Big Toe Arthritis (Hallux Rigidus) Treated at Mercy in Baltimore

Foot and Ankle Reconstruction at Mercy - Baltimore

At The Institute for Foot and Ankle Reconstruction at Mercy, our surgeons specialize in the diagnosis and treatment of big toe problems, including hallux rigidus. Patients from the Baltimore region seek the expertise of our top rated surgeons to help alleviate their big toe arthritis.

About the Condition

Movement of the big toe joint occurs typically in an up and down plane only (dorsiflexion and plantarflexion). The normal dorsiflexion is approximately 75 degrees and plantarflexion is 25 degrees. 

When the big toe has limited movement, it is often, but not always, associated with some form of arthritis of the big toe. This is referred to as hallux rigidus.

NEXT: Symptoms & Diagnostic Process ›
Symptoms & Diagnostic Process

Big toe arthritis symptoms include:

  • Pain
  • Swelling
  • Stiffness
  • Bump on top of the big toe

An orthopedic surgeon can diagnose hallux rigidus by conducting a physical exam of the foot. X-rays may be taken to view the extent of the arthritis of the big toe.

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Treatment Options

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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Patient Stories
Foot and Ankle Reconstruction - Baltimore


An active retiree embarks upon a second career but finds himself slowed down by arthritis in both feet. After surgery at Mercy he finds himself on the move once again.

Meet Our Doctors: Institute for Foot and Ankle Reconstruction
Foot and Ankle Reconstruction
Gary Pichney, DPM

Dr. Gary Pichney is a podiatrist specialized in advanced surgical techniques with expertise in forefoot, rear foot and ankle surgical reconstruction, sports medicine and amputation prevention in the diabetic foot.

Patient Story:
Institute for Foot and Ankle Reconstruction at Mercy - Baltimore

A successful scholar sets out on a personal research project to find the perfect doctor to address his ankle arthritis.

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