Treatment of hallux rigidus often has to be surgical but the joint can be made more comfortable with an appropriate shoe modification. To treat the pain in the big toe joint, the shoes are modified by stiffening the sole, inserting a stiff orthotic arch support in the shoe and sometimes adding a small rocker effect (called a metatarsal bar) that is glued to the bottom of the sole of the shoe. Thin-soled shoes and high heels aggravate this condition because more stress is placed on the joint, increasing pain.
Surgical treatment options for hallux rigidus are determined by the extent of the arthritis and deformity. For the more minor type of hallux rigidus, shaving the bump of the bone on top of the metatarsal is sufficient (a cheilectomy). As the stiffening of the big toe joint increases, a cheilectomy is not sufficient and an additional bone cut may be needed on the big toe itself (an osteotomy of the phalanx).
As the arthritis increases, the ability of an osteotomy or cheilectomy to correct the problem, maintain motion, and prevent the arthritis from worsening is very limited. For these patients, either a fusion of the big toe (an arthrodesis) or removal of bone from the joint (an arthroplasty) is performed. The big difference between a fusion and arthroplasty is the movement of the big toe.
The main advantage of a fusion is that it is a permanent correction with elimination of the arthritis and pain. The disadvantage is the restriction of movement of the big toe. Patients are typically able to exercise, run and wear most shoes quite comfortably. Wearing a heel higher than an inch and a half is difficult after fusion of the big toe.
Removal of a bone from the joint (a resection or interposition arthroplasty) shortens the big toe slightly but maintains some movement. This is an effective operation, particularly for individuals who would prefer to have movement of the big toe after this type of surgery. It is not as reliable and predictable as a fusion in terms of recurrent problems with the big toe and push off strength. The decision to perform a fusion or an arthroplasty of the joint is often a matter of patient and physician preference, a decision that is made together.
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