Arthritis of the big toe

Common names

• Hallux Rigidus

Who does it affect?

Males more common than females often no definite cause can be found though it can be related to gout or trauma. The symptoms are pain round the joint of the big toe, stiffness and a bony
lump often on the top of the joint which may rub on shoes.

Investigations

X-rays of the foot reveal the severity of the arthritis within the joint.

Non-operative treatment

Rest, painkillers (analgesia), an avoidance of provoking activities, intra-articular steroid injection and rocker bottom sole to the shoe.

Operative treatment

Various treatment options are available:

Cheilectomy – this is a small procedure with relatively quick recovery. It tends to improve symptoms up to about 75%, although will not entirely eliminate symptoms. Cheilectomy tends to ‘buy time’ before a much bigger and more definitive operation is required. It can lead to some stiffening in the big toe joints. 

Big toe fusion – gold standard treatment. 5-10% non union rate however. May need a further operation. Most patients walk with an entirely normal gait.

Plastic (silastic) replacement – this gets rid of the joint, but unlike a fusion, keeps some movement, allowing a variation in heel height. However the joint is artificial and can wear out with time needing further surgery. It can lead to transfer metatarsalgia (pain in the lesser toes). The procedure is often only advisable in people who are retired or in those patients who are not very physically active. 

Ceramic replacement – like silastic replacement, it is an artificial joint and thus maintains movement, however it can wear out with time. It has only been on the market for around five years and it’s long term survival is unknown. 

Excision arthroplasty – in the very elderly who walk very little, the simplest operation may be to cut out the arthritic joint and replace it with fibrous scar tissue.