“After 20 years of happy running, my mid 40’s brought a pain in my left foot and big toe when walking which was subsequently diagnosed as Hallux rigidus. Unable to run I discovered cycling and am now loving that. I now want to take up Triathlon/Ironman but the question is, without surgery is there anything I can do, especially with regards to footwear?”
Running Fitness Magazine, December 2014
Hallux rigidus, literally translated as ‘stiff big toe’ is a condition that many runners are unaware of and sadly ignore until surgery has become one of the only viable treatments. As far as managing it goes and being able to run, it very much depends on the cause and extent of the restriction in the big toe joint. As I am not personally aware of your case history, I will give you a generic breakdown that I hope will be of use.
Hallux rigidus implies no movement at all in the big toe joint due to severe degenerative arthritis. If there is no movement at all, surgery is normally the only way to eliminate the pain. That said, hallux rigidus is normally preceded by a period of time in which there is limited movement as opposed to none at all, for which the term hallux limitus is used. Hallux limitus is graded according to how much movement is available (Grade 0 to IV) and whether the restriction is caused by the mechanics of the foot (functional hallux limitus) or by joint degeneration (structural hallux limitus). When caught early, there are more ways to manage hallux limitus without the need for surgery than there are for hallux rigidus.
A podiatrist may be able to fit you with custom foot orthoses that will restore normal motion to the joint when weight bearing. Sometimes a change of footwear to something with maximal stiffness can help, e.g. trying a lightweight hiking shoe instead of a running trainer. In the early stages, changing ground surface can also make a difference, i.e. swapping roads (asphalt) for grass or dirt trails.
Unfortunately, many runners turn too quickly to NSAIDS (Non-Steroidal Anti-Inflammatories) like Ibuprofen. Though these may prove helpful to reduce acute pain, they will not help sort the symptom. The same goes for corticosteroid injections. These can be great for reducing pain but again they do not provide a solution to the problem. Whilst you are masking pain, deterioration of the toe joint can still occur.
Manual therapy such as joint mobilization can help increase range of movement in the big toe, as can strengthening of the muscle that pulls down the big toe (flexor hallucis longus) and the plantar intrinsic muscles of the feet. The most important thing is to get assessed by a professional and check if the issue is structural, functional, and to what extent mobility has been compromised. Once this has been done, there may well be more options than you initially suspected.
Matt Phillips is the in-house Running Injury Specialist for UK magazine Running Fitness. Buy your copy today in all good magazine outlets, e.g. WHSmiths.