What Is It
Pain and stiffness within the great toe joint can be caused by a number of reasons but the most common is due to overuse of the joint. Over time, the great toe joint becomes achy with limited motion: Hallux Limitus. As this progresses, the joint becomes more stiff and may not move at all: Hallux Rigidus. This degradation of the joint over time will lead to a number of symptoms.
Pain is usually associated with any motion within the great toe joint. Initially, this may be after activity but can intensify during the push-off phase of the gait cycle and subsides with rest. As symptoms progress, the pain will become more intense, commonly described as a deep dull ache within the joint itself or a sharp shooting pain over the top of the foot. The great toe joint may also appear more prominent over time, making it difficult to wear some shoes.
Hallux Limitus or Rigidus can be as a result of genetics, overuse or both. As the cartilage wears down, the proximal phalanx and the head of the metatarsal begin to rub against each other, causing significant discomfort. This can be caused by blunt trauma, abnormal biomechanics of the first ray, systemic disorders such as rheumatoid arthritis, gout, pseudogout or sepsis with in the joint. These things can compromise the integrity of normal health cartilage within the joint, which precipitates the degenerative cycle. As this disorder progresses, the underlying cartilage becomes weak, breaks down and causes a narrowing of the joint space. The joint continues to flatten over time, becoming swollen and more pronounced from the accumulation of extra bone and bone fragments in the area, thus causing painful limited joint motion, or Hallux Limitus/ Rigidus.
Clinical evaluation by a podiatrist who is board certified in surgery is imperative in the early detection of this disorder. When you first notice your great toe getting stiff or hurting while walking or squatting, it is time to have an exam. With a thorough history of your symptoms, clinical range of motion exam and radiographs, the joint can be thoroughly evaluated.
There are a number of different conservative treatments available to take pressure off of the joint if the disorder has not progressed too far. Typically a stiff soled, wide toe box shoe will help accommodate the deformity and take pressure off of the area. The other type of shoe that may be helpful is one with a rocker bottom sole. Custom orthotics, when made correctly, can also be of a great benefit for the initial stage of the disorder by redistributing ground reactive forces through the rest of the foot. Injections and non-steroidal anti-inflammatory (NSIADs) may also help reduce some of the swelling and fibrous tissue in the area.
In some cases, when conservative treatment has failed to decrease the pain, surgery is required. One of the most common types of procedures is a cheilectomy. This is a process where osteophyes (spurs) in the joint are simply cleaned up. This in conjunction with early range of motion exercise will help.
For later stages of the disease, a decompression of the joint, a joint replacement or joint fusion may be required. These procedures will eliminate the pain within the joint and provide a stable platform on which to walk. Recovery from surgery will depend on the type of procedure that performed.
There are many variables to consider, such as age, occupation and activity when selecting the right procedure to correct degenerative changes within the great toe joint. If you experience any of these symptoms, your Board Certified Podiatrist is surgically trained to select the best procedure for you. FBN
Written by Dr. Anthony Rosales, DPM
Foot and Ankle Surgeons
Podiatrist Specializing in Foot and Ankle Surgery,
Sports Medicine & Diabetic Foot Care
421 N Humphreys St
Flagstaff, AZ 86001
601 N. Navajo
Page, AZ 86046