|What is hallux rigidus? | What symptoms might I get with hallux rigidus? | What causes hallux rigidus? | I have a bunion but my toe is also very stiff and painful | What treatments are available? | What are the most common operations for hallux rigidus? | What is a debridement and how does it work? | After the operation | What is a Fusion? | After the operation | I still don't like the sound of a fusion, what about a replacement?|
Normal big toe x-ray
Hallux rigidus describes wear and tear of arthritis (osteo-arthritis) of the great toe. The condition is not particularly related to osteo-arthritis in other areas of the body and in most people it is not related to osteo-arthritic conditions elsewhere in the foot and ankle. The key features are a stiffening of the movement through the main big toe joint, thickening and bony spur around the joint (particularly noticeable on the top of the foot) and pain from the joint. Pain due to hallux rigidus of the big toe is very variable and may not correspond particularly well to any x-ray or other clinical findings.
Like osteoarthritis in other joints there are a spectrum of presentations. These range from a painless bony "growth" on the top aspect of the big toe
Arthritic big toe with osteophyte
to discomfort in particular positions of the big toe (especially in higher heels or during "push off" in running when the toe becomes maximally extended). Eventually pain may be present throughout most weight bearing activities or even be present regardless of whether a patient is weight bearing on the foot or not. As with other arthritic conditions the progression of hallux rigidus is unpredictable and may not necessarily occur.
Most commonly the cause is multifactorial. This means a combination of reasons, partly inherited partly related to previous activities/events. It can also occur as the end point of an inflammatory arthritis such as rheumatoid arthritis or gout. In most people, however, it is not related to these conditions. Very occasionally it occurs as a direct result of an injury to the joint (big toe MTP joint ).
It is certainly possible to have a bunion and hallux rigidus at the same time. Usually one is more of a problem than the other. The nature of the surgery is generally decided by which the more prevalent problem is. For example if there were only mild arthritic symptoms with a more painful bunion then a debridement of the joint (a small operation, see below) could be combined with a correction of the hallux valgus.
If the arthritic symptoms are more problematic then the main operation should be aimed at this with either a fusion or a modified Kellers/Hamilton operation. These pictures illustrate such a case (in a patient with rheumatoid arthritis as well as lesser toe deformities). The left foot has undergone a fusion of the big toe and correction of the lesser toes.
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