The Center for Podiatric Care and Sports Medicine

Older MacDonald Had a Farm: Hallux Rigidus Surgery for Active Workers

Posted by on Thursday, February 7th, 2013


Yesterday I wrote about the aging workforce in academia, but this is not an issue that affects just one sector of the economy. Demographics are shifting everywhere—from manufacturing to nursing to retail—and in many of these jobs older workers are feeling their age. There is perhaps no more demanding job than that of a farmer. And farmers are getting older too. The Washington Post calls it “… an epidemic sweeping America’s farmlands.” The trouble isn’t just that farmers are retiring later, trying to make the most of their retirement dollars, it’s that there are fewer and fewer young farmers ready to take their place. These aging farmers are suffering from a familiar foot condition, a product of age and hard work: Hallux rigidus. Let’s explore treatment options for all the farmers out there. These are hard-working people who need to get back to the fields as quickly and painlessly as possible.



A quick recap: Hallux rigidus is a stiffening of the big toe joint (the MTP joint), typically the result of arthritis. The joint’s cartilage wears out until bone touches bone. This can result in painful bone spurs and in a loss of range-of-motion in the joint. As we discussed yesterday, losing mobility in the big toe joint can impact the entire body, causing pain in the legs, hips, and back. And it can really get in the way of daily activities, like milking the cows, mucking out stalls, and lifting heavy hay bales.



In more advanced cases (and, let’s face it, many hard-working people tend to ignore a problem until it gets bad enough that they can’t avoid treatment) surgery tends to be the best option for restoring functionality in the joint. There are several kinds of surgery, each with its own risks and benefits. You can also contact The Center for Podiatric Care and Sports Medicine (212.996.1900) for more information.



Cheilectomy: This is a procedure to remove bone spurs that are inhibiting movement in the joint. It can be an effective procedure for grades I and II (less severe hallux rigidus) but, based on a 10 year retrospective study, appears to be ineffective in more advanced stages.

Keller Resection Arthroplasty: This procedure involves the resectioning of bone in the joint and soft tissue reconstruction to improve pain and range-of-motion. There are some potential side effects including toe weakness and metatarsalgia.

Interpositional Arthroplasty: This is a relatively new treatment for advanced hallux rigidus that uses biologic tissue from a donor to cushion the MTP joint. This may present certain advantages for the very active sufferer since it involves minimal bone resection and doesn’t preclude future surgical procedures if it fails. It’s typically recommended for patients with moderately severe arthritis (stage III).

Joint Replacement: This is a procedure that tends to work well for advanced hallux rigidus. It is a total first joint replacement (we prefer a double-stemmed, hinged artificial joint). In many cases it results in dramatically reduced pain and excellent range-of-motion (see History and Advances for Surgical Correction of Advanced Hallux Rigidus. Foot and Ankle Quarterly, Spring 2013.)

Joint fusion: This may not be the best option for farmers who need to maintain good range-of-motion. It involves a fusion of the MTP joint and relieves pain but does not restore mobility.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.