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Arthritis of the Big Toe

Hallux Rigidus

Hallux rigidus is arthritis of the big toe (great toe). It specifically affects the 1st metatarsal phalangeal joint.

As a result the cartilage in this joint becomes thinned. The joint becomes stiff, swollen and bony spurs form at the edges of the joint called osteophytes.

What is the cause?

Most of the time it is just down to general wear and tear but sometimes it is as a result of a previous trauma to the great toe.

It can be caused by inflammatory arthritis such as rheumatoid arthritis.

What is the cause?

Pain, swelling and stiffness are the main symptoms. Because movement of this joint is required to go up on tip toes walking, running are painful. The spurs (osteophytes) can rub on footwear.

What is the treatment?

1, Non surgical treatment;
Painkillers and anti inflammatory medication can be used. A stiff insole can be used and this can be combined with a shoe modification called a rocker bottom sole to help with walking.

2, Injection and manipulation;
Injection of local anaesthetic and steroid can be used in early disease but often this only works in the short term.

3, Arthroscopy;
Occasionally arthroscopy of the 1st metatarsal phalangeal joint can be indicated. This is aimed at tidying up the inside of the joint to make it move more freely.

4, Cheilectomy;
This operation removes the spurs (osteophytes). Cheilus is Greek for lip so essentially the lip of bone at the edges of the joint are removed. The aim is to achieve more movement in the joint to improve function. It does not cure the arthritis but it can work well in mild and moderate disease. The operation is done as a day case and full weight bearing can occur straight away in a post op shoe. At two weeks post operation full mobilisation can occur in a normal shoe.

5, Arthrodesis (Fusion). This operation turns a stiff painful great toe into a completely stiff pain free toe. It is a successful operation and previous audits of Mr Sturdee’s practice has shown a fusion rate of 94% (See Research / audit section for more details.

6, Joint replacement. This has been around for many years and currently the implant that Mr Sturdee uses is called Cartiva. This is a cartilage replacement device that maintains movement and if it fails it is easy to convert to a fusion. More details on Cartiva can be found here .