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Big Relief Is in Sight for a Painful Big Toe

While many people give little thought to their big toes, many others are plagued by a painful condition that limits or eventually totally restricts movement of that all-important toe (digit). Once the big toe starts to hurt, it is obvious just how much we use it get around, bend over or even stand. 

According to the American College of Foot and Ankle Surgeons, for those with this common degenerative disorder—known as hallux limitus in its earlier stages and hallux rigidus later on—everyday motion, such as walking, stooping and climbing stairs, can be a struggle. The good news is that proper treatment can bring tremendous relief.

"If you have this condition, your big toe hurts, but it doesn't have to," says Laurence Rubin, DPM, FACFAS, a foot and ankle surgeon in Richmond, VA. Rubin has seen numerous patients with pain in the big toe (called the hallux), and he notes that many of them have ignored the problem for years.  

"People with this disorder seem to suffer much longer than they need to," he says. "They're often pleasantly surprised when they find out their problem can be fixed."

This tendency to just bear the pain and do nothing should be avoided because early diagnosis and treatment can make a world of difference in alleviating the symptoms through simple, conservative treatment.

"The further the progression of the condition, the more difficult it is to treat conservatively," says Rubin.

Hallux limitus starts out as a painful big toe joint that has stiffness and usually a little loss of motion. As the disorder progresses, arthritis sets in and continually worsens. Bone spurs (overgrowths) can develop, and the toe increasingly loses its range of motion. At the end stage (hallux rigidus), all motion is lost and the toe is rigid.

When it gets to that point, walking is severely impaired and pain may be present even at rest. Shoes can be difficult to wear due to bone spurs, and gait changes that were made to compensate for the painful toe can lead to other problems such as pain in other areas.

Overuse of this digit is most often the culprit in painful big toes. "We frequently see this condition in people who are active and those who do a lot of bending or kneeling in their work," says Rubin. Hallux limitus/rigidus can also develop after an injury, such as badly stubbing your toe. In some people, it can run in the family and is a result of inheriting a foot type that is prone to developing the disorder.

Hallux limitus/rigidus can be easily diagnosed by your local foot and ankle surgeon. The best time to see this specialist is when you first notice symptoms. To reach a diagnosis, the surgeon will examine your foot, take x-rays and sometimes order other tests such as a CT scan or MRI to further evaluate your joint damage and rule out other conditions.

"If we catch the condition early, we can relieve the symptoms by conservative measures," says Rubin. "But if it has progressed to the point where the joint is destroyed, we have fewer conservative options." 

Conservative treatment options include wearing custom-made insoles (orthotics) to correct the structural foot abnormalities that are causing the problem, as well as perhaps changing footwear. Other strategies include oral anti-inflammatory medications, cortisone injections and physical therapy.

While these approaches can eliminate or adequately reduce the pain for many patients, some people may require further treatment. Says Rubin, "When there's been an attempt at conservative care and the patient has persistent symptoms, surgery is the next step."

Various types of surgery are available today to treat hallux rigidus. "Your foot and ankle surgeon will evaluate your foot and review these options with you," explains Rubin. "Once you and your surgeon have discussed the options, he or she can advise you on which procedure will best benefit you."

The time it takes to return to normal activity after surgery will depend on the procedure performed. Regardless of the recovery time, the end result is typically the same: a big toe that feels remarkably better.

For more information on foot and ankle injuries and conditions, schedule an appointment with a foot and ankle surgeon near you. You may find one by using our "Find an ACFAS Physician" search tool.