In the simplest of terms, Hallux Rigidus is arthritis affecting the big toe joint. It starts with a limitation of motion in the joint at the base of the big toe. Over time, the joint gets damaged and leads to degenerative joint disease (DJD) which is a kind of wear-and-tear arthritis. With hallux rigidus the big toe joint becomes progressively stiffer and more painful.
created by San Francisco Foot Surgeon Dr. Segler. WARNING: this video contains graphic surgical images from actual foot surgery.
In joint fusion (also called arthrodesis) the cartilage is removed, screws are placed across the joint and the two bones grow together, much in the same way that a fractured or broken bone heals. Once it is all healed, the joint is gone, so there is no more painful motion. The trade-off is stiffness. Fusing the big toe joint has a high success rate, but it makes it very difficult to wear shoes with different heel heights.
We are currently developing exciting new surgical treatments to help avoid the historically destructive procedures that have been performed for more advanced cases of hallux limitus. This exciting research has the potential to bring a higher quality of life to those suffering from halux rigidus.
Provided that all goes well, you should be back to activity fairly quickly after surgery. Most of these procedures are “outpatient surgery” performed at an ambulatory surgery center. You should expect to be able to go home about one to two hours after the surgery. There is typically no overnight hospital stay associated with hallux rigidus surgery.
If you have joint preservation surgery, you may be able to walk in a protective post-operative shoe or surgical boot. If you have joint destructive surgery, the recovery can be more extensive. In many cases, you will need crutches for six to eight weeks after surgery.
Keep in mind that hallux rigidus is always treatable, and the sooner it is treated, the easier it will be for both you and your surgeon to get back to the activities you love…faster.
Bunions and hallux rigidus are both conditions affecting the great toe joint. They also both can involve pain, destruction of the cartilage in the joint and bone spurring. However, these two conditions are opposite problems.
A bunion develops when there is instability in the foot. Faulty biomechanics lead to joint instability and the big toe drift toward the second toe (laterally), while the first metatarsal bone drifts away from the second toe (medially).
Hallux rigidus develops because there are faulty biomechanics that leads to rigidity (hence the name) in the great toe joint. Because motion in the joint is limited and restricted, the big toe joint jams every time you take a step.
Over time, the cartilage becomes damage and worn away. Bone spurs start to develop. The spurring blocks motion further. Sometimes it can even be felt as a lump on the top of the foot at the base of the big toe.
In contrast, any bone spurring related to a bunion happens on the inside of the foot (medially) at the big toe joint where it may rub against the inside of the shoe.
While both bunions and hallux rigidus can be corrected surgically, they are caused by very different problems. Those who are prone to bunions typically have low arches, flat feet and a “pronated” foot type. Those who develop hallux rigidus tend to have higher arches and a “supinated” foot type.
Dr. Christopher Segler is a San Francisco Podiatrist and Foot Surgeon. He has a special interest in Hallux Rigidus and wrote the chapter on Hallux Rigidus in the “Handbook of Podiatric Sports Medicine.” He also published an article in the “Journal of Ambulatory Surgery” which teaches other foot surgeons how to use the same methods he uses to minimize pain after foot surgery. His podiatry practice is based in the San Francisco Bay Area.