Dorset Foot & Ankle Clinic

Figure 1 – The joints have been fused using screws which has relieved the pain very effectively

Figure 2 – This patient has severe arthritis affecting both big toes which are almost totally rigid bit painful

Figure 3 – X Rays of a patient with a painful arthritic big toe joint (hallux Rigidus). You can see a large osteophyte on the top of the toe joint (arrow) which rubs in shoes

Figure 4 – TheseX Rays show the same patient following insertion of a ceramic Moje replacement joint

Hallux Rigidus (Osteoarthritis of the Big Toe Joint)

Osteoarthritis is a common occurrence in the big toe joint and is often known as hallux rigidus due to the stiffness of the joint. It often occurs in both big toes, usually one toe is worse than the other. There are several options for treatment:

1. Steroid Injection plus Manipulation

For mild cases a steroid injection with manipulation can often relieve the pain from the joint for many weeks or months and a manipulation improves the range of movement. We normally can do one or two injections at any one time and occasionally a third is required. If a poor response is achieved then we often go on to one of the other options.

2. Removal of Bone Swelling

A swelling round an arthritic joint is known as an osteophyte. Removal of the osteophyte is known as a cheilectomy. In the big toe joint the osteophyte often is the cause of limitation of movement particularly going upwards, and simply removing this can sometimes relieve symptoms extremely well. This can last for many years on some occasions. We do not usually recommend this treatment however when the joint is very inflamed and irritable.

3. Fusion of Big Toe Joint

This is probably the most durable treatment for this condition whereby the two bones that form the big toe joint are cleared of their articular surface and then brought together with metal screws or staples. The two bones then heal together creating a totally stiff joint. The joint is normally elevated by about 10 degrees to allow the foot to roll forward during walking.

The main disadvantage of this operation is that it does remove all movement from the toe joint and can limit choice of shoe wear. It can also sometimes lead to wear and tear in the joint in the middle of the big toe (interphalangeal joint).

Once done however a fusion will never need to be undone or re-done and is very durable.

4. Replacement of Big Toe Joint

In the last few years better designs of big toe replacements have come onto the market. We are currently using a ceramic replacement called the Moje replacement (Orthofix Orthosonics).

This is a ceramic replacement comprising two components that are fitted securely into the base of the big toe and the head of the metatarsal through a small operation. Over a 6 week period the natural bone will fuse on to the surface of these components anchoring them securely into the bone. During the 6 week period the patient will have to walk with a special heel weight bearing shoe to keep the pressure off the big toe joint. Any adverse pressure on the joint could lead to the fusion process not occurring and the joint becoming loose.

After 2 weeks the patient undergoes physiotherapy to work on range of motion of the joint. At 6 weeks an X-ray is taken to ensure the joint is secure and the patient may then take weight on the front of the foot in normal shoes.

X-rays are taken at 6 months and then yearly thereafter (see recommendation by previous patient).