Stiff Big Toe (Hallux Rigidus)
The big toe connects to the foot at a joint is called the metatarsophalangeal, or MTP joint. It’s important because it has to bend every time you take a step. If the joint starts to stiffen, walking can become painful and difficult. Hallux rigidus, or a stiff big toe, usually develops in adults between the ages of 30 and 60 years.
In the MTP joint, as in any joint, the ends of the bones are covered by a smooth articular cartilage. If wear-and-tear or injury damage this cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The result is a stiff big toe. No one knows why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.
Signs of this condition include pain in the joint when you are active, especially as you push-off on the toes when you walk; swelling around the joint: a bump, like a bunion or callus, that develops on the top of the foot; and stiffness in the great toe or an inability to bend it up or down.
If you find it difficult to bend your toe up and down or find that you are walking on the outside of your foot because of pain in the toe, see your doctor right away. Hallux rigidus is easier to treat when the condition is caught early. If you wait until you see a bony bump on the top of your foot, the bone spurs will have already developed and the condition will be more difficult to treat.
Pain relievers and anti-inflammatory medications such as ibuprofen may help reduce the swelling and ease the pain. Applying ice packs may also help reduce inflammation and control symptoms for a short period of time. Wearing a shoe with a large toe box will reduce the pressure on the toe, and you will probably have to give up wearing high heels. Your doctor may recommend that you get a stiff-soled shoe with a rocker or roller bottom design and possibly even a steel shank or metal brace in the sole. This type of shoe supports the foot when you walk and reduces the amount of bend in the big toe. None of these measures, however, will stop the condition from progressing.
If conservative treatments do not bring relief, there are several surgical options.