In this article, we will discuss in detail:
- What is a stiff toe?
- Symptoms of a stiff toe
- The importance of diagnosis: related pathologies
- Why do I have pain in the sole and the surgeon diagnoses a toe problem?
- Surgical intervention
Feet are certainly very important from an aesthetic point of view, particularly for women.
However, foot health is a problem that goes far beyond small calluses and blemishes. If neglected, it can lead to painful consequences and, not infrequently, have an impact on the patient's quality of life.
For this reason, it is crucial to consult competent specialists: to avoid simple conditions from turning into significant problems that could influence choices (not just on an aesthetic level).
What is Stiff Toe?
Stiff toe is a deformity that affects the big toe, causing stiffness, functional limitation, and, over time, degenerative arthritis of the joint.
However, this condition does not always present itself as a pathology: some people tolerate this rigid foot condition very well throughout their lives, without it causing them pain or difficulties.
In these cases, in the absence of specific symptoms, it is usually not advisable to treat this problem as a disease.
Symptoms of Stiff Toe
Stiff toe is often diagnosed through a noticeable sign: dorsal exostosis, which is often confused with the bunion (hallux valgus) but appears dorsally, right where the phalanx articulates with the metatarsal, rather than laterally.
Dorsal exostosis tends to become reddened due to friction with socks and shoes, which can lead to significant symptoms, to the point where the patient can no longer walk in normal footwear.
Stiff toe can be associated with other deformities and problems, such as:
- Toe deformities (especially the second and third toes) in various forms, like hammer toes, claw toes, or mallet toes. These are almost always caused by altered overload, due to malfunctioning of the big toe and the different tendon tensions that develop in each individual.
- Metatarsalgia, another consequence of metatarsal overload, which correlates with both big toe deformities (hallux valgus or stiff toe) and claw toes, and manifests through the tendency to form painful calluses on the bottom of the foot.
- Tendinitis of the big toe, which is inflammation of the tendons that can worsen the symptoms of the rigid foot.
From the onset, stiff toe causes a limitation in movement at the joint.
When the range of motion of the big toe reduces below 70 degrees, during the push-off phase of walking, the other toes are forced to compensate for the big toe’s deficiencies.
In the long term, this causes deformities and pain in the bottom of the foot and the toes.
The Importance of Diagnosis: Related Pathologies
The foot and the joints that support it must be considered as an interdependent system: a defect or deformity in one part is a signal of an imbalance that influences the entire anatomy of the area.
Stiff toe might therefore be merely the most obvious manifestation of a broader issue that should be treated as a whole.
One of the reasons why treatment for stiff toe should be entrusted to a specialist is because this condition can sometimes be associated with other foot pathologies, such as flat feet.
In these cases, a comprehensive analysis of the biomechanics of the entire foot, including the forefoot and hindfoot, is essential. This broader understanding can help us intervene correctly, avoiding annoying and harmful recurrences.
This is why it is crucial to consider the potential pronation of the hindfoot, observe the patient while walking barefoot, ask them to rise onto the balls of their feet, or have them maintain balance by lifting one foot at a time. These are all fundamental gestures that an orthopedic surgeon specializing in foot and ankle pathologies must not overlook.
Why Do I Have Pain in the Sole and the Surgeon Diagnoses a Problem with the Big Toe?
As mentioned earlier, the symptoms of stiff toe, especially in the initial stages of the condition, can be diverse and may not affect the toe itself.
Pain in the sole of the foot, for example, known as metatarsalgia, occurs due to an overload in the smaller rays of the toes, which may lead the patient to seek medical attention for that type of pain, only to later discover that the problem stems from the big toe.
At other times, poor posture and gait can lead to imbalances that affect the plantar fascia and the tendon of the big toe. In these cases, the condition may be referred to as plantar fasciitis or hallux tendonitis.
The first thing the specialist should do if a diagnosis of stiff toe is suspected is to examine the patient clinically and also take an X-ray, which should be performed with the foot bearing weight (i.e., while the body's weight is naturally supported by the foot). This will allow for an undeniable confirmation of the diagnosis and help determine the most appropriate treatment.
Surgical Intervention
Rarely, the treatment for stiff toe (hallux rigidus) can be conservative. This does not depend on how much the condition worsens over time, but rather on the patient's specific symptoms.
If the pain is located in the sole of the foot, at the metatarsals, a specific insole for hallux rigidus may help reduce the overload on the foot, control the pain, and improve the quality of walking.
In some cases, hallux rigidus is associated with a change in the posture of the toe, which tends to bend upwards. For upward-pointing hallux, one of the most effective remedies is the use of custom insoles, which help improve alignment and reduce overload. In more severe cases, surgical interventions may be necessary to correct the deformity and restore foot function.
If we are dealing with plantar fasciitis related to a contraction of the calf muscle (gastrocnemius) and poor, compromised gait, stretching the posterior leg muscles can be very useful.
However, if the pain is at the level of the big toe, typically on the dorsum corresponding to the exostosis or increased during attempts at mobilization, then the solution is surgical.
The type of surgery we perform is called an oblique osteotomy, which allows the metatarsal to "slide" into the correct position, no longer preventing the proper movement of the big toe, which is directly tested in the operating room. If present, the dorsal exostosis is removed through an additional procedure called cheilectomy, which improves both function and aesthetics.
This procedure is typically performed using a mini-invasive approach, under regional anesthesia, with a small incision of a few centimeters. This approach allows for a quick recovery.
The patient will immediately be able to bear weight on the operated foot using an orthopedic shoe (flat shoe), which should be worn for four weeks to allow for proper tissue healing.
One month after the surgery, the patient will be able to wear comfortable shoes, while the much-anticipated return to high heels can take place about 90 days post-surgery.