Non-surgical management is always the first line treatment for this condition. A physician may suggest pain relievers and anti-inflammatory medicines, ice or heat packs, or even injections into the joint to reduce pain and stiffness. Changes in footwear may also be suggested, including advice to avoid thin-soled shoes or high heels, wear wider shoes with a curved sole (rocker bottom), or even add shoe inserts that limit the motion at the MTP joint. Although these treatments may help decrease the symptoms, they do not stop the condition from progressing.
Surgical treatments for hallux rigidus are determined by the failure of non-surgical treatment and the extent of arthritis and deformity of the toe.
For the more minor type of hallux rigidus, when the damage is mild to moderate, shaving the bone spur on top of the metatarsal (cheilectomy) is sufficient. Removing the bone spur allows more room for the toe to bend and alleviates pain caused when pushing off the toe. The advantages of this procedure are that it is joint sparing, preserves joint motion and maintains joint stability.
Figure 3 Cheilectomy
Advanced stages of hallux rigidus, when the joint damage is severe, are often treated by fusing the big toe (arthrodesis). In this procedure, the damaged cartilage is removed and the two bones are fixed together with screws and/or plates to allow for them to grow together. The main advantage of this procedure is that it is a permanent correction with elimination of the arthritis and pain. The major disadvantage is the restriction of movement of the big toe.
For the patient with moderate to severe hallux rigidus who is unwilling to accept the loss of motion at the big toe, an interpositional arthroplasty may be an option. This procedure consists of taking away some of the damaged bone and placing a piece of soft tissue from the foot, such as tendon or capsule, between the joint to allow for some motion. The operation is effective but not as reliable or predictable as a fusion.
Figure 4 Interpositional arthroplasty
Figure 5 Interpositional arthroplasty