Big toe – Trouble

The big toe is a critical part of the forefoot that allows us to walk, run, climb and balance.  It bears more weight than any of the other toes and plays a very important role in propulsion.

The base of the big toe is made up of a joint between the metatarsal and phalanges (toe) bones.  One disorder affecting this joint is a condition called Hallux Rigidus.

Hallus Rigidus is a degenerative condition mostly seen in middle age.  As the name suggests stiffness and pain are the major signs of this condition.  Sufferers find that both the stiffness and pain restrict any activity involving movement at the big toe.  Walking, running, squatting and climbing may get progressively more difficult as the condition progresses.

The most common cause of Hallus Rigidus is osteoarthritic change in the joint.  Poor foot biomechanics, previous joint trauma and family history may be some of the factors involved in its development.

In normal walking the big toe must extend prior to push off to assist with propulsion of the foot.  In the presence of Hallux Rigidus this is not possible affecting the efficiency of foot function and a shortening of the stride length.  As the degeneration progresses the joint will stiffen further and bony thickening around the joint margins may develop.

Apart from Orthopaedic intervention there are a number of management tools available to your physiotherapist experienced in dealing with this area of the foot.

A thorough examination of the foot function will be undertaken and your physiotherapist will discuss these findings with you.

An X-Ray may be indicated to determine the extent of any bony and joint changes.

Early intervention using very specific joint mobilising techniques can help maintain joint motion by reducing ligament contracture.  This helps keep the joint mobile and should reduce the pain associated with joint stiffness.

Orthotics may be prescribed to help normalise foot function which may be a contributing factor to developing the condition.  Footwear advice may include the use of stiff soled or rocker shoes to reduce the load on this joint during push off.

It should be noted that this conservative management will not cure the condition but should help to prolong the useful life of the joint and make walking more comfortable.

Mike Stewart

Mike Stewart is a Physiotherapist at the Oamaru Physiotherapy Clinic.  He has post graduate qualifications in Manipulative Physiotherapy and Sports Medicine and is a Registered Physiotherapy Acupuncturist.

He toured as a Physiotherapist with the Maori All Blacks for 14 years up until 2008.

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk


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