Effective Rehabilitation Strategies After Hallux Rigidus Surgery

Hallux rigidus, a form of degenerative arthritis affecting the big toe joint, can cause significant pain and limit mobility. Surgery often becomes necessary when conservative treatments fail to provide relief. The success of surgery can depend heavily on the rehabilitation process that follows. Proper rehabilitation helps restore function, reduce pain, and prevent complications.

This article outlines effective strategies to support recovery after hallux rigidus surgery, helping patients regain mobility and improve quality of life.

Post-surgery foot care with bandaged big toe

Understanding the Goals of Rehabilitation

After hallux rigidus surgery, rehabilitation aims to:

• Reduce swelling and pain

• Restore joint mobility

• Strengthen surrounding muscles

• Improve balance and gait

• Prevent stiffness and scar tissue buildup

  
  

Each phase of rehabilitation focuses on specific goals, progressing gradually to avoid setbacks. Patients should follow their surgeon’s and physical therapist’s instructions closely to ensure safe and effective recovery.

Early Phase: Protect and Reduce Inflammation (0-2 weeks)

The first few weeks after surgery are critical for healing. During this phase:

• Rest and Elevation: Keep the foot elevated above heart level to reduce swelling. Avoid putting weight on the foot unless advised otherwise.

  The ankle should be rested and elevated above the level of your hip regularly throughout the day for 20 to 30 minutes. Phase 1 exercises can be undertaken whilst the ankle is elevated to help reduce swelling.

• Wear a Walker Boot (if prescribed): Do not sleep in the boot or shoe. It is important to place as much weight as possible through the boot or shoe when walking to help the healing process. The boot should be worn when walking but can be taken off when you are:

  • Resting

  • Applying ice

  • Elevating the ankle

  • Doing simple exercises

  Ice Therapy: A cold pack or frozen peas wrapped in a towel can be applied to the foot for 15-20 minutes, 3 to 4 times a day. The ice must not come into direct contact with the skin. Ice is most effective within 72 hours of post-surgery or injury to control inflammation and pain.

• Compression: Use compression bandages or socks to minimize swelling but avoid excessive tightness.

• Toe strapping (if provided)

  Apply daily for 2 weeks, avoiding getting it wet.

• Medication: Take prescribed pain relievers and anti-inflammatory drugs as directed.

  
  

Avoid any strenuous activity or movements that stress the big toe joint. Protecting the surgical site allows tissues to heal properly.

How To Fit a Walker Boot

Phase 1 Exercises (0-2 weeks post surgery)

Intermediate Phase: Regain Mobility and Strength

Once swelling decreases and pain is manageable, usually after 2-4 weeks, rehabilitation shifts toward restoring movement and strength.

• Gentle Range of Motion Exercises: Begin with passive and active toe movements to prevent stiffness. For example, gently bend and straighten the big toe several times a day.

• Toe Stretching: Stretch the muscles and tendons around the toe to improve flexibility.

• Strengthening Exercises: Use resistance bands or towel scrunches with the toes to build muscle strength gradually.

• Weight Bearing: Gradually increase weight bearing as tolerated, using assistive devices like crutches or a walking boot if recommended.

  
  

Phase 2 Exercises (2 - 4 weeks post surgery)

Phase 3 Exercises (4 + weeks post surgery)

Advanced Phase: Functional Training and Gait Improvement

By 6-8 weeks post-surgery, most patients can focus on regaining normal walking patterns and functional activities.

• Balance Training: Practice standing on one foot or using balance boards to improve stability.

• Walking Drills: Work on heel-to-toe walking to restore natural gait mechanics

• Low-Impact Activities: Swimming or cycling can help maintain cardiovascular fitness without stressing the toe.

• Footwear Advice: Transition to supportive shoes with a wide toe box and stiff sole to protect the joint during daily activities. An insole (with a Morton's extension) may be helpful in the short-term.

  
  

This phase prepares patients to return to regular activities and reduces the risk of re-injury.

Toe stretching exercises using resistance band for rehabilitation

Tips for Successful Rehabilitation

• Follow Professional Guidance: Always adhere to your surgeon’s and therapist’s recommendations.

• Be Patient: Healing takes time. Avoid rushing exercises or returning to high-impact activities too soon.

• Monitor Symptoms: Report increased pain, swelling, or redness to your healthcare provider promptly.

• Maintain Hygiene: Keep the surgical site clean and dry to prevent infection.

• Use Assistive Devices: Crutches, boots, or braces can protect the foot during early recovery stages.

  
  

When to Seek Additional Help

If you experience persistent pain, limited mobility, or signs of infection such as fever or discharge, contact your healthcare provider immediately. Sometimes, complications require adjustments in the rehabilitation plan or further medical intervention.

Final Thoughts on Rehabilitation After Hallux Rigidus Surgery

Effective rehabilitation after hallux rigidus surgery is essential to regain foot function and reduce discomfort. Starting with protection and inflammation control, progressing through mobility and strength exercises, and finally focusing on functional training creates a strong foundation for recovery. Patients who commit to their rehabilitation plan and communicate openly with their care team tend to achieve the best outcomes.