Hallus Rigidus (Stiff Great Toe)

With normal gait (the movements involved in walking), there are three phases:

Heel strike, when your heel contacts the ground,

Mid-stance, when you weight is centered over the foot, and

Toe off, when you’re coming up on the ball of your foot ready to push off with your toes before taking the next step

Swing through, which is just like it sounds, when your weight is on the other foot, and the foot that just pushed off with the toe is swinging through to start again with heel strike.

In the last phase of the gait cycle, during toe off, your toes are flexing upwards.

In patients with hallux rigidus, the great toe has limitation of motion, usually due to either a bone spur or more advanced arthritic process, which prevents the toe from accommodating that upward motion.

As the patient tries to come up on the ball of the foot before taking the next step, the bone spur causes pain and often as a result, patients find they are walking on the outside of their foot to avoid this motion at the joint at the base of the toe.

The treatments include:

Non-operative: anti-inflammatory medicines, shoe supports preventing the bending motion of the forefoot, or a post op shoe, as pictured here to the right, which doesn’t bend at the ball of the foot.

Operative: Removal of the bone spur (cheilectomy) or fusion or implant for the involved joint.

With a fusion (also called an arthrodesis), there is a trade off whereby the patient gives up the little bit of residual and painful motion in return for a fused (like glued together with bone) joint that will never move again.