Hallux Rigidus

August 27, 2012

More than twelve years ago I started having pain in my left heel. Turns out it was a heel spur. The spur was reduced through a series of ultrasound treatments at my chiropractor's office. Several months after my left heel was treated I developed the same pain in my right foot. Another round of ultrasound reduced that spur too.

My Left foot

In 2004 I started having constant pain in my right big toe. Massaging the toe at the end of the day helped some, but over time the pain grew worse and worse. I tried different shoes, icing, and over-the-counter pain medicines but got no long lasting relief.

In 2006 I went to see a chiropractor in Overland Park where I was living at the time to see what could be done. As soon as I explained my history of heel spurs and the pain in my toe she told my I had fallen arches. Sure enough, when I stand bare foot my arches are flat.

Since that day I have religiously worn arch supports in all my shoes. I never go bare foot. The arch supports helped but didn't eliminate the pain. My toe often appears to be swollen and the base knuckle (metatarsophalangeal joint or MPT joint) is enlarged. When I use my fingers to explore the MTP on both my feet I can tell there is a large lump of something in my right foot.

This morning I met with an orthopedic surgeon to confirm that this was in fact arthritis, and to discuss treatment options.

It is arthritis and the specific condition is called hallus rigidus or stiff big toe. X-rays taken today confirm that there are a couple of bone spurs in that joint and one rather large "loose" piece of calcification. Loose in the sense that it isn't attached to any bone in my foot. It's held in place by the tissues in my foot so it isn't moving around. Much.

Note the enlarged knuckle on the right big toe

There are several options for treatment. I can continue to live with it, using over-the-counter pain and anti-inflammatory medicines as needed to manage the pain. Or, I can have a Cheilectomy (kI-lek'-toe-me) to remove the bone spurs, the lose bit of calcification, and enough surrounding bone to return my toe to a "normal" range of motion. Or, I can have a Arthrodesis (are-throw-dee'-sis) to fuse the joint together permanently.

Oblique view of right foot

The surgeon said that my case didn't scream out a need for the fusion. In the fusion all the cartilage in the effected joint is removed and a metal plate and screws are used to fuse the bones together. That joint is given a slight (30º) upward angle to facilitate walking without a limp. This surgery is done once and the hope is that it eliminates the source of the pain (an arthritic joint with bone spurs) forever.

The cheilectomy removes the osteophytes (bone spurs) that have formed allowing the toe to return to normal range of motion. In my case there is still some cartilage in the joint so it function properly. There is no guarantee that arthritis won't return to the joint, therefore the surgery may need to be repeated in 5 or 10 years.

Side view showing bone spur and loose calcification

The recovery time varies from patient to patient, but is a minimum of 2-weeks in a wooden sandal to support the toe, followed by a gradual return to normal footgear. Swelling is the major side effect of the surgery, and can persist for several months after the procedure.

Since I'm committed to orchestra this fall, with rehearsals every Saturday and a concert in November, I am planning on having the cheilectomy performed the week after Thanksgiving. Once the pain from the procedure abates I am looking forward to vastly reduced soreness and pain in my toe for the next decade.

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Mark H. Nichols

I am a husband, cellist, code prole, nerd, technologist, and all around good guy living and working in fly-over country. You should follow me on Twitter.