Hallus Rigidus

With normal gait (the movements involved in walking), there are three phases:

Heel strike, when your heel contacts the ground,

Mid-stance, when you weight is centered over the foot,

Toe off, when you’re coming up on the ball of your foot ready to push off with your toes before taking the next step, and

Swing through, which is just like it sounds, when your weight is on the other foot, and the foot that just pushed off with the toe as the foot is swinging through to start again with heel strike.

In the toe off phase, the motion at the joints between the metatarsals and the phalanges (toes) involves the toes moving upward (toward your shin bone).

As the patient tries to come up on the ball of the foot before taking the next step, the bone spur causes pain and often as a result, patients find they are walking on the outside of their foot to avoid this motion at the joint at the base of the toe.

Non-operative: anti-inflammatory medicines, shoe supports preventing the bending motion of the forefoot like a post op shoe which doesn't bend at the ball of the foot as pictured here to the left, or an insert with a Morton's extension to the right, which doesn’t allow the great toe to bend upwards.

Operative:   Surgical options are shown here.  To the right, resection of the bone spur to allow the great toe to move upward, is called cheilectomy.

Interposition arthroplasty:  Like cheilectomy, but also some bone is removed from base of great toe, and soft tissue is put in the joint space to create a fake joint.  Motion is spared.

With a fusion (also called an arthrodesis), there is a trade off whereby the patient gives up the little bit of residual and painful motion in return for a fused (like glued together with bone) joint that will never move again.

Another options is to put an implant in the joint space, but these implants are subjected to a lot of force with walking on a small area of bone, and sometimes will get loose.