Early signs and symptoms of hallux rigidus include the following [8]:

• Discomfort experienced while walking, bending or standing
• There is pain and stiffness which gets aggravated during cold weather conditions [9]
• Development of swelling along with inflammation in the affected joint

In addition to these, affected individuals would also experience certain additional symptoms as the condition progresses to more advance stages. These include:

• Pain in the affected joint even at rest
• Due to bone overgrowth there is significant amount of difficulty while wearing shoes
• In severe cases, the individual would have to limp while walking
• There is change in gait which causes development of pain in the back, knee and hip region

Early diagnosis is essential to arrest the progressive damage to the articular cartilage. A prior physical examination will be required, wherein the surgeon would move the foot in various directions to understand its range of motion and degree of damage to the area. Following this, radiographs would be indicated which show degenerative changes.

In the early stages, non-surgical treatment approach is adopted to effectively manage the condition by controlling the symptoms.

Non-surgical approach:

• Wearing comfortable footwear having ample room for the big toe
• Women are advised against wearing high heels
• Some individuals benefit with shoes having stiff soles
• Inserting pads in the shoes can also help in limiting the movement of the toe
• Heavy exercises and high impact activities like jogging should be avoided
• Medication such as non-steroidal anti inflammatory drugs (NSAIDs) are employed for relieving pain and inflammation 
• Ultrasound therapy or physical therapy helps in providing temporary relief

Surgery

Surgery is the last resort and employed in more advanced and severe cases when other treatment methods do not reduce pain and discomfort. Several types of surgical procedures are available to treat hallux rigidus. The type of method employed depends on the extent of damage and severity of symptoms experienced. In many cases, cheilectomy which employs shaving off the bone spur can help relieve pain and restore motility [10].

A procedure known as osteotomy may be required which involves cutting the bone in order to shorten the toe. Other surgical procedures include interpositional arthroplasty and arthrodesis which may be conducted depending on the condition [11]. Interpositional arthroplasty is helpful for younger patients. The procedure involves placing a spacer between the ends of joint; this helps in relieving pain and discomfort. Arthrodesis is employed in severe and more advanced stages.

Prognosis of the condition is quite favorable with patients responding well to the treatment regime used. Post treatment, patients can carry out daily activities with ease and can even exercise, run and wear all types of shoes comfortably. However, wearing shoes with high heels may be a cause of discomfort for individuals who have undergone fusion of toe [7].

The exact etiology of hallux rigidus is unknown. However, trauma, structural abnormalities in the big toe combined with faulty biomechanics, are some of the factors known to cause hallux rigidus. Wear and tear in the first MTP joint is understood to be the major cause behind hallux rigidus.

Some research scholars have postulated the fact that repeated athletic activities leads to chronic gradual attenuation of the joint in the big toe; which subsequently paves way for development of osteoarthritis [2].

It has been estimated that hallux rigidus is the second most common problem concerning the first MTP joint after hallux vagus. Majority of about 80% cases of hallux rigidus are bilateral in nature. More women are affected than men and the condition commonly strikes adults between the age group of 30 to 50 years [3] [4].

The development and onset of hallux rigidus follows the principle of degenerative arthritis. Factors that cause undue stress on the articular cartilage include overuse of the joint, injury or faulty joint mechanics. These events gradually cause degeneration of the articular cartilage [5].

This in turn makes the joint more susceptible to wear and tear, thus making it more prone to injury. Such sequence of events causes increase in the subchondral density of bone, development of periarticular osteophytes and cystic changes. The formation of osteophytes causes considerable decrease in the MTP joint mobility with further degradation of normal joint mechanics. In more advanced or severe cases, articular cartilage undergoes denudation [6].

Onset of hallux rigidus cannot be prevented. However, its progression can be arrested by doing simple exercises to improve joint mobility. Adequate rest and not overusing the joint also are some of the preventive measures that can be taken.

Hallux rigidus is a progressive disorder, and gradually causes the big toe to stiffen giving rise to condition known as frozen joint. It is a form of degenerative arthritis of the first metatarsophalangeal (MTP) joint of the foot, requiring prompt diagnosis and effective management. Females are more prone to suffer from the condition than males [1].

• Definition: Hallux rigidus is characterized by development of stiffness along with pain in the joint of the big toe. The condition is also termed as stiff big toe.
• Cause: Various factors give rise to the condition of hallux rigidus. Injury, repeated use of the joint which poses stress on the joint causes articular damage with subsequent degeneration. Faulty biomechanics of the joint can also increase the risk of hallux rigidus.
• Symptoms: Affected individuals suffer from joint stiffness along with pain in the affected area. Individuals also experience great deal of difficulty while walking. In extreme cases, the pain aggravates in cold weather and there is gradual change in the gait of the individuals which forces them to limp while walking.
• Diagnosis: A preliminary physical examination is carried out to determine the extent of motility of the joint of big toe. This is followed by an X-ray of the toe to identify degenerative changes in the joint.
• Treatment: In initial stages, the condition can be managed by adopting a non-surgical approach which includes modifications in foot wear, and avoidance of high heels. Individuals are also given ultrasound and physical therapy to provide temporary relief. Medications are given to relieve pain and inflammation in the affected joint. Surgery is done during advanced stages.

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