Arthritic Conditions: Big Toe Arthritis (Hallux Rigidus)

In this video we discuss Big Toe Arthritis and advanced treatment options available at UFAI.

 

UFAI's at the forefront of treatment and research and committed to offering state-of-the-art care and assisted in the development of the leading hallux rigidus surgical implant. We are nationally recognized experts in hallux limitus treatment and have taught our techniques to foot surgeons throughout the world.

 

Our patients are our top priority and our goal is to them back on their feet in the quickest and least invasive way possible. You will be treated like family while receiving world-class care.

Causes & Symptoms of Hallux Rigidus

Hallux Rigidus

Arthritis of the big toe is caused by genetics or overuse. If there is a genetic predisposition to limited motion in the joint, the eventual osteoarthritis will cause pain and decreased function. Patients who have risk factors should seek treatment from a foot doctor before it becomes a continuous cycle of decreased motion, arthritis, extra bone formation and jamming of the joint.

 

Other patients develop arthritis in the big toe joint from a single trauma or overuse. This arthritis leads to limited motion, joint pain, and decreased function.

 

If you experience pain in your big toe when you move your foot, you may have an arthritic condition. Our patients typically describe a deep achy or sharp pain with use of the joint. It may hurt to move your toe up and down and you may find yourself walking on the outside of your foot to avoid putting pressure on your toe.

 

 

Hallux Limitus and Hallux Rigidus: what's the difference?

Osteoarthritis of the big toe joint is a progressive disease, the early stage of big toe arthritis is called Hallux Limitus, which is a condition where the motion is limited in the joint. As the disease progresses, the condition is referred to as Hallux Rigidus, which is when the joint is rigid and unable to move.

 

Learn more about the differences between Hallux Limitus vs Hallux Rigidus.

 

 

Diagnosing Hallux Rigidus

Doctors at the University Foot and Ankle Institute clinically evaluate a patient to determine if the have big toe arthritis by several means including range of motion testing, gait analysis and thorough history of the big toe pain and symptoms. X-ray evaluation is important to understand the amount of joint narrowing and extra bone (spur) formation.  

 

Onsite MRI and CT scanning can be used for additional examination of cartilage and bone damage as necessary.  In both cases, dedicated foot and ankle MRI and CT allow for improved testing and the most up to date information about your condition and its potential treatment options.

 

 

Non-surgical Treatment Options for Hallux Rigidus

While non-surgical treatment options of big toe arthritis are limited, but some that have been found to be effective therapies for many of our patients include:

 

Wider shoe gear

This accommodation for the deformity can be used to take the pressure off the area.

 

Stiff-soled shoes

Stiff-soled shoes can be helpful in limiting the amount of motion.

 

Custom-molded orthotics

Orthotics made especially for your feet can take pressure off the big toe and redistribute it through the rest of the foot.

 

Steroid Injections

Injections of catabolic steroid (cortisone) into the joint can reduce the inflammation and scar tissue. This type of injection often brings temporary relief.

 

Joint Fluid Injections

Several injections over many weeks of a normal joint fluid substitute (sodium hyaluronate) can increase the lubrication of the joint, often decreasing pain.

 

Stem Cell Treatment

A revolutionary new technique related to stem cells from your own body may be used to help with cartilage repair cases.  The stem cells are taken from the patient’s own bone marrow and concentrated at the time of the visit.  The concentrated stem cells are then injected into the great toe joint and may help repair cartilage damage.    

 

Surgical Options for Hallux Rigidus

As we mentioned previously, non-surgical treatment options of Big Toe Arthritis are limited but often worth trying first. But if they do not succeed, there are a number of very effective surgical options available. These include:

 

Cartiva Implant Procedure

Cartiva is a gel type implant that our surgeons often use instead of a fusion. While fusion can be a good surgical choice in certain cases, keeping motion in the great toe is often preferred and the best option for most patients. The Cartiva implant is a synthetic cartilage implant designed to act as a replacement for arthritic joint tissue. It reduces stress between the bones and decreases rubbing of the arthritic bones against each other.

