What is Hallux Rigidus & What Can I Do?

X-ray of my right foot, top view

• What is hallux rigidus? 

• What can I do about it? 

• How will it impact my life? 

• Let me tell you everything I've learned so far...

What is Hallux Rigidus

What is hallux rigidus? Quite literally, it means, stiff big toe. When cartilage wears away from the joint (due to injury or wear-and-tear), bones rub together. This can cause a bone spur to develop which prevents the toe from bending completely.

In my x-ray (above), normal cartilage is shown in my other toes as black spaces. In my big toe, that black space is mostly gone, showing that my cartilage is disappearing. And I am developing a bone spur bump (like a bunion) on top of my toe. I can bend my toe up comfortably, but it hurts to try to bend it down. This is likely due to degenerative arthritis and it's not reversible (gulp).

The American Academy of Orthopaedic Surgeons describes the symptoms this way:

• Pain in the joint when you are active, especially as you push-off on the toes when you walk

• Swelling around the joint

• A bump, like a bunion or callus, that develops on the top of the foot

• Stiffness in the great toe and an inability to bend it up or down

That perfectly describes what I've got going on right now. Running has gotten increasingly uncomfortable and my toe is now making its presence known even when I'm just sitting at my desk. Hence, my search for more accommodating dress shoes (read more here), and finally going to see a podiatrist.

If you think you might have hallux rigidus, go to a doctor now! 
The sooner the condition is diagnosed, the easier it is to treat. 
In advanced stages, this disorder can be disabling.

What Can I Do About It?

Short-Term

There were a couple of things we did today to reduce the pain and hopefully restore greater mobility to my toe.

Cortisone Injection

Dr. Gordon recommended a cortisone injection right in the middle of my toe bump. I've heard cautionary tales from my runner friends of the pain of the cortisone injection. My stomach knotted up in dread. But my toe's pain level was high enough that I was willing to endure the discomfort. 

Dr. Gordon applied a liberal amount of "freezing spray" to my toe to help numb the skin. Overall the injection takes about 20 seconds, and he let me know when we were halfway done. I reminded myself that I've given birth to a child, certainly I can do this! And although it was a little uncomfortable, it was nowhere near as bad as I expected it to be.

The pain could get worse over the next two days as a side effect of the injection, but after that it should improve overall as the inflammation calms down. 

Dancer's Pads

Dancer's pads go under the ball of the feet and reduce the pressure on the big toe joint. They are similar in concept to the metatarsal pads I tried before for my neuromas (read more here). Dr. Gordon put a pad on my foot and taped it in place. I am supposed to keep it dry and wear it for 3-5 days.

Limit Activity

We knew this was coming, right? Hopefully it won't be for very long. No running until the weekend (about five days), and then just a bit to see how it goes.

Paper from the exam room chair - thanks Jen for pointing it out!
It has nothing to do with the rest of this post but it made me laugh.

Longer-Term

In two weeks I will go back to Dr. Gordon and we will check on my progress. A lot of the long-term recommendations are similar to those I am already implementing for my neuromas (read more here). 

Shoe modifications

Shoes with a larger toe box are a must. High heels and flip flops should be avoided.

Orthotics

Custom orthotics are recommended. I explored them previously when I was diagnosed with neuromas, and they are several hundred dollars/not covered by my insurance. So I've opted to use Green Superfeet inserts in my athletic shoes. Dr. Gordon said he would be able to work with the Superfeet, likely modifying them with the addition of dancer's pads.

Medical & Physical Therapy

Medical interventions range from cortisone injections, use of non-steroidal anti-inflammatory drugs (e.g., ibuprofen), and supplements such as glucosamine-chondroitin sulfate. Physical therapy such as ultrasound or other modalities may be recommended. 

Surgery

There are some surgical options for severe cases. I'm not researching these because I am determined to stay off that path!

How Will It Impact My Life?

This last question remains to be determined. Clearly I need to redouble my efforts to find accommodating shoes for work. And in the weeks ahead we will see what this means for my running journey. I hope that it is just a small speedbump in the road...slow down, get over it, drive on!

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Questions:

• Have you had a cortisone injection? Where, why and did it help?

• Have you used support pads like the metatarsal and dancer's pads?

• Do you use shoe inserts? Over-the-counter ones or custom orthotics?

• Do you have any advice for me?