Hallux rigidus refers to arthritis affecting the joint at the base of the big toe, representing the most prevalent arthritic condition in the foot. It commonly affects individuals over the age of 30, with women being more susceptible than men. The joint in question, termed the hallux metatarsophalangeal (MTP) joint, connects the first foot bone (metatarsal) with the base of the first toe bone (proximal phalanx) and two small bones underneath the metatarsal. Typically, the most significant wear occurs at the top of this joint.

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Symptoms

Pain in the big toe joint during activity, particularly when pushing off to walk, is a hallmark symptom of hallux rigidus. Swelling around the joint and difficulty bending the toe may also be experienced. Over time, a bony bump, similar to a bunion or bone spur, may develop atop the joint, aggravating discomfort by rubbing against footwear.

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Causes

The precise cause of hallux rigidus remains unclear, although several risk factors have been identified. These include variations in foot anatomy (flatfeet, high arched, etc.), such as a long or elevated first foot bone, previous injury to the big toe, and familial predisposition. These factors contribute to excessive wear of the joint, ultimately leading to arthritis.

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Diagnosis

In many instances, a diagnosis of hallux rigidus can be established through a physical examination. Dr. Kamel will assess the mobility of the MTP joint and pinpoint areas of pain. Additionally, the presence of bone spurs may be evaluated. X-rays, preferably taken with weight-bearing, are typically employed to assess joint degeneration and the size and location of bone spurs. MRI and CT scans are rarely necessary for diagnosis.

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Treatment

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Non-Surgical Treatment

Initial management of hallux rigidus typically involves non-surgical approaches. These may encompass pain-relieving medications, anti-inflammatory drugs, and applications of ice or heat to alleviate discomfort. Injections of platelet-rich plasma into the joint show promise but vary in efficacy. Footwear modifications, such as opting for shoes with stiff or curved soles, can help reduce pressure on the joint. Inserts and arch supports may also limit motion at the MTP joint, providing relief.

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Surgical Treatment 

If non-surgical interventions fail to alleviate symptoms, surgical options may be explored based on the severity of arthritis and toe deformity.

• Cheilectomy: For mild to moderate cases, removing bone and spurs from the top of the foot and big toe (cheilectomy) can enhance toe mobility and alleviate pain.

• Arthrodesis (Joint Fusion): In advanced stages with significant joint damage, fusing the big toe joint (arthrodesis) may be necessary to reduce pain. This procedure restricts toe movement but provides lasting pain relief.

• Interpositional Arthroplasty: An alternative for moderate to severe cases involves removing damaged bone and placing a spacer between the bones to minimize joint contact.

• Arthroplasty (Joint Replacement): While joint replacement has shown success in other joints, its application in hallux rigidus remains limited due to concerns regarding complications and unpredictable outcomes.

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Recovery

Recovery duration varies depending on the type of surgery performed. Most patients can resume normal activities after a period of immobilization and rehabilitation. Stiff-soled footwear may provide added comfort during exercise.

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Risks and Complications

As with any surgery, there are risks, including infection and scarring, although they are rare with these procedures. Factors such as smoking or compromised immunity may increase these risks. Consultation with Dr. Kamel is essential for personalized guidance.