Early signs and symptoms of hallux rigidus include the following [8]:

• Discomfort experienced while walking, bending or standing
• There is pain and stiffness which gets aggravated during cold weather conditions [9]
• Development of swelling along with inflammation in the affected joint

In addition to these, affected individuals would also experience certain additional symptoms as the condition progresses to more advance stages. These include:

• Pain in the affected joint even at rest
• Due to bone overgrowth there is significant amount of difficulty while wearing shoes
• In severe cases, the individual would have to limp while walking
• There is change in gait which causes development of pain in the back, knee and hip region

• Pain

  Topical Pain Relievers: Natural pain relievers may help reduce swelling, pain, and inflammation. Stretches: Daily stretches, such as the Toe Extensor Stretch and the Big Toe Stretch, are often helpful. [naturalfootgear.com]

  […] a doctor for painful stiff big toe before bone spurs develop. [barkingdogshoes.com]

  Pooled results showed superiority of arthrodesis compared with total joint replacement for improving clinical outcome (by 43.8 versus 37.7 points on the AOFAS-HMI score) and reducing pain (a decrease of 6.56 versus 4.65 points on the VAS pain score). [ncbi.nlm.nih.gov]

• Swelling

  Topical Pain Relievers: Natural pain relievers may help reduce swelling, pain, and inflammation. Stretches: Daily stretches, such as the Toe Extensor Stretch and the Big Toe Stretch, are often helpful. [naturalfootgear.com]

  Topical pain relievers: Natural pain relievers may help reduce swelling, pain, and inflammation. Avoiding any stretch or motion that lifts the toes into dorsiflexion. (ex. lunges, squats, and certain yoga positions) [correcttoes.com]

  Complications may include infection, joint stiffness, progression of the arthritis, recurrence of the deformity, and persistent swelling. [my.clevelandclinic.org]

  Swelling and inflammation of the joint Callus on side of big toe Out-toeing (walking duck-like) Symptoms of Hallux Rigidus Bump or knot that looks like a bunion, but on the top of the big toe joint Significant arthritis-type pain within the joint Little [pafootdoctors.com]

  Difficulty with certain activities such as running or squatting is common as well as swelling and inflammation around the joint. [cdafootankle.com]

• Inflammation

  Topical Pain Relievers: Natural pain relievers may help reduce swelling, pain, and inflammation. Stretches: Daily stretches, such as the Toe Extensor Stretch and the Big Toe Stretch, are often helpful. [naturalfootgear.com]

  Putting an ice pack on your foot for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and the area of discomfort; do not apply ice directly to the skin. Medications. [trinityfootandankle.com]

  Topical pain relievers: Natural pain relievers may help reduce swelling, pain, and inflammation. Avoiding any stretch or motion that lifts the toes into dorsiflexion. (ex. lunges, squats, and certain yoga positions) [correcttoes.com]

  […] and pain Corticosteroid injections for inflammation and pain are occasionally used Physical therapy and ultrasound therapy may provide some relief Surgery is often an option to relieve hallux rigidus. [cedars-sinai.edu]

  Treatment options for mild hallux rigidus include: Medication You can take over-the-counter NSAIDs such as ibuprofen to reduce pain and inflammation Shoe modification Wear proper-fitting shoes that apply equal pressure to the whole foot. [happyphysio.com.au]

• Surgical Procedure

  GROWING POINTS: To assess whether benefits from surgery, validated and standardized measures should be used to compare the outcomes of patients undergoing standard surgical procedures. [ncbi.nlm.nih.gov]

  609 Traditional Procedures for the Repair of Hallux Abducto Valgus 623 Surgical Procedures of the Hallux 639 Complications of Hallux Abducto Valgus Surgery 655 Hallux Limitus and Hallux Rigidus 679 Compound Deformities 713 PesCavus 761 Pathologic Pes [books.google.ro]

  Other surgical procedures involve placing new tissue between the joints, or joint fusion to prevent painful movements. Bunions / Hallux Valgus Bunion can be treated with both surgical and non-surgical procedures. [wimbledonclinics.co.uk]

  There are no other complications from the surgical procedure. [journals.lww.com]

• Toe Pain

  Vionic sandals and Vionic Slippers both have a built-in arch support that we have found is the best on the market for our patients with big toe pain. Read here about other home treatments for a painful big toe joint. Don’t live with big toe pain. [footankle.com]

  Hallux rigidus is stiffness and pain in the big toe caused by arthritis of the metatarsophalangeal (MTP) joint. (The MTP joint of each toe is composed of two bones: the proximal phalanx and the metatarsal bone.) [hss.edu]

