Hallux Rigidus – A Comprehensive Guide
Besides looking cute in sandals and peep toe shoes, did you know your toes play a pretty important role for your body? According to experts “Of all your toes, your big toes are the most important. They play the most critical role in maintaining your balance. They also bear the most weight…Your big toes can bear almost twice as much weight as the other toes combined.” Our big toe also helps our body propel forward while we step, in a feet of engineering known as the windlass mechanism. Here’s how that works: A thick rubber band-like tissue (plantar fascia) runs along the bottom of our foot from heel bone to our toes bones. Each time you step your big toes flex. This makes the rubber band wind tighter around the toe bones and lifts your arch. I found more about this online “As the foot comes down for landing, the toes are flexed up so that the foot lands with the arch high like a shock absorber at full extension. Then as the body bears weight on the foot, the toes lower and the arch flattens, dissipating shock in a controlled manner.”
Unfortunately for some women, this fancy toe maneuver gets in trouble because they have stiff sore big toes from a foot condition known as Hallux Limitus, or the more serious Hallux Rigidus. In fact one way to know you have Hallux Rigidus is that you can’t lift your big toe off the ground while weightbearing. Besides putting a pain in your step, Hallux Limitus and Hallux Rigidus can make shoe shopping impossible as you try to protect the toe joints and avoid pressure on bone spurs, while still maintaining a sense of style (orthopedic shoes anyone?). We’re happy to tell you a bit more about this condition and show you comfortable, stylish shoes for Hallux Limitus/Rigidus.
What is Hallux Limitus and Hallux Rigidus
The big toe is known in medical language as the hallux. Hallux Limitus means a stiff toe right at the metatarsophalangeal, or MTP joint where your toes typically bend. In big words it’s the meeting place of the proximal phalanges (toe bones) and the metatarsal bones. Hallux Rigidus is a rigid toe joint that you can’t bend or can’t move without a lot of pain.
Causes of Hallux Limitus/Rigidus
For a variety of reason as a result of injury or the way your foot is shaped, the big toe can become sore or too stiff to move. It may surprise you to learn this condition is actually considered arthritis in your big toe joint. The American Academy of Orthopedic Surgeons (AAOS) website says the most common site of arthritis in your foot is at the base of your big toe. This joint has to bend every time you step. Normally a layer of cartilage protects the two bones from rubbing together in the spot where they meet. If the cartilage on the ends of the bones wears out or goes away following injury, this can lead the bones to move closer together, making the joint smaller. Sometimes the bones rub together and cause bone spurs, preventing the toe from moving or making it painful when shoes press on the bone spur.
Typically the condition shows up in teenagers or in middle aged active adults. A traumatic injury or repeatedly stubbing your toe can lay the groundwork for this condition to develop later on. It can also develop from overuse injuries on the job. Your genes make a difference too in how your toe joints are shaped and move. Those with flat feet (fallen arches) often have an elevated big toe bone which affects your ability to properly move your big toe. If your first or second toe bones are longer than normal, this can also cause Hallux Limitus. ( If you have long toes or hammertoes, you may want to stick with the higher toe box provided by Alegria, Dansko and Sanita–three great brands with rocker/rigid soles.) A few more potential causes are excessive pronation (puts pressure on the side of your big toe joint) and rheumatoid arthritis – which causes inflammation in the joints. My RA earned me a diagnosis of Hallux Limitus a few years back.
Symptoms of Hallux Limitus/Rigidus
Besides feeling the pain and stiffness, women may see a bump on the top of their big toe. It looks like a bunion or callus, but it is on the top of the toe. Other symptoms may include:
- Pain stiff in cold damp weather (like typical arthritis)
- Pain when doing sports (Running or impact sports)
- Pain all the time in the toe joint
- Sore in other spots such as hip, knees or lower back because you are walking differently to avoid the toe pain
- Can’t bend your toe up or down
- Sometimes people develop tingling in the toe joint
- Gets worse over time- first hallux limitus, then rigidus may develop
Treatment of Hallux Limitus/Rigidus
Experts say it is better to see a doctor for painful stiff big toe before bone spurs develop. Treatment options may include:
Rest and ice
Taping the toe
Non-steroidal anti inflammatories to help reduce the inflammation
Orthotics Your doctor may prescribe orthotics, custom or over the counter, to put less pressure on the big toe joint. If you find a shoe you like with a removable insole, you might want to try a pair of Hallux Rigidus full length inserts to further reduce the movement of the big toe joint.
Changing your shoes (we can help!) Your doctor may suggest toes with a wider toe box to remove pressure on the bone spurs. And they will likely suggest a rocker sole to reduce pressure and bend in the toe joint. Depending on your condition they may recommend shoes with a steel shank in the sole.
Steroid injections in the toe joint
X Ray – your doctor may take an x ray to check for bone spurs and look at the cartilage in your joint
Physical therapy – your doctor may recommend physical therapy for limitus but not rigidus
Surgery – If less invasive treatments aren’t helping, your doctor may recommend surgery. Surgeries for hallux limitus/rigidus are intended to either help you keep your toe moving or to reduce your pain by stopping the motion in your toe joint. The AAOS website explains a few of the surgical options:
- Cheilectomy – A surgeon removes your bone spur and a portion of the foot bone, making room in the joint for your toe to bend.
