A common problem which affects the big toe is called hallux rigidus or stiff big toe. ‘Hallux’ is the Greek word for big toe and ‘rigidus’ indicates the joint is stiff and inflexible. Hallux rigidus is a form of osteoarthritis which occurs when the cartilage within the joint wears out.
Your big toes bear a great deal of pressure as you walk. With every step, a force equal to about twice your body weight passes through this very small joint. The big toe is used every time we walk, bend down, climb up and even stand still.
Symptoms
The condition varies in terms of stiffness, pain and loss of mobility. Some people will develop what is known as hallux limitus, where mobility is restricted rather than lost. Symptoms of hallux limitus include:
Pain and stiffness during movement
Problems with some activities such as running
Swelling and inflammation around the joint
Symptoms are worse during cold and damp weather
At a more advanced stage, symptoms include:
Pain when resting
Development of bony bumps (osteophyte) may develop on the top of the joint which can rub on shoes
People may walk on the outer side of the foot to avoid pain from the big toe. This can produce pain in the ball or outside of the foot.
The big toe can become what is known as a “frozen joint” when all movement is lost. At this end stage of hallux rigidus, other related problems are likely to have developed in the foot.
Hallux rigidus can start early in life, even during teenage years or the twenties. However, in the majority of cases, it does not get progressively worse. About 20 to 25 per cent of patients experience increasing stiffness and loss of mobility and are likely to require treatment.
Causes
Hallux rigidus can occur spontaneously, without any obvious cause. In other patients, there can be one or a combination of factors which trigger the development of this condition. People with flat feet and other structural deformities such as fallen arches and excessive pronation (rolling in) of the ankles are particularly susceptible to hallux rigidus because of the stress placed on their big toe joints.
Some people may have a family history of the condition and inherit a foot type which is more prone to developing problems within the big toe joint. Hallux rigidus can also be triggered by injury, inflammation and infection.
Diagnosis
The condition is simpler to treat in its early stages. Therefore it is recommended that you see a foot and ankle specialist when your big toe feels stiff or when you experience pain as you walk, bend or stand. Once the condition becomes more advanced and bone spurs develop, it is more complex to manage.
Our clinician will examine your feet and assess your range of movement. X-rays may be used to evaluate the extent of arthritis and any abnormalities which may have developed.
Treatment
Non-surgical treatment
If the condition is caught early, non-surgical treatment is more likely to be effective.
Shoe Modifications
The joint is usually most painful when it is bent upwards during walking. Therefore it can be helpful to stiffen the sole of the shoe so it does not bend during walking. A small ‘rocker bar’ can be fitted so you can rock over while walking, rather than bending your toes. Shoes with a large toe box should be worn, because they put less pressure on the toes. High heels and shoes with pointed toes should not be worn.
Custom-made orthotics
These can be helpful, particularly if your condition is caused by abnormal foot biomechanics. Orthotics are designed to alter the function of your foot. Custom made orthotics have been a specialty for over 15 years our experts have been field leaders. We have prescribed and dispensed thousands of orthotics in the Niagara region are recognized within the medical community as the regional experts.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
These include ibuprofen, and may be prescribed to help reduce pain and inflammation.
Hammer Toe
Hammer Toe
A hammer toe results from mechanical failure of the so-called MTP or metatarsophalangeal joint, located at the point where the toe is connected to the foot. Usually after a period of pain in the ball of the foot, the toe rapidly deforms. This is due to rupture of a structure called the plantar plate.
When it deforms, the foot can become less painful, but this is usually temporary. Eventually pain in the ball of the foot can reappear and the toe will start to rub on shoes and can be very painful indeed. Correctly made custom orthotics help alleviate pain and prevent worsening of the condition.
Other conditions
There are a number of rarer conditions where the lesser toes can be excessively short, long, big or bent.
Treatment
Treatment of all of these problems can be non-operative or operative but it is important to make a correct diagnosis and to understand the underlying mechanism that has lead to the deformity.
Likewise, the cause of clawing of the toes should never go un-investigated, as the underlying neurological condition needs to be identified so that treatment and expectations can be managed in an optimal way.
Once appropriate investigations have been completed, the condition can be treated.
Non-surgical treatment
Non-operative management of lesser toe deformities include advice on footwear, dealing with corns and callosities and the use of protective silicone sleeves to avoid pressure and rubbing.
Surgical Treatment
Operative treatment involves correction of the deformity and at the same time, addressing the mechanical cause of the underlying problem. Surgery can be performed under local or general anaesthesia and for many lesser toe problems, a temporary wire in the toe will be required for four to six weeks.
Whilst this is inconvenient, the problem with lesser toe deformities is that they generally get worse with time and appropriate intervention to correct the problem can save a lot of trouble in the future.
Claw Toe
Claw Toe
A claw toe may look similar to a hammer toe but rarely occurs in isolation: a claw toe arises as a result of a neurological (nerve) disorder and therefore normally all the toes of one or both feet are affected.
Other conditions
There are a number of rarer conditions where lesser toes can be excessively short, long, big or bent.
Treatment
Treatment of all of these problems can be non-operative or operative but it is important to make a correct diagnosis and to understand the underlying mechanism that has lead to the deformity. For example operating on a hammer toe that has arisen as a result of a bunion will not be successful unless the bunion is addressed at the same time.
Likewise, the cause of clawing of the toes should never go un-investigated, as the underlying neurological condition needs to be identified so that treatment and expectations can be managed in an optimal way.
Once appropriate investigations have been completed, the condition can be treated.
Non-surgical treatment
Non-operative management of lesser toe deformities include advice on footwear, dealing with corns and callosities and the use of protective silicone sleeves to avoid pressure and rubbing.
Mallet Toe
Mallet Toe
A mallet toe is due to an excessively tight flexor tendon and is the easiest condition affecting lesser toes to be treated.
Other conditions
There are a number of rarer conditions where lesser toes can be excessively short, long, big or bent.
Treatment
Treatment of all of these problems can be non-operative or operative but it is important to make a correct diagnosis and to understand the underlying mechanism that has lead to the deformity. For example operating on a hammer toe that has arisen as a result of a bunion will not be successful unless the bunion is addressed at the same time.
Likewise, the cause of clawing of the toes should never go un-investigated, as the underlying neurological condition needs to be identified so that treatment and expectations can be managed in an optimal way.
Once appropriate investigations have been completed, the condition can be treated.
Non-surgical treatment
Non-operative management of lesser toe deformities include advice on footwear, dealing with corns and callosities and the use of protective silicone sleeves to avoid pressure and rubbing.
Cross-over Toe
Cross-over Toe
A cross-over toe can be a variant of a hammer toe but when present at birth, almost invariably affects the little toe.
Other conditions
There are a number of rarer conditions where lesser toes can be excessively short, long, big or bent.
Treatment
Treatment of all of these problems can be non-operative or operative but it is important to make a correct diagnosis and to understand the underlying mechanism that has lead to the deformity. For example operating on a hammer toe that has arisen as a result of a bunion will not be successful unless the bunion is addressed at the same time.
Likewise, the cause of clawing of the toes should never go un-investigated, as the underlying neurological condition needs to be identified so that treatment and expectations can be managed in an optimal way.
Once appropriate investigations have been completed, the condition can be treated.
Non-surgical treatment
Non-operative management of lesser toe deformities include advice on footwear, dealing with corns and callosities and the use of protective silicone sleeves to avoid pressure and rubbing.
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