  Topical pain relievers: Natural pain relievers may help reduce swelling, pain, and inflammation. Avoiding any stretch or motion that lifts the toes into dorsiflexion. (ex. lunges, squats, and certain yoga positions) [correcttoes.com]

  Correct Toes : A toe spacing appliance that helps realign the big toe with the first metatarsal. Topical Pain Relievers: Natural pain relievers may help reduce swelling, pain, and inflammation. [naturalfootgear.com]

• Erythema

  She now presents with pain, swelling and erythema of the MTPJ. She is afebrile, bloodwork reveals normal ESR, CRP and WBC, and her erythema resolves with elevation. NSAIDs and activity modification have failed to provide relief. [orthobullets.com]

  Gout - Significant Findings - Acute severe pain tenderness, erythema, joint irritability localized to 1st MTP. Elevated uric acid. Sodium urate crystals. Treatment of Hallux Rigidus/ Hallux Limitus The treatment of Hallux Limitus is symptom based. [physiotherapy-treatment.com]

  When she removed her shoes, erythema was present bilaterally over the bunion and bunionette (tailors' bunion, lateral fifth metatarsal head) areas, indicating that her shoes were too narrow. [academic.oup.com]

  […] from procedures for hallux valgus in which preexisting osteoarthritis existed, osteochondral fractures of the first MPJ and a squared first metatarsal head.6,7 Clinical examination of the first MPJ will reveal an enlargement of the joint with localized erythema [podiatrytoday.com]

• Blister

  Friction blisters are a common health problem. [nwfootankle.com]

  You may find that you are getting blisters more easily. A pronounced case of hallux valgus is often associated with hammer toes. [wimbledonclinics.co.uk]

  A couple years later I was on vacation in Colorado with blistered heels from hiking, and my boyfriend recommended I go see one of his college buddies. [caminodesantiago.me]

• Arthritis

  Proximal plantarflexion osteotomy is used only in the presence of an elevated first metatarsal with a limit to dorsiflexion but without the presence of arthritis at the first metatarsophalangeal joint. [ncbi.nlm.nih.gov]

  Surgical treatments vary, depending on how far the arthritis has progressed. [hss.edu]

  Patients with less severe arthritis usually do better with orthotics that improve motion of the big toe joint 2. Patients with more severe arthritis usually do better with orthotics that limit motion of the big toe joint. [footankle.com]

  […] the joint is more prone to arthritis) Rheumatoid arthritis One of the hallmarks of great toe arthritis is loss of cartilage in the joint. [mdmercy.com]

• Osteophyte

  Also, forced plantar flexion produces pain as the dorsal capsule and the extensor hallucis longus tendon are stretched across the dorsal osteophyte. The dorsal osteophyte is easily palpable and typically exquisitely tender. [physiotherapy-treatment.com]

  Osteophytes. Altered joint mechanics. Pain and loss of function result from dorsal osteophytes, inflammation and irregularity of joint articular surfaces. [patient.info]

  Additionally, capsular release and periarticular osteophyte debridement were performed. Staging was made according to Coughlin and Shurnas' clinical and radiological grading system. [ncbi.nlm.nih.gov]

• Foot Pain

  The postoperative perceptions of foot pain were comparable with the postoperative results from a range of previously published studies. [ncbi.nlm.nih.gov]

  Symptoms of stiff big toe are: Pain in the joint when flexed A bump in the joint Stiffness Swelling These conditions may cause you to walk on the sides of the foot if the foot pain is too intense. [casteelfootandanklecenter.com]

  Orthotics can be very effective in supporting the joint, reducing pain and postponing the need for surgery. Get started on resolving your foot pain today. Fill in the form below to make an appointment at one of our clinics. [footmechanicspodiatry.co.nz]

  The resulting stiff big toe can make walking painful and difficult. Symptoms include: A bump, like a bunion or callus, that develops on the top of the foot. Pain in the joint when active, especially as you push-off on the toes when you walk. [afcenters.com]

• Ankylosis

  In the podiatric literature, we typically refer to hallux rigidus as the end stage of hallux limitus, when motion is absent or severely restricted to the point of near ankylosis. [podiatrytoday.com]

  Hallux rigidus is a condition characterized by near-ankylosis, or a state in which the big toe becomes stiff and immobile due to the partial fusion of the involved bones. [naturalfootgear.com]

  Ankylosis (arthrodesis) If your joint has completely deteriorated, we can fuse the big toe joint. This decreases your pain and increases the stress tolerance. [schoen-clinic.co.uk]