- Arthrodesis – Doctors fuse the bones together when your cartilage is very damaged. This procedure uses pins, screws or a plate to set your big toe joint in a permanent position. Eventually leading the bones to fuse together. It takes away motion but experts say it can help with the pain.
- Arthroplasty – This is actually joint replacement surgery for your toe joint
Artificial cartilage? New – a synthetic cartilage implant is in development which is intended to avoid joint replacement. The Cartiva SCI just received preliminary FDA approval. More to learn here we’re sure, but here’s an article about the development of the product if you’re interested in learning more.
How to find comfortable stylish shoes for hallux limitus and hallux rigidus
As I’ve said on my reviews over the years, Friends, I hate to say it, but hallux limitus will in fact limit us, as far as stylish shoes are concerned. We may have to redefine what we consider “stylish.”
The best footwear for this condition will have a roomy and higher toe box to keep pressure off the big toe joint. You’ll also need shoes with a rigid sole to keep the big toe from bending past its limited range of motion. And you’ve probably figured out that most heels are only a huge pain in the big toe. At barkingdogshoes.com we’ve reviewed dozens of shoes for hallux limitus and rigidus.
You’ll want to visit our reviews of 6 Shoes for Hallux Limitus without the Orthopedic Look. We try out shoes and also collect feedback from real readers. Check out our review of stylish footwear for hallux limitus where you’ll find clogs from Keen, including the Mora Button, options from Dansko, and even closed toe sandals. You may also like a slip on shoe with metal detail with a comfy polyurethane platform sole to propel the foot without making your big toe do as much work. Dromedaris makes a cute oxford, the Merlin, which comes in pattered leather with laces.
Based on reader request for help finding something other than clogs for special occasions, we’ve done the work of finding Dress Shoes for Hallux Rigidus, including the Taryn Rose pump with a low heel.
If you’re interested in a cute mary jane-style clog, check out the Sanita Amorai. The rocker sole helps reduce forefoot pressure and the roomy toe box should allow you to wear shoes that don’t make your bone spurs hurt.
Why all the talk about rocker sole clogs for hallux limitus?
Wearing shoes that reduce movement in your foot can help relieve the pain of hallux limitus and hallux rigidus. Rocker sole clogs, like the warm wool-wrapped Merrell Ice typically have a stiff, curved bottom that allows your foot to make a rocking movement instead of flexing and extending the toes. Some just have a rounded sole up front by the toes which helps you roll into the step instead of flexing your toes as much. These can be great choices for some women but we know that we girls love our shoes and we want a life beyond rocker clogs!
If you must wear a heel or hate the look of clogs, try the Dansko Tamara from their new Ventura line. It features a 2 inch lightweight heal with ¾ inch platform and a buckle detail.
Dromedaris has rocker sole loafers, if that’s your style. I’ve also reviewed a rocker sole sandal, the Dromedaris golden eagle is a favorite of some. If sandals are what you’re shopping for , check out my reviews of sandals and platforms in my review of the best shoes for hallux limitus/rigidus, and you may have success with the recent sandal line from Born. We’ve also found closed toe sandals for work and comfortable sandals with adjustable front straps that may work for bone spurs. And be sure to visit my reviews of 6 sandals for hallux rigidus.
If you need more casual shoes that won’t be a pain in your toe, consider the Drew Blast slip on sneaker which comes with a rocker sole. The mesh upper should work for bone spurs and it works with orthotics too thanks to a removable footbed. Another choice that may help with Hallux Limitus are the fitness shoes from Altria footwear. Their ‘footshape toe box’ – allows the foot to splay naturally and they come with a zero drop, which means the heel is not higher than the toe. For some people this is a big help for pain.
Ankle boots for hallux limitus/rigidus
We’ve even found cute ankle boots that can work with your stiff toes, including several from Sanita with removable insoles and comfy polyurethane rocker soles. And speaking of style, you may like the stylish back detail on the Sanita Dakota, an ankle boot for gals with hallux limitus. We’ll also mention Dromedaris again for comfortable stylish ankle boots.
Tip: If your boot has a removable insole, try replacing it with Superfeet insoles. Superfeet berry
for medium arch support and Superfeet green for high arch support. The insoles should help relieve pressure on your toes. If your toe is very stiff and painful, you might consider Turf Toe full steel insoles.
We want to hear from you
We hope you’ve learned more about the stiffness in your big toes. We hope this page also gives you hope that by spending a few minutes on our blog you may uncover shoes that you not only love wearing but also make it less painful to deal with hallux limitus and rigidus. If you have shoes or boots that you’ve found help with your hallux pains, please share! We also have an active community of readers and tips on our Barking Dog Shoes Facebook page.
American Academy of Orthopedic Surgeons Hallux Limitus page
Lemsshoes.com Windlass mechanism explanation
OurHealthNetwork.com Hallux rigidus and hallux limitus information page
Wonderopolis Why Do You Need Your Toes
Note: the above content is not intended to be medical advice or substitute for seeking the advice of a qualified medical professional. We’re talking shoes here.