Big Stiff Toe Joint (Hallux Rigidus)

A stiff big toe joint is a very common problem seen within the foot and is often termed hallux rigidus. As the name suggests the condition results in gradual stiffening of the first toe joint with bony outgrowth, which can be seen as a lump over the top of the joint. The joint tends to become increasingly painful over time due to poor movement of the joint and rubbing of the lump on shoes.

Hallux rigidus is invariably associated with trauma, although this may have been some years previous, something as simple as stubbing the toe. When seen on x-ray the joint shows typical features of osteo-arthritis or wear and tear changes. Surgical intervention is used for those patients who are finding it increasingly difficult to cope with normal shoes, either through pain or increasing deformity around the joint. Often secondary problems can occur within the foot such as pain in the ball or lesser toe deformity due to walking badly.

Correction of the deformity will involve the removal of bony outgrowths and loose bodies through the joint as well as dealing with any soft tissue pathology. The surgery will involve an incision on the top of the foot over the joint. This will allow good visibility of the damaged structures and the scar will be protected from the pressure of walking and running.

At TFH we do not tend to undertake joint replacement therapy as this can be unreliable and difficult to deal with should problems occur. The favoured procedure of cheilectomy has been shown to be effective for 95% of patients suffering from hallux rigidus.

After surgery:-

• The foot is supported by heavy dressings of gauze, wool and crepe
• Leave dressings in place until your next out patient appointment
• DO NOT get the dressing wet or remove it
• Post-operative complication may result from wet dressings, or removal of dressings
  To heal well your foot will need rest and elevation, particularly in the first 48 hours.
• Keep the foot elevated for 48 hours. You can potter to your foot’s tolerance.
• Elevate your foot above your hip level, one or two pillows is usually the correct height.
• Use your painkillers as necessary.
• Always use the post-operative shoe when mobile.
• Use the crutches (provided by the hospital) for the first few days.

When your foot settles be as active as the foot will let you.

Keep the weight away from the front of the foot until you feel comfortable.

Within a couple of days you should be able to put weight on the foot.

When a fuller understanding of the foot mechanics is necessary a full biomechanical examination or a gait analysis may be recommended. Both of these procedures can now be carried out in our practice.