  An operation on the tendons may be necessary or a rocker bar may be fitted to the shoe. hallux rigidus ankylosis or grossly reduced sagittal-plane motion of first metatarsophalangeal joint (i.e. [medical-dictionary.thefreedictionary.com]

  Ankylosis of the joint may also occur, but is usually present at a later stage of the disease. When there are minimal plain film findings, an MRI may document a more isolated chondral lesion. [fifamedicinediploma.com]

• Great Toe Pain

  Contraction of the metatarsophalangeal joint of the great toe. Br Med J 1887;1:728. Cotterill J. Stiffness of the great toe in adolescents. Br Med J 1887;1(1378):1158. Dellenbaugh SG, Bustillo J. Arthritides of the foot. [lermagazine.com]

• Suggestibility

  Radiographically, the procedure types resulted in similar changes, suggesting that neither joint preservation nor joint destructive procedures were more stable over time. [ncbi.nlm.nih.gov]

  A physician may suggest pain relievers and anti-inflammatory medicines, ice or heat packs, or even injections into the joint to reduce pain and stiffness. [tri-countyortho.com]

  Your doctor may suggest toes with a wider toe box to remove pressure on the bone spurs. And they will likely suggest a rocker sole to reduce pressure and bend in the toe joint. [barkingdogshoes.com]

• Irritability

  There were 2 revisions for screw irritation. [ncbi.nlm.nih.gov]

  Dorsal joint hypertrophy can be a source of irritation from footwear and may lead to pain secondary to skin or soft tissue irritation. [physiotherapy-treatment.com]

  Potential complications of the surgery include infection, wound healing problems and irritation of the nerve that provide sensation to the toe. [togct.com]

  With hallux limitus/rigidus, pain is typically transferred to the 2nd metatarsal phalangeal joint or to the hallux interphalangeal joint Difficulty walking Callus to the bottom of the 2nd MPJ or hallux IPJ Pain with shoe gear as a result of irritation [timoniumfootandankle.com]

• Abnormal Gait

  The following risk factors can be derived from the suspected causes of hallux rigidus: Poorly fitting, tight footwear Foot deformities Flat foot arch with inwardly turned heel Incorrect or excessive strain, for example, due to abnormal gait pattern or [medi.de]

  Abnormal gait patterns are epidemic in this patient population, however, and need to be addressed as part of a successful treatment protocol. [lermagazine.com]

  Should the joint also be arthritic, the surgeon should avoid fusing both IP and MTP joints to prevent abnormal gait patterns. [wjgnet.com]

• Seizure

  Medications : Certain medications (primarily beta-blockers and anti-seizure drugs) may increase the likelihood of a plantar fibroma. An MRI or biopsy can also help confirm or rule out a plantar fibroma. [nwfootankle.com]

Early diagnosis is essential to arrest the progressive damage to the articular cartilage. A prior physical examination will be required, wherein the surgeon would move the foot in various directions to understand its range of motion and degree of damage to the area. Following this, radiographs would be indicated which show degenerative changes.

In the early stages, non-surgical treatment approach is adopted to effectively manage the condition by controlling the symptoms.

Non-surgical approach:

• Wearing comfortable footwear having ample room for the big toe
• Women are advised against wearing high heels
• Some individuals benefit with shoes having stiff soles
• Inserting pads in the shoes can also help in limiting the movement of the toe
• Heavy exercises and high impact activities like jogging should be avoided
• Medication such as non-steroidal anti inflammatory drugs (NSAIDs) are employed for relieving pain and inflammation 
• Ultrasound therapy or physical therapy helps in providing temporary relief

Surgery

Surgery is the last resort and employed in more advanced and severe cases when other treatment methods do not reduce pain and discomfort. Several types of surgical procedures are available to treat hallux rigidus. The type of method employed depends on the extent of damage and severity of symptoms experienced. In many cases, cheilectomy which employs shaving off the bone spur can help relieve pain and restore motility [10].

A procedure known as osteotomy may be required which involves cutting the bone in order to shorten the toe. Other surgical procedures include interpositional arthroplasty and arthrodesis which may be conducted depending on the condition [11]. Interpositional arthroplasty is helpful for younger patients. The procedure involves placing a spacer between the ends of joint; this helps in relieving pain and discomfort. Arthrodesis is employed in severe and more advanced stages.

Prognosis of the condition is quite favorable with patients responding well to the treatment regime used. Post treatment, patients can carry out daily activities with ease and can even exercise, run and wear all types of shoes comfortably. However, wearing shoes with high heels may be a cause of discomfort for individuals who have undergone fusion of toe [7].

