Tag Archives: Big Toe

Hallux Rigidus

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Hallux Rigidus

 

Fall is upon us here in Anchorage.  We hope that you, like us here Alliance Foot and Ankle,  have lingering beautiful memories of clear skies, great evenings with friends and family,  beautiful mountain vistas, and fish in your freezer. Or maybe your most lingering part of summer is foot pain.  If so, we are here to help.

At our practice, we notice that once the weather starts to cool and the days become shorter and our patients find them in our office rather than on the mountain side. One of the more common problems we see with our very active community is pain in the joint of the big toe called hallux rigidus.  Common symptoms are pain deep within the joint, a large spur on the top of the joint and decreased range of motion.

This problem usually occurs very gradually. Perhaps you have had occasion discomfort for years or you are just starting to notice a painful bump on your great toe joint.  For many people, this can cause significant decrease in doing the recreational activities they love or even difficulty on the job.

 

What causes it?

There are usually two common causes of hallux rigidus. The first cause is chronic repetitive trauma to the joint that causes a jamming motion such as running, climbing or stubbing your toe can damage the cartilage in the joint. Over time the cartilage may start to erode and your body lays down more bone to protect itself which is what causes the bone spur you may feel at the top or side of the joint.

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The second cause is a biomechanical problem related to how the bones in the great toe joint act. The two bones that involved are the first metatarsal (the long narrow bones of the midfoot just behind the toes) and the proximal phalanx (the bone at the base of your great toe). These two bones should line up well allowing the toe to easily glide over the smooth cartilage of the 1st metatarsal. Often times people are born with a slightly more elevated 1st metatarsal. This causes jamming when the great toe attempts to move up and over the head of the metatarsal bone. Over time, this chronic jamming leads to wearing away of the cartilage and extra bone being deposited.

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How can it be treated?

Fortunately, we have a variety of ways to treat this condition both from a conservative and surgical approach.  The more conservative (non-surgical) approaches involve orthotics that you wear in your shoe to restrict motion of the joint which helps alleviate some of the pain. Icing and anti-inflammatory medications such as Ibuprofen or Naproxen can provide temporary help.  Cortisone injections can also be of great benefit in reducing the swelling and discomfort.

For some people, conservative measures simply aren’t enough. We offer a variety of surgical procedures to correct the issue and return you to your activities.  During an office visit, x-rays are taken and reviewed with you by one of our doctors to determine if a surgical procedure is a good fit for you.  The procedure chosen is based on the severity of the damage done to the joint, the underlying cause of the hallux rigidus, and the patient’s goals after surgery. Possible procedures are cheilectomy which involves shaving down the painful prominent bone, bone cuts to get correct the alignment of the joint, joint replacement or joint fusion (arthrodesis).

If you think you suffer from hallux rigidus or any other foot problem, we would be happy to help you get back on your feet again.

 

Dr. Kristin Klingenstein DPM

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Hallux Rigidus/Limitus Treatment in Anchorage, AK

 

 

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Hallux Limitus/ Rigidus is a condition where the big toe joint degenerates and becomes stiff and arthritic.  The hallux (big toe) needs to flex upward and downward at the first metatarsal phalangeal joint (big toe joint) to function normal.  Due to certain conditions such as trauma/ injury, genetic predisposition to faulty structure, generalized (whole body) arthritic conditions or prior surgery, the big toe joint may start a process known as degenerative joint disease.  This progressive condition leads to wearing out of the articular cartilage (the pearl white shinny tissue seen where two bones form a joint), and the big toe joint starts to become stiff and painful to move.  Once the body recognizes that this process is occurring extra bone is laid down around the joint (bone spur) to begin a process of fusing the joint solid thus no motion, no pain.  While this process is occurring pieces of the extra bone can break off into smaller fragments and cause pain to the joint.

 

Hallux limitus is more common in men than women but plenty of active women are diagnosed with the condition.  It consists of four stages.  Most people are unaware of any symptoms in stage one other than possible progressive joint stiffness.  Many present for treatment in stage two as the joint becomes more painful to move and fracture fragments may start to jam the joint.  If left untreated as one progresses toward stage four the joint becomes very stiff and bulbous as the body places bone around the joint in an attempt to fuse it (no motion, no pain).  Small amounts of motion though stiff occurs and the poor quality of this motion combined with extensive bone spur development (some pieces may even be fractured) can lead to extreme pain with ambulation.

 

Treatment is patient specific depending on age, activity level, type of employment, stage of condition, prior treatment, shoe choices, and expectations.  Hallux limitus is progressive over time and is not reversible.  Non-surgical treatments may alleviate pain and slow progression.  Stiff sole shoes with an appropriate orthotic (shoe inlay) may off load the great toe joint and support the transverse and longitudinal arch of the foot.  Anti-inflammatory medications and injections into the joint can temporarily ease symptoms.  Self-directedor formal physical therapy may help improve function, decrease swelling, and increase local blood flow.  As the condition progresses with increased pain and decreased function, surgical options are usually considered.  If it is possible, an attempt is made to reconstruct the degenerative joint to reduce the stage of the condition.  This preserves ones natural joint and although far from perfect may function pain free for many more years.  As one advances to stage three or four, reconstructing ones joint may not be possible and joint destructive procedures such as a joint implants or surgical fusion need to be considered.  Joint implants may be limited to a select type of person.  Joint fusion (arthrodesis) is a very powerful procedure to eliminate pain and still allow for a high level of activity.  Joint fusion requires a committed rehabilitation and understanding that adjacent joints can be affected in the future.

Visit http://alaskapodiatry.com/ for more information.