Great Toe Arthritis (Hallux Rigidus)

Great Toe Arthritis (Hallux Rigidus)

The great toe joint or the 1st metatarsophalangeal joint is the most common location in the foot and ankle to develop arthritis. Arthritis occurs when you lose cartilage or the shock-absorbing, smooth-gliding surfaces of a joint. In the great toe, this can oftentimes lead to a large “bump” or bone spur on the top of your great toe joint. The medical term for arthritis in the 1st MTP joint is hallux rigidus.

Arthritis causes the joint to narrow leading to stiffness and pain from the “bone-on-bone” contact. We use our great toe for push-off while walking, jogging, running, and jumping. 

Treatment is based on the severity of the arthritis. There are many options for non-surgical management of hallux rigidus, including:

• Stiff-soled shoe
• Carbon fiber footplate
• Non-steroidal anti-inflammatory medications, both oral and topical
• Steroid injection into the joint

A stiff-soled shoe or carbon fiber footplate, prevents your great toe from moving during walking. It serves as a “brace” to prevent motion in the joint and thus less pain.  

Hoka® shoes are a great example of a stiff-soled shoe to try.

In patients who have daily walking pain and restriction in activities after trying conservative management, there are two different surgeries Dr. Kohring recommends based on the severity of your arthritis.

Cheilectomy

If you have overall well preserved joint space and a large bone spur (osteophyte) on the top of your joint, you may benefit from a cheilectomy or “joint clean-up” procedure. This involves a small incision on the top of your joint and removal of the osteophytes. This is a low-risk surgery that allows for immediate weight-bearing after surgery. This can be a very effective option for patients with successful results leading to many years of pain-free walking.

Fusion

For patients with more advanced hallux rigidus, Dr. Kohring recommends a joint fusion. This is a very effective pain-relieving and functional procedure. Patients who undergo this procedure are able to return to walking, hiking, golfing, tennis, yoga, and many other activities with the exception of long-distance running. Prior to surgery, the joint is often stiff, so a fusion will lead to a pain-free stiff joint. The toe is fused in a slightly elevated position to allow for a normal gait cycle and great toe push-off after the fusion procedure.

After a 1st MTP joint fusion surgery, you are placed into a walking boot or postoperative sandal. For the first 2 weeks after surgery, you are restricted to touch-down weight-bearing on your heel for balance. After suture removal at 2 weeks, you are allowed to slowly increase the amount of weight you put on your foot in the walking boot or sandal. Most patients transition into a regular shoe around 6 to 8 weeks after surgery depending on swelling and pain.

Failed previous surgeries

Dr. Kohring has extensive experience in converting failed previous great toe surgeries into successful fusions. She will be happy to review your previous surgery and discuss treatment options for your specific issue.