Pain on top of the first toe, often occurring in the elderly or athletes, leading to osteoarthritic changes or damage to the soft tissues around the joint. Caused by repeated strains of the joint, inflammatory arthritis or other systemic conditions.

Diagnosis

Diagnosis of Hallux Rigidus is derived from the patient’s history and physical exam with an unremarkable neurological exam and no indicators of potentially serious pathology.

Chiropractors perform a thorough history of complaint and examination (orthopaedic, neurological and chiropractic testing). Reduced movement of the toe with pain most aggravated by bending backwards. A bunion may also be present. Assessment may also include the use of diagnostic imaging.

Patients whose symptoms fail to resolve may benefit from surgery to reduce the osteoarthritic changes to the bone.

Evidence based summary for manual therapy [53]

There is favourable but inconclusive evidence of effectiveness of manipulative therapy combined with multimodal or exercise therapy for hallux rigidus [108].This is not strong enough evidence to warrant the inclusion of manual therapies with exercise as an effective treatment for hallux rigidicus.

However chiropractors may be able to help general aches and pains associated with tight joints and muscle spasms.

Other effective non-invasive physical treatments or patient education [53]

Back-in-Action clinical comment

Chiropractic treatment of Hallux Rigidus is aimed at mobilization and manipulation to attempt to increase the movement. Stiff soled shoes or foot orthotics may be beneficial. Manual therapies may be applied to improve the function of related joints, muscles and ligaments throughout the body.

Our approach may incorporate exercises (individually tailored self mobilisation, stretching and strengthening), referral for massage therapy, diet and nutritional advice, functional neurological exercises, acupuncture (dry needling), cryotherapy (heat and/or ice) and techniques to help improve posture.

Patients whose symptoms fail to resolve may benefit from surgical interventions to reduce the osteoarthritic changes around the toe.