A stiff big toe joint is a very common problem seen within the foot and is medically 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 and rubbing of the lump on shoes.
Hallux rigidus may be associated with trauma, although this could have been some years previous, something as simple as stubbing the toe. We do, however, see the problem within family groups so there may well be some inherited tendency to the condition. When seen on x-ray the joint shows typical features of osteo-arthritis or wear and tear changes, these changes are graded from I to IV and are important in deciding the type of intervention to be undertaken.
Initially conservative care is utilised, such as injection and manipulation under anaesthetic, but only if the joint sill has good viability. 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.
Lyndon’s first line procedure of cheilectomy has been shown to be effective for 95% of patients suffering from hallux rigidus and would be expected to give improvement in function, footwear and pain. Extra movement of the joint can be seen, although this often depends on the degree of joint disturbance seen on x-ray. The surgery involves the removal of bony outgrowths and loose bodies through the joint, as well as dealing with any soft tissue pathology.
Joint replacement is an option, but patient selection is vital as the joint itself is not as strong as say a hip or knee. As a result it is not a good option for an active or sporty person. It can, however, give an excellent clinical result particularly if good toe movement is a priority following surgery.
Fusion of the toe joint is useful when the joint has been very badly damaged, either through the progression of arthritis or external factors such as severe trauma or failed surgery. As with all surgery a well managed post-operative recovery is vital. Fusions will often require some time of complete immobilisation by either a plaster cast or an Aircast boot. Lyndon and the team will make sure that the advice you need is given to help you achieve the best possible outcome.