Arthritis in the big toe can cause significant pain

Each day with every step that is taken, the big toe bears a tremendous amount of stress-a force equal to about twice one?s body weight. Most of us don?t realize how much we use our big toe. We tend to take it for granted, unless a problem develops.

One problem that afflicts the big toe is called hallux rigidus, a condition where movement of the toe is restricted to varying degrees. This disorder can be very troubling and even disabling, since we use the all-important big toe whenever we walk, stoop down, climb up, or even stand.

Hallux rigidus is an arthritic disorder of the joint located at the base of the big toe. It causes pain, stiffness in the big toe, and with time it gets increasingly harder to bend the toe. ?Hallux? refers to the big toe, while ?rigidus? indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of arthritis, or a loss of the cartilage within the joint that can occur in the foot or anywhere else in the body.

Because hallux rigidus is a progressive condition, the toe?s motion decreases as time progresses. In its earlier stage, motion of the big toe can be full and not limited, however, arthritis can be starting with pain present. As the problem advances, the toe?s range of motion gradually decreases until it potentially reaches the end stage of ?rigidus?- where the big toe becomes stiff, or what is sometimes called a ?frozen joint.?

Early signs and symptoms of great toe arthritis include pain, stiffness, pain aggravated by cold weather, and difficulty with running or squatting. There may also be inflammation or swelling present to the joint.

As the arthritis and the disorder progresses, symptoms can include pain when sitting, limping, or pain in the rest of the lower leg.

Shoes can also become uncomfortable for they can rub against the top of the great toe joint where bone spurs can develop from the arthritis. Also for women, high heeled shoes become very painful to wear as the hallux rigidus disorder progresses.

Common causes of hallux rigidus are faulty biomechanics and structural abnormalities of the foot. In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition.

In other cases, it is associated with overuse-especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury-even from stubbing ones toe.

The sooner this condition is diagnosed, the easier it is to treat. Therefore, if pain develops in the great toe joint it should be evaluated immediately by a podiatric physician. X-rays are usually required to determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.

Treatment for mild or moderate cases of hallux rigidus may include one or more of these strategies:

- Shoe modifications. Shoes that have a large toe box should be worn, because they put less pressure on the toe. Stiff or rocker-bottom soles will also feel more comfortable for there is less bending of the great toe when walking. Women most likely will have to stop wearing high heels.

- Orthotic devices. Orthotics will improve the function of the foot.

- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to help reduce pain and inflammation.

- Injection therapy. Injections of corticosteroids in small amounts are sometimes given in the affected toe to help reduce the inflammation and pain.

- Physical therapy. Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.

In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery that can be undertaken to treat hallux rigidus.

The procedure that is used to correct hallux rigidus depends on many factors, including the cause of the condition and the severity, as well as the patient?s age, occupation and activity level.