Hallux rigidus or osteoarthritis of the first MP joint (great toe joint) is a very common condition affecting adults. The symptoms are pain and stiffness in the toe. Patients also have difficulty getting up on their toe, running and wearing a high-heeled shoe. Most patients notice a bump on the top of the foot at the big toe joint and a stiff and painful toe. The non-operative treatment for hallux rigidus involves shoe modification, which includes a rocker bottom to their shoe, custom orthotics or sometimes injections. Most patients with a hallux rigidus benefit from surgical intervention.
There are three types of procedures we do for hallux rigidus. The first procedure is called Moberg cheilectomy. In this procedure, we do a cheilectomy (a shaving on the bone off the top of the foot). This helps take the spurs off the joint. The second part of procedure is to wedge the toe a little bit up so that it bends more. This involves taking a small wedge out of the toe bone itself and inserting a small screw. This procedure is very effective for mild to moderate hallux rigidus and most patients can return to full activity afterwards.
The next procedure we do for hallux rigidus, reserved for more severe cases, is called capsular interpositional arthroplasty. In this procedure, we try to make a new joint in the arthritic joint. This is reserved for patients with very severe hallux rigidus or very severe arthritis. This procedure leads to some shortening in the toe but leads to markedly increased range of motion and very good pain relief. It is usually reserved for patients who are not high level athletes but who want to be able to walk comfortably, wear high heels, and participate in some recreational sports.
The final procedure we do for hallux rigidus is fusion of the first MP joint. This procedure is for patients with severe arthritis in the joint and often patients who have had previous surgery that has failed. This is a very effective treatment for relieving pain in the first MP joint. Patients are able to wear normal shoes but not able to wear more than a two-inch heel. They are able to walk because the joint in front of the big toe joint is not fused and the foot bends as well.
Joint replacement has been tried for over 20 years in the first MP joint. To date, the results still remain very poor. A recent study compared joint replacement to fusion of the first MP joint, showing that even patients who had a successful joint replacement still had a lower function score than the patients with a fusion. The complication rate from the joint replacement is unacceptably high and to this date we have not perfected joint replacement of the first MP joint.