Hallux Rigidus Surgery

Hallux rigidus, also known as stiff big toe is a form of osteoarthritis (degenerative arthritis).  Hallux (big toe) rigidus (stiffness) usually affects adults between the ages of 30 – 60 years.  Arthritis of the big toe is the most common site of arthritis in the foot and affects approximately 2.5% of people over the age of 50.

The hallux rigidus is the joint at the base of the big toe (metatarsophalangeal joint, or MTP joint) and when the cartilage covering the bones in the joint is damaged, the joint space narrows, causing painful bone spurs (small, pointed growths on a bone).

Causes of Hallux Rigidus

Although there is no known cause of hallux rigidus, there are a number of risk factors believed to contribute to developing the condition. These include:

Sporting activities

Certain sports that involve loading, stressing and extending movements of the feet are more likely to cause micro-trauma and sprains in the joint at the base of the big toe.  These injuries are commonly seen in footballers who play on artificial turf (known as turf toe).

Family History

You are at a greater risk of develop hallux rigidus if a member of your family has the condition.  This is because certain foot types are more prone to developing the condition.

Abnormal Foot Anatomy

Abnormalities in the structure of the foot can increase the risk of developing hallux rigidus.  Abnormalities include a long or elevated first metatarsal bone.

Gender

Hallux rigidus is more common in females; this is believed to be the result of wearing high-heeled shoes, particularly those that are higher than 2.5 inches.

Medical Conditions

Conditions such as osteoarthritis and specific inflammatory conditions such as gout and rheumatoid arthritis can also cause hallux rigidus.

Overuse

Activities that place a lot of stress on the joint can increase the risk of developing hallux rigidus.  Regularly stooping and squatting can cause overuse of the joint and big toe.

Injury

Stubbing the toe or spraining the big toe joint can result in developing hallux rigidus.

Symptoms of Hallux Rigidus

Common symptoms of hallux rigidus include:

• Pain and stiffness in the joint during use, particularly when you push off the toes when walking
• Swelling and inflammation around the joint, particularly on the top
• An inability to feel comfortable in shoes, particularly high heels for women
• Increased pain during cold, damp weather

As the condition progresses, other symptoms include:

• Reduced range of motion
• Pain even during rest
• Increased difficulty in bending the toe over time
• A bump, like a bunion or callus that develops on the top of the foot
• Limping

You may also experience pain in the hip, knee or lower back if symptoms cause you to limp or walk differently than you usually do.

Diagnosing Hallux Rigidus

If you are experiencing symptoms of hallux rigidus, such as difficulty in bending your big toe up and down or trouble walking on the outside of your foot due to pain, it is recommended that you visit your doctor for a consultation.

During your appointment, the doctor will take a full medical history of your symptoms and perform a physical examination of your foot.  They will move your big toe around to determine how much motion is possible without pain.  This will also help rule out other potential causes of your symptoms.  If a diagnosis cannot be made after a physical examination, you will likely to be referred for an X-ray.  This will show them the location and size of any bone spurs, as well as the degree of degeneration in the joint space and cartilage.

Treatment of Hallux Rigidus

Your doctor will likely recommend conservative treatments (non-surgical) to see if this offers any relief from pain.  They may also help slow the progression of the hallux rigidus. Non-surgical treatments can include:

• Anti-inflammatory painkillers such as ibuprofen to help ease pain and swelling
• Avoiding activities such as running
• Applying cold and heat several times a day
• Wearing shoes with plenty of room for the toes, preferably ones with stiff bottoms
• Corticosteroid injections for inflammation and pain relief
• Physical therapy and ultrasound therapy
• Avoiding high heeled footwear

If you find you are still experiencing a lot of pain and discomfort from hallux rigidus, your doctor will discuss the option of surgery to relieve symptoms.

Types of Surgery

Depending on the severity of the condition, your doctor will recommend one of the below procedures:

Cheilectomy

This form of surgery is recommended when damage to the hallux rigidus is mild to moderate.  It is also known as ‘shaving the big toe.’  It involves making an incision on the top of the foot to remove the bone spurs as well as a portion of the foot bone, so the toe has more room to bend.  The toe and incision site will likely remain swollen for several months post-surgery, and a wooden-soled sandal will need to be worn for at least 2 weeks after your procedure.

Arthrodesis

An arthrodesis, also known as joint fusion involves fusing the bones together when there is severe damage to the cartilage.  The damaged cartilage is removed, and screws, pins or a plate are used to fix the joint in a permanent position, resulting in the bones slowly growing together.  It is considered a ‘joint-sacrificing technique’ as arthrodesis results in a loss of range of motion, meaning you will not be able to bend the toe at all.  However, it can result in long-term control of pain and good functional results for severe cases of hallux rigidus.

You will need to wear a cast for the first 6 weeks post-surgery, followed by the use of crutches for another 6 weeks.  You will not be able to wear high heels and may need a shoe with a rocker-type sole.

Arthroplasty

Arthroplasty is a good option for older patients who place few functional demands on the feet.  It involves removing the joint surfaces with an artificial joint implanted. The operation may help relieve pain and preserve joint motion, although the procedure is still being evaluated and long-term effectiveness is still uncertain.

Post-Operative Recovery

Following surgery, your incision will be stitched and the foot bandaged.  These will be removed approximately 2 weeks after surgery, after which you should be able to wear regular, supportive shoes.  Women should avoid high-heeled shoes.

After surgery, you will likely experience some throbbing pain, although this can be managed by either prescribed or over the counter painkillers.  You will experience some swelling, but elevating the foot whenever possible in the first week following surgery will help alleviate this.  Applying an ice pack will also help ease pain and swelling.  You can ice the area for 15 minutes each time throughout the day.

You will likely be given some gentle stretches and exercises to perform at home after you leave hospital.  These will help improve flexibility and strengthen the foot.  It is important that you perform them regularly, as they are an important part of the recovery process.

The area is likely to feel sensitive for several weeks, so remember to take things slowly and ease back into high-impact activities.

Risks and Complications

Hallux rigidus surgery is considered a safe procedure; however, with all invasive procedures, there are some associated risks. These include:

• Bleeding
• Scarring
• Infection
• Allergic reaction to the anaesthetic

If you think you have an infection, you should contact your doctor. Symptoms of an infection include:

• Fever
• Redness at the incision site and surrounding area
• Increased pain
• Discharge at the incision site

Blood clots are rare, but if you experience any of the below symptoms, it could be a sign of one and you should contact your doctor immediately or call NHS 111.

• Swelling in the calf
• Firmness in the calf or thigh
• Redness
• A worsening pain in the calf or thigh
   

Outlook

Hallux rigidus is a progressive condition that will likely worsen over time.  Although you may be able to manage your symptoms with home remedies, surgery will be your best option if home treatments no longer provide relief.

There is always the possibility that surgery will not fix the condition, in which case you may require further surgery at a later date.

Need Help?

At One Healthcare we can book you in to see a specialist Podiatric or Orthopaedic surgeon, usually within 48 hours, for an initial consultation.  Hallux rigidus surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.

You can use your private medical insurance or pay for your Hallux Rigidus Surgery treatment. We offer competitive, fixed price packages as well as the ability to spread the cost of your treatment over a number of months. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

Why One Healthcare

• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• Private, spacious, en-suite rooms
• Specialist Physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

Contact us and find out more

If you live in and around the Kent area and would like to visit our One Ashford Hospital please click here

If you are based in and around Hertfordshire and would like to visit the One Hatfield Hospital please click here.