 

Recovering from a Cartiva implant surgery is much easier than recovery from a fusion surgery. Patients are in a boot for 2-3 weeks and are then given at-home exercises or sent to physical therapy. After 6 weeks, when there is decreased swelling and improved range of motion, patients can return to regular activity and normal shoes.

 

Read more about the Cartiva implant here.

 

Cheilectomy Procedure

Cheilectomy cleans (removes) scar tissue and spurs from the joint to allow for far better range of motion. Physical therapy begins shortly after surgery to facilitate joint movement and prevent scarring and stiffness. Though recovery is rapid with this procedure, it is not recommended for severe arthritis cases.

 

Hybrid Cheilectomy Procedure

Another surgical option combines a cheilectomy with a cut in the metatarsal (foot) bone to shorten and lower the bone to prevent jamming by slightly shortening and dropping down the elevated bone leading to the great toe. Recovery is somewhat slower than with traditional cheilectomy because there is a waiting time for the bone cut to heal. A screw is used to hold the bones together, which allows immediate weight bearing and early return to shoes compared (compared to not using a screw).  Patients usually return to full activity after about two months. Physical therapy is also used to decrease stiffness and pain after surgery.

 

Laxity Correction

In some cases, the 1st metatarsal bone leading to the great toe joint is so elevated and loose that the laxity must be corrected. Surgery is performed by bringing the 1st metatarsal to the ground and fusing it to a bone in the midfoot. This helps to decrease arch collapse and helps with normal positioning of the foot. After the 1st metatarsal has been re-aligned, the great toe joint is cleaned of scar and spur formation. This procedure is an excellent long-term correction option and addresses the source of an elevated 1st metatarsal and jamming of the great toe.

 

Fusion or Great Toe Implant Surgery

In severe cases, the great toe joint is either fused or an implant is placed to make a smooth surface much like a knee replacement implant. The great toe arthritis replacement implant option was actually clinically developed with the assistance of the doctors at University Foot and Ankle Institute.

 

The great toe joint replacement procedure can replace either the base of the toe or the head of the metatarsal.  The benefit to this procedure is continued movement of the toe and very rapid return to shoes.  The downside is that the implant may not last the rest of a patient’s life and may need revision over a lifetime. This type of procedure is best for a woman who would like to wear high heels.

 

Fusion of the great toe removes all motion from the joint, but also removes all pain from the great toe joint. This procedure is reserved for severe cases with a great deal of pain and limited to no motion of the great toe joint prior to surgery. Recovery is six to eight weeks in a boot with limited weight on the foot. Patients typically return to their normal activities with no pain and the procedure is good for a lifetime. After a great toe fusion, women can usually go back to dress shoes with up to a 2 inch heel, or higher if it is wedge that is 2 inches total.

 

Browse our patients' before and after pictures of Hallux Limitus surgery here.

 

 

UFAI Offers the Most Advanced Treatment for Big Toe Joint Pain and Hallux Rigidus


 
University Foot and Ankle Institute is at the forefront of big toe arthritis treatment. We offer a full level of care including conservative treatments, a spectrum of diagnostic imaging MRI and CT scanning services and a dedicated foot and ankle physical therapy and surgical options.

The implant that is designed for the great toe arthritis replacement option was clinically developed with the assistance of the doctors at University Foot and Ankle Institute.  Our doctors not only helped develop the implant, but have taught hundreds of other doctors how to perform the surgery for their patients.  

 

If a fusion is necessary, our advanced technique of using a plate for fixation and adding stem cells to the fusion site allows for improved and more rapid healing and immediate weight on the foot.  This is dramatically different than other doctors who may not allow weight for 6-8 weeks post surgery.  Our fusion success rate is over 99% with proper patient care and follows up.

 

By offering a full spectrum of work up, conservative, surgical and recovery options, we are truly taking care of you in a state of the art manner without the need to go from place to place.

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