Hallux Rigidus Treatment Options

For patients in the early stages of hallux rigidus, conservative treatments aim to reduce pain, improve mobility, and slow the progression of arthritis. These options are typically the first line of management before considering surgery.

Footwear Modifications

Wearing proper footwear can significantly relieve discomfort associated with hallux rigidus. Stiff-soled shoes, rocker-bottom soles, and shoes with a wide toe box help limit movement in the MTP joint, reducing pain and preventing excessive bending of the big toe. Avoiding high heels and tight shoes is also essential, as they can exacerbate symptoms.

Orthotics and Shoe Inserts

Custom or over-the-counter orthotics can provide additional support and offload pressure from the affected joint. Rigid orthotics help limit painful motion, while cushioned insoles reduce impact and improve comfort. Carbon fiber inserts can also be placed inside shoes to restrict excessive toe movement and decrease stress on the joint. A Morton extension orthotic is typically prescribed in order to provide stability to the first MTP joint and decrease motion throughout

Activity Modification

Patients are advised to avoid high-impact activities such as running and jumping, which can accelerate joint degeneration. Instead, low-impact exercises like swimming, cycling, and elliptical training can help maintain overall fitness while reducing stress on the big toe.

Physical Therapy

Stretching and strengthening exercises for the foot and lower leg can improve flexibility and reduce stiffness. Manual therapy techniques, such as joint mobilization and soft tissue massage, can also enhance joint function. A physical therapist may incorporate exercises to strengthen the surrounding muscles and improve gait mechanics.

Medications and Pain Management

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, help manage pain and inflammation. Acetaminophen can be used as an alternative for pain relief. In more severe cases, corticosteroid injections may be administered directly into the joint to provide temporary relief from pain and swelling. However, repeated steroid injections should be used cautiously, as they may contribute to cartilage degeneration over time.

Platelet-Rich Plasma (PRP) and Other Biologic Injections

Some patients may benefit from regenerative medicine treatments such as platelet-rich plasma (PRP) or hyaluronic acid injections. PRP therapy involves injecting a concentration of the patient’s platelets to promote healing and reduce inflammation. some studies suggest it may provide symptom relief in early to moderate cases.

If nonsurgical treatments fail to provide sufficient relief or if hallux rigidus progresses to an advanced stage, surgical intervention may be necessary. The choice of surgery depends on the severity of the condition, the patient’s activity level, and long-term goals.

Cheilectomy (Joint Debridement)

Cheilectomy is a joint-preserving procedure that involves removing bone spurs and excess bone growth from the top of the first metatarsal. This surgery is typically recommended for patients with mild to moderate hallux rigidus who still have some joint mobility. By eliminating bone impingement, the procedure can improve range of motion and reduce pain. Recovery typically involves several weeks of limited weight-bearing and physical therapy to restore movement.

Arthrodesis (Joint Fusion)

For patients with severe hallux rigidus and extensive joint damage, arthrodesis is often the most reliable surgical option. This procedure involves fusing the bones of the first MTP joint, eliminating motion in the joint and relieving pain. While fusion restricts toe movement, it provides long-lasting pain relief and allows patients to resume many daily activities. Recovery involves wearing a boot for several weeks while the bones heal.

Recovery from hallux rigidus surgery depends on the procedure performed. Most patients require a period of non-weight-bearing or protected weight-bearing using a walking boot. Physical therapy plays a crucial role in restoring strength, mobility, and function after surgery. Patients who undergo cheilectomy or joint-preserving procedures generally recover faster than those who undergo joint fusion.

For patients undergoing joint fusion, full bone healing can take several months, but once healed, the procedure provides excellent pain relief.