The Center for Podiatric Care and Sports Medicine

Hallux Rigidus(stiff big toe)-Joint Replacement Surgery

Posted by on Monday, January 16th, 2012

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Hallux Rigidus is a specific osteoarthritic condition of the great toe joint. It can result from severe injury to the big toe but is most likely an inherited problem. It is usually present in both great toes but usually one is worse than the other. The process usually starts as a bony bump on the large joint of the great toe. It starts on the part of the joint that faces the second toe. It then proceeds over the top of the joint and around the inside border of the joint facing the other foot. As the process progresses, the bony bump gets larger. Eventually,the bumps on the top of the toe joint hit one another and prevent the toe from bending up. This can become very painful when one is walking, running, jumping, or dancing. It will become increasingly painful to wear shoes with an elevated heel.We refer to this condition as an arthritic condition.Unique to hallux rigidus is that the center of the joint and the bottom portion of the joint are spared until the very end stages of this process. At the very end stages ,the joint becomes very stiff in all directions.When the first metatarsophalangeal joint becomes arthritic this way, it becomes enlarged due to the bony bumps around the top and sides of the joints. Therefore, the initial treatment for pain has to be a shoe with a wider and higher toe box. This will prevent the shoe from squeezing the enlarged joint. When the pain associated with hallux rigidus can no longer be relieved in an acceptable manner,surgery is an option.As with bunion surgery,the surgery should be done to relieve the pain and discomfortand to improve one’s quality of life. As with all surgeries, it is important to remember that there are potential complications as a result of the surgery. The desire or need for surgery should outweigh the potential risks and complications. The most common procedure done for hallux rigidus,when the center and bottom parts of the jointare moving decently, is to shave off the top part of the metarasal head with the abnormal bony bumps and corresponding enlarged portion of the base of the proximal phalanx. This procedure is called a Cheilectomy. We published a 10 year retrospective study on this procedure in the Journal of Foot Surgery. This procedure removes the arthritic spurs in the top part of the metatarsal head and proximal phalanx. The toe usually moves well at the end of the operation. Generally, exercises to start moving the toe up and down should be started within the first week after surgery. If the center and bottom parts are damaged and there is little to no movement in the joint,then either a joint replacement (implant) or fusion of the joint should be considered. The joint can be replaced on the toe joint side , the metatarsal side or both sides of the joint. The implant is either made of a nickel and titanium alloy or high molecular weight silastic. The doctors in our office have over 40 years of experience in successfully replacing painful arthritic joints. The doctors have found that  joint replacements provide  functional and pain free movement of the big toe joint. The doctors also perform fusions of the joint . A fusion means that the large bone in the toe is put against the metatarsal bone,and they grow together. They will heal like a broken bone but will heal to form a solid union. Generally, people with a fusion function well, although they are limited in their choice of shoes.

If you have a stiff, painful big toe joint and would like one of the doctors evaluate your foot condition call 212-996-1900 or if you live in Westchester 914-328-3400.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.