Hallux Rigidus – Turf Toe

First metatarsophalangeal-joint osteoarthritis (First MTPJ OA) also known as hallux rigidus is big toe joint disease primarily describes a painful complaint of the first metatarsophalangeal joint identified predominantly by reduction of the first metatarsophalangeal joint dorsiflexion at it is maximal range of motion. The condition is especially prevalent among the elderly, as well as women who frequently wear high-heeled shoes. Many professionals predicted that osteoarthritis was initiated by wear and tear of the cartilage. But, recent studies indicate that osteoarthritis is an illness of the entire joint. Collectively, many studies have demonstrated the risk factors for first MTPJ OA as being foot structure, trauma, joint disease, and gait abnormalities (Zammit et al., 2010; Welsh et al, 2012). The condition is also more common among the musician, and athletes and Agoropoulos et al., (2013), have concluded that there is a connection between 1st MTPJ osteoarthritis, and an individual’s genes.

Hallux Rigidus, also known as Turf Toe, is a joint disorder usually located at the base of the big toe. Hallux is the big toe, and rigidus means rigidity of inability to move.  As time goes by, it makes it harder to bend the toe since it causes pain and stiffness.

This condition is actually among the many forms of degenerative arthritis.

This disease can cause the inability to perform many activities such as climbing, standing, walking, or stooping since the big toe is largely involved in these activities.

Many patients are usually unable to identify the difference between this condition and bunion which also affects the same toe. The treatment procedures for these two conditions are completely different.

Since Hallux rigidus progressively worsens, the toe’s ability to move also decreases as time goes by. This condition is called Hallux Limitus at the early stages when the toe’s ability to move is only limited. However, as the condition advances, the big toe lapses its ability until it is no longer able to move. This stage is called the Rigidus. The toe becomes stiff and the condition is sometimes called the frozen joint.

Causes of Hallux Rigidus

There is no specific cause of this defect. However, frequent use of the joint, for example in people who participate in sports, squatting exercises, and stooping. An injury such as a sprain on the joint or stabbing it may also cause a “turf toe.” Genetic factors may also cause this condition, for example where one inherits a particular type of foot that makes him to walk in a way that puts more pressure on the toe. Wear and tear arthritis, osteoarthritis, and other inflammatory diseases like gout may also cause Hallux Rigidus.

Structural abnormalities and biomechanics of the foot can also cause osteoarthritis (results from wear and tear).  For instance, people with fallen arches or excess pronation of the ankle are at a high risk of developing Hallux Rigidus. In some cases, someone may inherit a foot that has structural defects that may predispose the toe to this condition. People who also use their foot excessively, for example, those whose occupations require that they apply pressure on the toe are at risk of developing this condition. An injury, for example, stabbing your toe may also cause Hallux Rigidus. Inflammatory diseases like gout and rheumatoid arthritis may also cause this condition. At Optimum Care Foot and Ankle we examine the toe and determine the cause and condition. Based on our assessment and findings we will recommend the most appropriate treatment for you.

Symptoms of Hallux Rigidus

Patients may experience pain, swelling, and stiffness on the great toe joint. Activities involving hill climbing, prolonged walking and running, and repeated upward movement of the big toe may aggravate the pain. Swelling of the joint may also occur on the upper half and is frequently associated with bone spur formation, generally referred to as the new prominence by patients. Patients often compensate this defect by putting more pressure on the outer side of the toe when they walk.

Signs and symptoms at an early stage include the following:

  • Stiffness and pain on the toe when performing activities like walking, bending, running, and squatting.
  • During cold or damp weather, pain and stiffness may be felt.
  • Inability or difficulty when performing certain activities like running and squatting.
  • Inflammation and swelling of the toe on areas around the joint.
  • As the problem develops, the patient may experience other additional symptoms which may include the following:
  • Experiencing pain even as one rests.
  • As bone spurs develop, one may also face difficulty when wearing shoes.
  • Shallow pain in the knee, hip, or lower back due to some changes, for example how you walk.
  • In severe cases, patients may start limping.

Diagnosis of Hallux Rigidus

It is recommended to see your podiatrist as soon as you start experiencing difficulties bending your big toe up or down. Also, seek medical help when pain in the toe makes you to start putting more pressure on the outside your feet to relieve the inner side. The condition is difficult to treat when a bony bump has developed on the top side of your toe. Therefore, it is recommended that you see a a podiatrist as soon as you experience the signs and symptoms. This will help in early diagnosis and treatment will be much easier than during advances stages.

The diagnosis of this condition involves moving the toe up and down to determine the range of movement.

Loss of MTP joint cartilage on the weight bearing to as seen on X-ray results may suggest the presence of this condition. This loss of cartilage may also appear as narrowing of this space on the X-ray. Osteophytes or joint fragmentation may also be noticed on this toe, a condition that does not exist on the other joints in the other toes.

Nonsurgical Treatment

Early treatment helps to eliminate or alleviate the possibility of a surgery in the future over most cases where the patient receives early treatment. Mild cases of Hallux Rigidus may be treated in the following ways:

  • Shoe modification. Increasing the size of the toe box of your shoe may help to reduce the pressure applied on the toe. Shoes with stiff or rocker-bottom soles may also reduce upward and downward movement of the toe during walking. Also, avoid wearing high heeled shoes.
  • Using orthotic devices. Improve foot functioning using custom orthotics.
  • To reduce the pain and inflammation, doctors recommend taking nonsteroidal anti-inflammatory drugs orally.
  • Injection therapy. Prolotherapy injections may help in reducing pain and inflammation.
  • Physical therapy.
  • Contact us on 03 9077 5915 for further assessment and treatment.