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Many people who endure the pain of an arthritic joint are often not fully aware of the treatment options available and often end up suffering with the issue for longer than necessary.  As our world continues to get smaller through the use of technology patients are able to research their condition and treatment options themselves. Therefore, giving us the power of knowledge. However; this is not always the case.  Occasionally patients aren’t aware of all the treatment options available for their particular ailment.

This maybe true for Hallux Rigidus AKA: “Stiff big toe”. The condition on Hallux Rigidus is noted by pain in the joint connecting the 1st metatarsal and phalanges (MPJ). Stiffness of this joint can be caused by a number of things but most commonly arthritis.

The Anatomy of the Foot

The big toe joint connects the head of the first foot bone (metatarsal) with the base of the first toe bone (proximal phalanx) and the two tiny cones (sesamoids) underneath the head of the first foot bone (metatarsal).  This big toe joint is called the hallux metatarsal phalangeal or MTP joint (MTPJ).

Metatarsal: The metatarsal bones are a group of five long bones in the foot, located between the tarsal bones of the hind- and mid-foot and the phalanges of the toes.

Phalanges: The phalanges are long bones in the foot located distal to the metatarsals.  Each toe consists of three phalanges, what are names proximal, middle, and distal phalanges.  However, the hallux (great/big toe) only has two phalanges, a proximal and a distal one.

Tarsal:  The proximal tarsal bones are the talus and the calcaneus.  They form the bony framework around the proximal ankle and the heel area.

To see where the MTP joint is check out this Google image by clicking here.

What Is Hallux Rigidus?

Hallux rigidus is arthritis in the big toe joint.  It is the most common arthritic condition of the foot and second only to the hallux valgus (bunion) as a condition associated with the big toe.  According to the American Orthopedic Foot & Ankle Society, females are more commonly affected than males in all age groups, and the condition typically develops in adults between the ages of 30 and 60 years.

Symptoms of Hallux Rigidus

Symptoms of Hallux Rigidus can include:

  • Pain in the big toe while active, especially while pushing off to walk
  • Swelling and stiffness around the big toe joint
  • Inability to bend the toe, either up or down
  • A bump, like a bunion or a bone spur, can develop on top of the big toe
  • joint and be aggravated by rubbing against the inside of a shoe

What Causes Hallux Rigidus?

The cause of Hallux Rigidus is unknown although there have been a few risk factors indicated:

  • An abnormally long or elevated first foot bone (metatarsal)
  • Prior traumatic injury to the big toe
  • Family history
  • Differences in foot anatomy


Most of these risk factors can cause damage to the surface of the bone, which leads to wear and tear of the joint and eventually leads to arthritis.


In the past, surgical procedures to eliminate patient pain was limited to a Fusion. Fusion is defined as two bones becoming one. The MPJ was fused using a plate and screws (or just screws). This is problematic for the patient for obvious reasons:

  • The joint no longer has mobility
  • The recovery process is lengthy
  • When joint mobility is removed a host of other issues can arise with regards to gait and overcompensation on other joints


Cartiva Synthetic Cartilage Implant is a treatment option for Hallux Rigidus that allows patients to not only have pain relief but retain joint motion. It is a synthetic cartilage implant.  It is easy to see why this treatment form would be preferable to the traditional fusion.  Cartiva Synthetic Cartilage Implant is a small implant that is composed of Polyvinyl Alcohol (PVA) and is inserted into the head of the 1st metatarsal and provides the correct joint spacing.  Not only does it provide pain reduction but the recovery time is reduced significantly.


The American Foot and Ankle society published a level 1 study that showed that patients mean pain visual analogue scale (VAS) improved by 58 points from baseline.  Patient post-operative function was rated at 92% as well as 96% of patients stated that they would undergo the procedure again.


When we think about all the things that the motion of our toes provide us, like the freedom to choose any footwear, ability to comfortably run or walk then it is easy to see why cartilage replacement is the right choice for first surgical intervention.


For more information on Cartiva Synthetic Cartilage visit their website at  Ask your doctor if this is right for you.


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