There are hallux rigidus exercises that can help with big toe movement. When evaluating a foot, I always check the motion at the big toe. A stiff big toe changes the way people walk. This tends to lead to other problems. These new issues might be in the foot but they could also present in the ankle, knee, hip, or low back. However, they all stem from the big toe. The big toe, or hallux as we call it in the medical world, is an extremely important component in walking, running, and balance. This is why hallux rigidus (extreme stiffness in the big toe) is such a problem. Read on to learn more about this condition. Let’s start with anatomy!
What is the hallux?
The hallux is the medical term for the big toe. The big toe is made up of two joints. The first one is the metatarsophalangeal joint (MTP). This is the larger of the two joints and is where the first metatarsal (long bone of the foot) meets the first phalanx (toe bone). The second joint of the big toe is the proximal interphalangeal joint (PIP). This joint is smaller and it is where the two bones (phalanxes) of the big toe meet.
The big toe is very important in daily life. While walking, the big toe bears twice the load of the other toes and plays a key role in forward propulsion of the body. The big toe is, also, a vital component in balance. The MTP joint is the joint affected by hallux rigidus. It has more movement than the PIP and plays a bigger role in walking, running, and balance.
What is arthritis?
Osteoarthritis is the breakdown of the articular cartilage in the joint. Articular cartilage is a smooth covering of the boney surfaces within the joint. It allows the bones to glide on one another without friction during movement. As the articular cartilage erodes, the bones will begin to become irritated and form bone spurs. As OA progresses, the joint itself will become deformed and there will be limited to no joint space available for the bones to move.
What is hallux rigidus?
Hallux rigidus is a condition that refers to osteoarthritis arthritis of the MTP of the big toe. It is degenerative in nature and causes the big toe to become stiffer and stiffer over time. It is the most common arthritic condition in the foot.
Hallux rigidus can lead to severe limitation in the movement of the big. More, specifically, it limits flexion and extension of the big toe. Flexion is the action of curling the toe and extension is bending the toe backwards. Extension of the big toe is very important for walking. About 60 degrees of MTP extension is needed for normal walking.
When the big toe becomes very stiff and painful, then it is natural to avoid walking on it. People will walk more on the outside of their feet, rotate the hip more, or hike the hip to avoid putting weight through the big toe. This creates a whole new set of problems and injuries that could span from the feet to the low back.
What causes hallux rigidus?
The majority of hallux rigidus cases are idiopathic in cause. This means that it is unknown why this person developed the condition. The underlying cause is unknown but likely has many factors that contribute to the condition. It is common to have both big toes affected. It is also more likely to affect females with a family history of hallux rigidus and/or hallux valgus (big toe turning in towards 2nd toe).
What are the symptoms of hallux rigidus?
There are several symptoms associated with hallux rigidus. These include:
- Pain in the big toe
- Burning pain with possible pins and needles sensation
- Swelling and redness in the joint
- Enlargement of the MTP joint
- Stiffness
- Loss of mobility at the MTP joint
- Loss of ankle mobility – especially pointing the foot down
- Abnormal walking
- Pain with walking, running, and squatting
Who gets hallux rigidus?
There are some risk factors for developing hallux rigidus. These include:
- Knee arthritis
- Hallux valgus (big toe turning in towards 2nd toe)
- Episodes of gout
- Family history of hallux rigidus
- Previous trauma at the big toe
- Greater than 50 years old
- More prevalent in females
- Increased height increases the risk of developing hallux rigidus
Hallux rigidus vs hallux limitus
Hallux limitus is the beginning stages of hallux rigidus. Hallux limitus is mild stiffness and decreased motion at the MTP joint of the big toe. It is easier to treat than hallux rigidus. However, without treatment, hallux limitus will progress into severe arthritis at the joint and into hallux rigidus. Hallux rigidus is a more severe motion restriction of the MTP joint with associated degenerative arthritis.
Who should I see?
- Physical therapy – Physical therapy can help decrease the pain and swelling with techniques including manual therapy and dry needling. PT can evaluate and address abnormal joint mobility, muscle weakness, and flexibility. Some PT’s or an orthotist can measure your foot for custom made orthotics. Orthotics are needed to off-load the big toe while standing, walking, or running. Your PT will also assess your gait and shoe wear to help you walk, run, and squat with minimal pain or difficulty.
- Orthopedic physician – An orthopedist that specializes in the foot and ankle will be necessary if your condition is not responding to physical therapy. Anti-inflammatories or an injection might help with inflammation and pain. Your orthopedist can order imagining to determine the extent of the damage to your toe. Depending on the stage of your arthritis, activity level, and level of pain, you might be a candidate for surgery.
What can I do at home?
- Relative rest – Reducing the stress to the area to decrease further pain and damage from occurring is one of the best ways to control pain and inflammation at the toe. Basically stay away from the activities that are causing pain. If you are a runner you might think about switching from asphalt to trails. Swimming and biking would be good alternative activities that do not put much stress through the ankle and foot.
- Ice – Ice can help decrease the pain and swelling at the joint. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or preventing you from participating in an activity. Ice immediately after activity.
- Stretching – Stretching the calf muscles and plantar fascia can help improve the motion at the toe. This includes stretching the gastrocnemius and the soleus. See the video below.
- Strengthening – It is important to strengthen the muscles of the foot, leg, calf muscles, knee, and hip. All of these muscles work together to stabilize the ankle and foot while running, walking, and jumping. Using loop resistance bands , resistance bands and ankle weights can increase strength and difficulty of the exercises. See the videos below.
- Balance – Working on balance is important in strengthening the foot and ankle but also improving proprioception. Improving proprioception will help improve the overall stability of the foot and ankle. See the video below.
- Shoe wear and orthotics – Changing shoe wear or using orthotics to off-load the big toe will help decrease your pain and improve your ability to walk and run. A rocker bottom or stiff soled shoe can help decreased the amount of extension needed from the big toe. Also you will want a shoe with a wide toe box. Most running stores can suggest appropriate shoe wear. Your PT can also evaluate your foot and help determine appropriate shoe wear.
In review
- The hallux is the medical term for the big toe.
- The big toe is made up of two joints.
- The first one is called the metatarsophalangeal joint (MTP). This is the larger of the two joints and is where the first metatarsal (long bone of the foot) meets the first phalanx (toe bone).
- While walking the big toe bears twice the load of the other toes and plays a key role in forward propulsion of the body.
- Hallux rigidus is a condition that refers to osteoarthritis arthritis of the MTP of the big toe.
- It is the most common arthritic condition in the foot and it is a degenerative condition.
- It causes a severe limitation in the movement of the big toe.
- Symptoms include severe stiffness in the big toe and pain with walking and running.
- It is more common in females especially if they have a family history of hallux rigidus or hallux valgus.
- Physical therapy can help with big toe mobility and orthotics/shoe wear to help off-load the big toe.
- Orthopedic surgeon can help decrease inflammation with medication and injections.
- Surgery is an option if the arthritis is severe and the condition is not responding to physical therapy.
- There are things that you can do
- Relative rest
- Ice
- Stretching
- Strengthening
- Balance
- Shoe wear/orthotics
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources