Ask the Expert: Hallux Rigidus

SORE BIG TOE JOINT?

IT COULD BE HALLUX RIGIDUS. INTRODUCTION

Hallux Rigidus is a condition that affects the joint at the base of your big toe. It is a form of osteoarthritis (OA).

SYMPTOMS Pain Stiffness Difficulty bending the toe The condition can be caused by general wear and tear, an injury or be inherited – however, appropriate footwear can definitely help!

WHAT’S GOING ON THEN?

As the condition progresses, the cartilage around the joint is damaged. Hallux rigidus progresses through four stages, each characterized by specific symptoms. During an assessment with a podiatrist, the appropriate management advice is issued depending on the stage: -

Stage 1: The joint is stiff and sore but there is still good range of motion. Pain may only be present with certain activities.

Stage 2: The joint becomes more stiff and movement more limited. Pain is present with more activities and may be present even when not moving the joint.

Stage 3: The joint is severely stiff and movement is limited significantly. Pain is present even when not moving the joint and can be severe.

Stage 4: Hallux rigidus can be self-limiting; in that the joint can fuse and become rigid (hence the name!). Pain is usually not present in this stage because the joint can no longer move.

COMPLICATIONS Difficulty walking

Pain ± swelling in the affected area Tricky to find comfortable footwear Untreated hallux rigidus can lead to other problems i.e. hammer toes, calluses (hard skin), and chronic foot pain.

DIAGNOSIS & TREATMENT OPTIONS

Diagnosis of Hallux Rigidus is typically made through a physical examination by an appropriately qualified medical professional, such as a podiatrist, and x-rays (arranged via your GP) which can show the degree of arthritis present in the joint. Differential Diagnoses Hallux Limitus Bunion (Hallux Abductovalgus) Gout Stress fracture Turf toe Sesamoiditis Tendonitis Infection

Treatment options for Hallux Rigidus include:- Physical therapy incl. mobilisation, massage and manipulation Pain relief incl. steroid injections Footwear adjustments and orthoses (insoles) Corrective surgery (last resort)

Early diagnosis and management can help slow the progression of the condition and reduce the likelihood of complications.

Let’s talk about footwear...

ORTHOSES/ORTHOTICS Orthoses are worn in shoes to provide extra support, redistribute pressure and offer comfort & stability. These can be made in-clinic by a podiatrist, or you may require a more bespoke prescription, which involves taking casts of your feet. With respect to the latter, you may need to see a musculoskeletal specialist podiatrist – the requirement for this is assessed on an individual basis. If you are issued orthoses, it’s important that you choose footwear that can accommodate them.

SHOES ARCH SUPPORT

Shoes with good arch support can help distribute weight evenly across the foot, reducing pressure on the big toe joint. This can help reduce pain and stiffness in the joint.

CUSHIONING

Cushioning (I’m looking at you, Skechers) can help alleviate the discomfort caused by Hallux Rigidus by offering shock absorbency during walking. Sadly, it will not improve your mobility, but it may help to ease your pain. However, there is definitely a sweet spot – if you go too soft, this creates an unstable environment for your feet which can lead to other problems, such as clawing of the toes, pain further up the kinetic chain (ankles, knees, back – even neck!) and potentially, falls.

FIT

Shoes that fit well can help reduce pressure on your joint, as well as help to prevent blisters, calluses, and other foot problems developing. Toe Box – should be wide enough to accommodate your toes without constricting them, and deep enough to stop rubbing across the tops of the toes. Even if you have hallux rigidus, your toes still need plenty of room to function correctly. If your toes feel squashed together, the shoe is too small or narrow for your feet. Rear Shoe – should not slip up and down on the back of your foot. Fastening – slip-on shoes really are bad news. Laces, a zip or Velcro are ideal for securing your foot in the shoe, offering stability. Shape – if you are unsure whether your shoe is a good fit for your foot shape, take a piece of plain paper, pop your foot on it and draw around your natural foot shape when standing. Remove your foot and pop your shoe over the tracing. If the tracing of your foot sits outside the borders of the shoe, that shoe is squashing your foot and causing more problems. Material – if you have a bunion, choosing a material with some stretch in it e.g. neoprene, soft leather, is a good option to allow the shoe to accommodate the shape of the joint. ShoeMed offer online and in-person consultations to find the right shoes for your foot shape and lifestyle. Use the code FELIC10 for £10 off your order (both in store and online).

ROCKER SOLE SHOES

Rocker soles are the mainstay of offloading the big toe joint to offer pain relief and reduce further damage to the joint, and they are not as scary as they sound! I wear Hoka One One trainers for long (dry) walks and for running, and Joya’s in clinic. Both incorporate a rocker sole – but you’d never know!

The sole is typically thicker in the middle and curved, allowing for a smoother, rolling motion as you walk. Pressure is offloaded away from the forefoot and redistributed across the sole. Rocker soles can be particularly helpful if you have Hallux Rigidus, as they encourage your feet to go through a more natural range of motion and decrease the need for excessive bending at the big toe joint.

WHAT NOT TO DO

Avoid these shoes: - OVERLY FLEXIBLE SHOES These will increases the stresses exerted on the big toe joint, potentially worsening the problem

HIGH HEELS

These throw your centre of gravity forward, and you will drive much more pressure through the big toe joint. these will exclusively make things worse – guaranteed!

Ouch...

TOO CUSHIONED (E.g. memory foam)

Don’t get me wrong, I love those squashy walking-on-air memory foam trainers as much as the next person; but less is more. Some cushioning will help absorb shock and reduce pain, but too much will affect your foot’s proprioception (the little nerves in your feet that tell your brain where your feet are in space), causing instability. WHAT ABOUT THOSE NIGHT SPLINTS I’VE SEEN? They’re rubbish. Don’t waste your money.

WHERE NEXT?

Well, you could make an appointment with a podiatrist and go from there.

Certainly, the information within this blog is for interest only and does not replace a professional diagnosis and management plan.

CONCLUSION

To conclude, Hallux Rigidus can be painful and debilitating, but the right footwear can make a huge difference in limiting pain and improving mobility. Shoes with cushioning and rocker soles can help redistribute pressure and allow for a more natural foot motion when walking. If you’d like more information about how Oxfordshire Chiropody & Podiatry can help – please get in touch!

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