Hallux Limitus/Rigidus Surgery

Hallux limitus/rigidus is an arthritic condition that impacts the big toe joint where it meets the foot. If you are experiencing intense pain, stiffness, and limited range of motion in this joint on an ongoing basis, hallux rigidus may be the culprit.

Often times hallux limitus and rigidus are used synonymously. Hallux Limitus is considered a limitation in the range of motion of the big toe joint, whereas hallux rigidus is defined as the end stage of hallux limitus. With hallux rigidus there is also severe joint limitation and often associated with severe pain as well. 

While hallux rigidus can often be managed non-surgically, surgery is indicated in cases where the condition is impacting daily activities and more conservative treatment options have proven ineffective. Below, we’ve provided an overview of hallux rigidus and the cheilectomy/first metatarsophalangeal joint fusion surgery that are sometimes used to treat it:

Understanding Hallux Rigidus and Associated Surgical Correction Procedure.

Sometimes referred to as “big toe arthritis” , hallux rigidus (which literally means big toe stiffness) is a form of osteoarthritis, a degenerative disease that causes joint inflammation, pain and discomfort. This condition affects the first metatarsophalangeal (MTP) joint, where the base of the big toe meets the foot.

Anatomy of the Big Toe

The big toe, also known as the hallux, is made up of two joints. The bigger of the two, the MTP joint, is where the first bone of the big toe (proximal phalanx) meets the first long bone of the foot (metatarsal). The MTP joint is surrounded by a variety of different stabilizing structures, including a network of tendons, ligaments, and tissues known collectively as the plantar complex.

Causes and Symptoms of Hallux Rigidus

Hallux rigidus does not always have an identifiable cause. Rather, it often develops over time and may simply be a part of aging wear and tear process on the cartilage that cushions the MTP joint. This joint experiences a tremendous amount of stress during walking and even more as a result of higher impact activities. Dancers, athletes, runners, taller individuals, patients with chronic gout and people over the age of 50 may be particularly prone to developing hallux rigidus. Other hallux rigidus risk factors can include old trauma such as stubbing or spraining your big toe (sometimes called Turf Toe) years prior.

Common symptoms of hallux rigidus can include:

• Big toe joint pain (1st metatarsophalangeal joint)
• Pain on top of and/or within the big toe
• MTP joint stiffness
• Swelling around the MTP joint
• Redness around the MTP joint
• Limited range of motion in the big toe
• A bump on top of big toe that looks like a callus or bunion (bone spur)
• Aggravation when standing, moving, or wearing improperly fitting shoes

Diagnostic Approach for Hallux Rigidus

To diagnose hallux rigidus, your doctor or surgeon will take your medical history and perform a physical examination of your big toe joint to assess its range of motion. X-rays or other diagnostic imaging tests may also be ordered to check for the presence of bone spurs and arthritic changes present in the joint. After analyzing the condition of your MTP joint, your doctor may assign your hallux rigidus a stage or grade from 1-4, with 4 being the most severe.

Treatment for Hallux Rigidus

In many cases, non-surgical treatment of hallux rigidus can effectively manage the condition. Conservative treatment options may include:

• Customized foot orthotics with a kinetic wedge, 1st ray cutout, or mortons extension depending on the severity of the condition.
• Corticosteroids (cortisone injections into the big toe joint). This can be of diagnostic and of therapeutic values for a period of time
• Investing in proper footwear (avoiding high heels and shoes that compress the toes)
• Regular icing and the use of over-the-counter pain relievers
• Icing the big toe joint for no longer than 20 minutes at a time to help decrease inflammation 
• Having an activity plan and taking rests as needed in order to limit the symptoms experienced

The Cheilectomy Procedure for Hallux Rigidus

If the conservative treatment approaches listed above prove ineffective, with pain and stiffness persisting, negatively impacting your daily activities and overall quality of life, it may be time to consider surgery for hallux rigidus.

Hallux rigidus surgery treatment can include several different options, one of the most common being a cheilectomy procedure. During a cheilectomy procedure, growths and bone spurs on your big toe joint are shaved down to relieve pain and promote improved range of motion. Depending on the circumstances, the surgery may be performed as an open procedure or via the less invasive insertion of instruments through small incisions.

The 1st Metatarsophalangeal Joint Fusion Procedure for Hallux Rigidus

In more serious cases, a cheilectomy may not suffice nor provide the pain relief required. It may be more strongly suggested to perform a arthrodesis (joint fusion) procedure. 

A 1st MTPJ fusion procedure is considered one of the most functional fusions performed on the body. After the completion of the rehabilitation process, patients are able to return back to full activity, including sports. 

The procedure allows patient to return to walking on same day of surgery with a special walking boot. The procedure requires on average 2-3 months to fully heal procedure site and full return to activities is expected around the 4-6 month mark. 

Frequently Asked Questions

What Is the Post-Surgery Recovery Process for the procedures mentioned?

Both procedures are typically outpatient surgeries, meaning that you’ll return home the same day. For the first weeks following the surgery, you’ll wear a special shoe or boot (depending on the procedure) to keep your big toe joint stable and pain relievers will be prescribed.

What Are the Indications for Choosing Cheilectomy in Hallux Rigidus?

If you have mild to moderate hallux rigidus that is negatively impacting your daily life and more conservative treatment approaches haven’t been effective in managing it, a cheilectomy may be the appropriate next step. Speak with one of the world-class surgeons at Modern Orthopaedics of New Jersey to learn more.

What Is the Recovery Time After Cheilectomy Surgery?

The amount of time it will take to recover from hallux rigidus cheilectomy surgery will vary based on a variety of factors such as your age and medical history, overall health, and whether or not any other procedures were performed at the same time. Most patients are able to return to work within a month or two after cheilectomy surgery, but swelling may last anywhere from a few weeks to a few months, depending on the circumstances.

What Are the Possible Complications of Hallux Rigidus Surgeries?

Like any surgery, the surgeries mentioned come with the risk of potential complications. Hallux rigidus surgery complications can include infection, scarring, and pain in the ball of the foot. Speak with your surgeon for more specific details.

Consulting With a Specialist for Hallux Rigidus Surgery

If hallux rigidus is impacting your quality of life, it’s time to consult with a specialist who can help you permanently resolve the condition. At Modern Orthopaedics of New Jersey, our award-winning surgical team will tailor a treatment plan to your precise needs. Call us today to book an appointment!