What are the symptoms of hallux rigidus?

What is hallux rigidus?

Hallux rigidus is a foot condition characterized by stiffness and inflammation of the joint and tissues of the big toe. This condition corresponds to the wear and tear of the joint cartilages, which is most often caused by an old injury, but can also result from repeated microtraumas. The development of hallux rigidus is promoted by the morphology of the forefoot, especially in the case of a relatively long first metatarsal and a long big toe, called hallomegaly. Hallux rigidus causes chronic pain associated with acute painful flare-ups and difficulty walking, moving around, or playing sports.

What are the symptoms of hallux rigidus?

Hallux rigidus is characterized by several symptoms. We will detail them below.

Pain and stiffness in the big toe

One of the first signs of hallux rigidus is persistent, mechanical pain in the metatarsophalangeal joint of the big toe. This pain may be more intense during walking, physical activity, or in cold and damp weather. In addition to pain, stiffness in the big toe may also be felt. This stiffness can make it difficult to dorsiflex the toe and limit the overall mobility of the hallux or big toe.

Difficulty walking or running

Because of the pain and stiffness in the big toe, people with hallux rigidus may have trouble walking or running. These activities can exacerbate the pain and stiffness, making movement more difficult.

Swelling of the big toe joint

Another common symptom of hallux rigidus is swelling of the big toe joint. This swelling may be accompanied by redness and warmth to the touch. The swelling can be more noticeable after physical activity or at the end of the day.

It is important to note that these symptoms can vary depending on severity. In more advanced cases, the pain can be constant, even at rest, and the swelling may be more pronounced. If you experience any of these symptoms, it is recommended to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

Visible bony prominences

The metatarsophalangeal joint of the big toe may be thicker, particularly because of dorsal bone formation at the joint, known as osteophytosis. This bony prominence can come into conflict with stiff leather shoes.

How to diagnose hallux rigidus?

The diagnosis of hallux rigidus is clinical and is made during the physical examination. Medical imaging makes it possible to specify the lesions and guide the therapeutic management.

Physical examination

During the physical examination, we first assess the morphology of the foot, the gait, the mobility of the big toe joint, and any associated deformities. We check for joint pain during mobilization, as well as stiffness of the joint. We also observe the presence of swelling around the joint, and the presence of osteophytes.

• Observation of gait: We ask the patient to walk in order to assess the pain and difficulty moving the big toe.
• Palpation: We palpate the joint to detect any pain, swelling, or deformation.
• Mobility test: We mobilize the big toe to assess its movement and determine the degree of stiffness.
• Medical interview: Lifestyle is very important to know; it is essential to learn about your professional activity, your footwear habits, and your sports practices.

Medical imaging

Medical imaging allows us to obtain a precise image of the big toe joint, confirm the diagnosis of hallux rigidus, and specify the treatment.

• X-ray: This is the first-line examination. It makes it possible to visualize the joint, detect any possible deformity, and assess the severity of hallux rigidus.
• Ultrasound: This examination is not useful.
• MRI: It is not necessary, except in the particular case of hallux limitus when searching for an ectopy of the flexor hallucis longus muscle.
• CT scan: It can be very useful for assessing bone and joint deformities.

In summary, the diagnosis of hallux rigidus is based on a meticulous physical examination; standard weight-bearing foot X-rays are part of the initial assessment.

What are the possible treatments for hallux rigidus?

Hallux rigidus causes stiffness and pain in the big toe, which can be treated medically or surgically.

We will start with non-surgical treatments, which are always offered as a first approach to relieve hallux rigidus. These treatments aim to relieve pain and improve toe mobility. They include:

• Anti-inflammatory medications: These medicines can help reduce the inflammation and pain associated with hallux rigidus.
• Orthotics: Specially designed, rigid insoles can be used to reduce pressure in the toe and help improve walking.
• Physiotherapy: Physiotherapy exercises may be recommended to improve toe strength and mobility.
• Shoe advice: Wearing shoes with rigid soles and soft leather can help relieve pain by limiting joint movement and conflict with dorsal osteophytes.

Surgery

If non-surgical treatments do not relieve the symptoms of hallux rigidus, surgery may be considered. There are several surgical options for treating hallux rigidus, usually chosen based on the location of the pain, foot morphology, presence of intra-articular pain, and the desire to preserve joint mobility.

One of the surgical options when the joint cannot be preserved is spherical pyrocarbon arthroplasty, which involves implanting a metatarsophalangeal prosthesis. This surgery replaces the big toe joint with a prosthesis, allowing toe mobility to be maintained and pain to be relieved.

Another surgical option is arthrodesis for hallux rigidus, which involves fusing the bones of the big toe joint to reduce pain. However, this option eliminates toe mobility.

It is important to note that any treatment for hallux rigidus should be discussed and decided upon in consultation with a foot surgeon.
Hallux rigidus is a condition that requires medical attention to prevent worsening of symptoms. Pain, stiffness, and swelling are signs that should not be ignored. An accurate diagnosis is essential to determine the best treatment, which may include non-surgical options or, in some cases, surgical intervention. It is important to consult a healthcare professional for advice suited to your situation. Each case is unique and requires a personalized approach.

What are the possible risks and complications?

Like any surgical procedure, hallux rigidus surgery carries certain risks. First, there are general risks related to anesthesia and the surgery itself, such as infections, bleeding, or allergic reactions. Then, there are risks specific to this procedure. For example, there may be no improvement or worsening of the pain, persistent stiffness of the big toe, or residual deformity. Potential complications will be discussed with you during your consultation with your surgeon.

Please remember that the decision to undergo surgery is yours and depends on your level of disability.

To limit the risk of surgical treatment failure, it is necessary to have a personalized pre-operative evaluation with a complete, precise, and standardized radiological assessment. It is essential to know if the intervention can provide you with the result you expect; the pre-operative consultation is crucial, and you should ask all your questions to your surgeon.

How can complications be prevented?

To prevent complications, it is essential to follow your surgeon's recommendations before and after the procedure. This may include measures such as:

• Quit smoking before the operation, as tobacco can increase the risk of infection and delay healing.
• Maintain good foot hygiene to reduce the risk of infection.
• Do rehabilitation exercises to improve toe mobility and reduce stiffness.
• Follow your surgeon's instructions

Finally, it is crucial to quickly notify your doctor of any pain, swelling, redness, or other unusual symptoms after the operation.

What is the role of the orthopedic surgeon in the treatment of hallux rigidus?

The orthopedic surgeon plays a key role in the treatment of hallux rigidus. Their primary task is to assess the severity of the condition and propose an appropriate treatment plan. Depending on the degree of deformity and symptoms, they may recommend non-surgical options such as wearing suitable shoes, orthotics, or injections.

However, in cases resistant to medical treatment, the orthopedic surgeon may suggest a surgical procedure. This could involve a arthroplasty (joint replacement with a prosthesis), decompression osteotomies, debridement with cheilectomy, or an arthrodesis (fusion of the joint bones). The choice of procedure depends on many factors, including professional activity, physical activity, footwear habits, and the extent of joint degeneration.

The expertise of La Clinique du Pied

At La Clinique du Pied, we have a team of orthopedic surgeons specialized in the treatment of hallux rigidus. Thanks to ongoing training and extensive experience in the field, our professionals are able to offer personalized solutions for each patient.

We are committed to providing quality care, using the most up-to-date techniques that have proven their effectiveness. Our goal is to relieve pain and improve the mobility of our patients, so that they can regain an optimal quality of life.