatments available aim at reducing movement at the big toe joint.
Early treatment may include non-steroidal anti-inflammatory drugs, taping, and footwear modifications. Custom orthotics with a rigid ‘Morton’ extension are effective at limiting the motion in the big toe and thus reduce symptoms. What are the advantages of insoles? They can be moved between different shoes and can be worn with various types of shoes. What are its disadvantages? Unfortunately they can reduce the available room in the shoes and thus increase the pressure dorsally over the prominent arthritic joint.
Alternatively, shoe gear should consist of a rocker bottom sole (e.g., MBT shoes) or a stiff-soled shoe with low heel and a roomy upper toe-box to accommodate the enlarged big toe joint. However, these type of footwear may be unstable and non-aesthetically pleasing.
Despite intra-articular steroid injections may provide good temporary pain relief, repeated injections can promote further degenerative process in the joint and are discouraged.
Surgical treatment of hallux rigidus should be considered in advanced stages of the degenerative process, where the joint is normally fused to eliminate movement and pain.
Do you can discomfort in your big toe? Contact Clínica San Román where we will help you diagnose the problem and offer the best treatment options.