The exact etiology of hallux rigidus is unknown. However, trauma, structural abnormalities in the big toe combined with faulty biomechanics, are some of the factors known to cause hallux rigidus. Wear and tear in the first MTP joint is understood to be the major cause behind hallux rigidus.

Some research scholars have postulated the fact that repeated athletic activities leads to chronic gradual attenuation of the joint in the big toe; which subsequently paves way for development of osteoarthritis [2].

It has been estimated that hallux rigidus is the second most common problem concerning the first MTP joint after hallux vagus. Majority of about 80% cases of hallux rigidus are bilateral in nature. More women are affected than men and the condition commonly strikes adults between the age group of 30 to 50 years [3] [4].

The development and onset of hallux rigidus follows the principle of degenerative arthritis. Factors that cause undue stress on the articular cartilage include overuse of the joint, injury or faulty joint mechanics. These events gradually cause degeneration of the articular cartilage [5].

This in turn makes the joint more susceptible to wear and tear, thus making it more prone to injury. Such sequence of events causes increase in the subchondral density of bone, development of periarticular osteophytes and cystic changes. The formation of osteophytes causes considerable decrease in the MTP joint mobility with further degradation of normal joint mechanics. In more advanced or severe cases, articular cartilage undergoes denudation [6].

Onset of hallux rigidus cannot be prevented. However, its progression can be arrested by doing simple exercises to improve joint mobility. Adequate rest and not overusing the joint also are some of the preventive measures that can be taken.

Hallux rigidus is a progressive disorder, and gradually causes the big toe to stiffen giving rise to condition known as frozen joint. It is a form of degenerative arthritis of the first metatarsophalangeal (MTP) joint of the foot, requiring prompt diagnosis and effective management. Females are more prone to suffer from the condition than males [1].

• Definition: Hallux rigidus is characterized by development of stiffness along with pain in the joint of the big toe. The condition is also termed as stiff big toe.
• Cause: Various factors give rise to the condition of hallux rigidus. Injury, repeated use of the joint which poses stress on the joint causes articular damage with subsequent degeneration. Faulty biomechanics of the joint can also increase the risk of hallux rigidus.
• Symptoms: Affected individuals suffer from joint stiffness along with pain in the affected area. Individuals also experience great deal of difficulty while walking. In extreme cases, the pain aggravates in cold weather and there is gradual change in the gait of the individuals which forces them to limp while walking.
• Diagnosis: A preliminary physical examination is carried out to determine the extent of motility of the joint of big toe. This is followed by an X-ray of the toe to identify degenerative changes in the joint.
• Treatment: In initial stages, the condition can be managed by adopting a non-surgical approach which includes modifications in foot wear, and avoidance of high heels. Individuals are also given ultrasound and physical therapy to provide temporary relief. Medications are given to relieve pain and inflammation in the affected joint. Surgery is done during advanced stages.

1. Konkel KF, Menger AG, Retzlaff SA. Results of metallic Hemi-Great Toe Implant for Grade III and early Grade IV hallux rigidus. Foot Ankle Int. Jul 2009;30(7):653-60
2. Jack EA. The aetiology of hallux rigidus. Br J Surg. 1940;27:492-7.
3. Vilaseca RR, Ribes ER. The growth of the first metatarsal bone. Foot Ankle. Sep 1980;1(2):117-22.
4. van Saase JL, van Romunde LK, Cats A, et al. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis 1989; 48:271.
5. Altman RD, Fries JF, Bloch DA, et al. Radiographic assessment of progression in osteoarthritis. Arthritis Rheum 1987; 30:1214.
6. Ahn TK, Kitaoka HB, Luo ZP, et al. Kinematics and contact characteristics of the first metatarsophalangeal joint. Foot Ankle Int. Mar 1997;18(3):170-4.
7. Nilsonne H. Hallux rigidus and its treatment. Acta Orthop Scand. 1930;1:295-302.
8. Zammit GV, Menz HB, Munteanu SE. Structural factors associated with hallux limitus/rigidus: a systematic review of case control studies. J Orthop Sports Phys Ther. Oct 2009;39(10):733-42
9. Brennan SA, Harney T, Queally JM, et al. Influence of weather variables on pain severity in end-stage osteoarthritis. Int Orthop 2012; 36:643.
10. Lau JT, Daniels TR. Outcomes following cheilectomy and interpositional arthroplasty in hallux rigidus. Foot Ankle Int. Jun 2001;22(6):462-70
11. Barca F. Tendon arthroplasty of the first metatarsophalangeal joint in hallux rigidus: preliminary communication. Foot Ankle Int. Apr 1997;18(4):222-8