Hallux Rigidus vs Bunions: When Do I Need Foot Surgery?

Beware These Big Toe Conditions

Toes play a critical role in walking, running, standing, and even balancing. The big toe, in particular, helps with shock absorption and supporting the foot to push off the ground. Big toes also bear up to 40% of the body’s forces. Unfortunately, with constant use, injuries and ailments are sure to happen. Hallux rigidus and bunions are two such conditions that can be painful and may even require surgery.

A stiff big toe

Hallux rigidus is the scientific term for chronic pain of the metatarsophalangeal joint, or MTP joint in the big toe. The condition is often called turf toe or stiff big toe. Most hallux rigidus cases are a result of osteoarthritis. Years of walking, movement, and overuse can create bone spurs or damage the joint. Some doctors believe that the issue is hereditary and connected to other conditions like rheumatoid arthritis or gout. With hallux rigidus, flexing or moving the toe becomes painful. Eventually, the joint becomes stiff and inflamed, making walking difficult.

Do you have a bunion?

Bunions affect the same MTP joint as hallux rigidus. A bunion or hallux valgus is the most common of all toe injuries or conditions. With bunions, a large bump forms on the outside of the base of the big toe. The bump is usually a combination of bone spurs and swollen bursa. Bunions can be painful and eventually affect the big toe’s alignment. The big toe bends inward, increasing pain and discomfort. Bunions also damage surrounding tendons, causing further numbness and conditions like hammertoes.

The many causes of bunions

About 1 in 4 Americans have bunions due to several factors. Many cases are hereditary, with some people born with bunions. Other reasons for bunions include wearing ill-fitting shoes and poor walking habits. Spending long hours standing and walking can lead to bunions over time. Persons with a history of osteoarthritis or rheumatoid arthritis are also at risk.

Is surgery unavoidable?

Unfortunately, many people ignore the pain and discomfort of hallux rigidus or bunions. Yet, there are many effective ways to treat these conditions. Both can benefit from orthopedic shoes, painkillers, rest, and medication. For a long-term, non-surgical approach, corticosteroid injections can help. Surgery is necessary with increased pain or failed non-surgical treatments.

Stopping that stiff big toe

Based on the extent of pain or damage, the surgeon may combine different procedures for the best result. Some patients will benefit from just a cheilectomy. Using minimally invasive means, a surgeon shaves off the bone spurs on the MTP joint. Sometimes, cheilectomy is not enough. The surgeon may also cut out part of the bone to shorten the big toe. And for severe cases, the surgeon may opt to perform a joint fusion to stabilize the toe.

Straighten things out with bunion surgery

Bunion surgery requires both bunion removal and toe realignment. The podiatrist or orthopedic surgeon will make an incision at the top of the big toe. The surgeon then removes any bone spurs or bursa causing the deformity. In more severe cases, part of the bone is removed to realign the big toe. Overstretched or damaged tendons are cleaned up to allow flexibility. Both surgical procedures have high success rates.

Foot surgery may be the solution

Both hallux rigidus and bunions are painful, chronic conditions. Both affect the same joint, with bunions affecting the toe’s positioning. Left untreated, walking and even standing become painful. Consistent non-surgical treatment can help, but for some, surgery is the only option. Speak with a podiatrist or orthopedic surgeon for a detailed assessment and help.