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Treatment options for Hallux Rigidus

Discussion in 'General Issues and Discussion Forum' started by foot soldier, Jan 9, 2008.

  1. foot soldier

    foot soldier Member

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    Hi everyone, this is my first post. Im a second year pod student and I'm after some advice on Hallux Rigidus. Im conducting a case study on a patient and I'm getting conflicting information at uni! The subject of my case study has suffered pain at the 1st mpj for 18 months and there is very little ROM at the joint accompanied by dorsal exostosis. Having previously suggested options such as heat therapy and orthoses I was told these were not viable options as the condition had progressed too far for these measures to help, so I have stuck with using a 7mm SCF shaft pad. Although this initially helped with the pain the pt is beginning to experience pain again. Is it worth trying some other options?
  2. Craig Payne

    Craig Payne Moderator


    1. Surgery
    2. Imobilisation strapping
    3. Manipulation/manual therapy
    4. Injection therapy
    5. Rigid sole shoe or plate
    6. Rocker sole on shoe (or maybe orthotic, of can fit in shoe)

    Check the hallux rigidus tag for more.
  3. bkelly11

    bkelly11 Active Member

  4. foot soldier

    foot soldier Member

    Thanks both, you have been very helpful. Much appreciated!
  5. Ella Hurrell

    Ella Hurrell Active Member

    I agree with all the options Craig has suggested. It's probably returning as the felt is compressing and no longer achieving immobilisation. You could try using a small EVA shaft pad instead to test whether prolonged immobilisation is comfortable?
  6. Hey footsoldier. Welcome to the forum.

    First off, to be pedantic, i'm not sure you are talking about Hallux rigidus. Hallux rigidus is... well its rigid. And you said
    implying that there is in fact SOME ROM. Meaning what you have there is a hallux limitus. And a painful one by the sound of it.

    So far as the case progressing beyond orthotics i don't really see where they are driving at. If it can be helped by a pad on the foot, it can be helped by the same pad on the shoe!

    I'm inclined to think that if you are being conservative craigs suggestion of a plate in the shoe / rigid sole / rigid mortons extention / rocker would be the way forward. I have also seen excellant results with patients using MBTs. I'm not convinced that if they have had pain for 18 months that strapping is a long term option. If its as bad as all that it sounds to me like a referral to the chop shop might be in order... your friendly local pod surgery team might be required.

    An X ray will tell you if you are dealing with a primarily bony problem or a soft tissue one and i would suggest this as your next step.

  7. 7. Pharmacy/ drugs?
  8. Craig Payne

    Craig Payne Moderator

    To be even more pedantic, that would be a structural hallux limitus.
  9. Craig Payne

    Craig Payne Moderator

    There is always botox.
  10. foot soldier

    foot soldier Member

    Thanks Craig, that's an interesting option. I will look further into the possibilities of botox, should be enlightening! Cheers!
  11. kerstin

    kerstin Active Member

    BOTOX?? that's for wrinkles?
    I can see that it could do something but effective??? long term ?? Do you use this??

    best regards,
  12. Craig Payne

    Craig Payne Moderator

  13. :D:rolleyes:

    You win.

  14. Peter

    Peter Well-Known Member

    My Two-penneth.

    Short-term pain relief; periosteal acupuncture
    Long term; Rocker sole modification.

    If no success; surgical opinion.
  15. markleigh

    markleigh Active Member

    I know this is an old thread but just reading about certain conditions & this thread on hallux limitus/rigidus & the benefits of strapping the joint. What is the best way to strap the 1st MP joint? Thanks
  16. Intraarticular repository steroid injections to buy some time. Best options are cheilectomy (dorsal spur resections) to buy more time. Ultimately, arthrodesis.
  17. srd

    srd Active Member

    So having said it's structural hallux limitus, how rigid does it have to be to be treated as hallux rigidus and not hallux limitus?? So when do you start jamming up the joint as apposed to trying to get some more movement available?? Is this symptomatic??

    I still like the chop it off option.
  18. pgcarter

    pgcarter Well-Known Member

    These things are best driven by the patients pain level. Low pain low level response unless early surgery is indicated by good cartilage in the joint still, so that a reconstructive op would give a functional joint again. High pain is worth more hassle and money thrown at it so, so don't leave out any options from what you consider and discuss with the patient. One use of botox will at least cure the frown on their face caused by the pain.
    regards Phill
  19. Valerie

    Valerie Member

    What about sodium hyaluronate injections? I have Hallux Rigiditus and alhough only a recent graduate would hope that my Podiatrist will consider referring me to a Podiatric Surgeon. It's a mighty painful condition and although I deep massage the Ist MTPJ and wear orthotics, there are some occasions when I would love to be foot loose and fancy free and dance the light fantastic! I am hoping that if I get the referral that SR will help.
  20. Nope. :bang:

    If you've got hallux rigidus, your joint is fused and rigid. If there is no articulation then there will me no articular pain. If the joint is fixed rigid you can inject sodium hyaluronate till you're black in the face, it ain't gonna help.

    Of course if you have Hallux LIMITUS then thats different. And to treat effectively you must discover to what extent the HL is functional and to what extent structural.


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