Hallux Rigidus

The big toe consists of two joints, with the largest being the MTP joint. This joint connects the first long bone of the foot (the metatarsal) to the first bone of the toe (the proximal phalanx). The priomary role of the first MTP joint is to assist with push-off during walking and running.

Hallux rigidus is a form of arthritis that specifically affects the big toe joint. Over time, the joint cushion (cartilage) in this joint deteriorates, leading to pain, stiffness, and eventual loss of motion. The condition often begins as hallux limitus, characterized by a mild restriction in movement. Without appropriate management, it can progress to hallux rigidus, where the joint becomes increasingly stiff and painful.

Hallux rigidus is a common condition and is considered the second most prevalent disorder of the big toe after bunions. It typically develops in adults aged 30 to 60 but can affect individuals of any age, particularly those with a history of foot injuries or structural abnormalities.

The symptoms of hallux rigidus can vary depending on the severity of the condition but often include:

1. Pain in the Big Toe Joint: Pain may occur during activities such as walking, running, or climbing stairs. As the condition progresses, the pain can become persistent, even at rest.
2. Stiffness and Limited Range of Motion: Patients may notice difficulty bending the big toe, particularly upward (dorsiflexion). This restriction can interfere with daily activities such as walking and running.
3. Swelling and Inflammation: The joint may appear swollen and feel tender to the touch due to inflammation.
4. Bone Spurs: Over time, bony growths (osteophytes) can develop around the joint, causing additional pain and limiting movement further. These spurs may also create a visible bump on the top of the big toe.
5. Changes in Gait: To compensate for the pain and stiffness, patients may alter their walking patterns, which can lead to secondary issues such as knee, hip, or lower back pain.
6. Difficulty Wearing Shoes: Tight or restrictive footwear can exacerbate symptoms, making it challenging to find comfortable shoes.

Several factors can contribute to the development of hallux rigidus. These include:

1. Structural Abnormalities: Anatomical variations such as a long first metatarsal bone, flat feet, or an elevated first metatarsal can increase stress on the big toe joint, leading to arthritis.
2. Repetitive Stress and Overuse: Activities that place repetitive pressure on the big toe joint, such as running, jumping, or certain sports, can accelerate cartilage wear and tear.
3. Previous Injuries: Trauma to the big toe, including sprains, fractures, or dislocations, can damage the joint and predispose it to arthritis.
4. Genetic Factors: A family history of arthritis or foot deformities may increase the likelihood of developing hallux rigidus.
5. Inflammatory Conditions: Systemic inflammatory diseases such as rheumatoid arthritis, gout, or psoriatic arthritis can affect the first MTP joint, contributing to its deterioration.
6. Aging: As with most forms of arthritis, the risk of hallux rigidus increases with age due to natural cartilage degeneration.

Diagnosing hallux rigidus involves a combination of clinical evaluation, medical history review, and imaging studies. Dr. Allison Boden, M.D., employs a thorough diagnostic process to ensure accurate identification of the condition and the development of an effective treatment plan.

Medical History

The diagnostic process begins with a detailed discussion of the patient’s symptoms, including the onset, duration, and activities that exacerbate the pain. A history of foot injuries, overuse, or underlying medical conditions is also considered.

Physical Examination

During the examination, Dr. Boden assesses the affected joint for signs of swelling, tenderness, and bony growths. The range of motion in the big toe is evaluated, which is typically restricted in hallux rigidus. She may also observe the patient’s gait to identify compensatory patterns.

Imaging Studies

• X-Rays: X-rays are the most commonly used imaging tool for diagnosing hallux rigidus. They provide detailed images of the joint, revealing cartilage loss, bone spurs, and joint space narrowing. The severity of the condition is often classified based on these findings.
• MRI or CT scans: In some cases, advanced imaging may be necessary to assess soft tissue damage or to better understand the extent of joint involvement.

Differential Diagnosis

Dr. Boden ensures that other conditions with similar symptoms, such as gout, sesamoiditis, or turf toe, are ruled out during the diagnostic process.