Hallux rigidus

Hallux rigidus (also called hallux limitus, hallux flexus, hallux non-extensus) is the term used to describe arthrosis (circumferential joint wear) in the metatarsophalangeal joint of the big toe. This is a painful restriction of movement that can lead to stiffening of the big toe, i.e. the metatarsophalangeal joint, in the further course. “A hallux rigidus often occurs in older people, but can also cause problems in younger people,” says the hallux rigidus expert. “Hallux rigidus is the second most common functional disorder of the big toe after hallux valgus. In some cases, hallux rigidus and hallux valgus occur in combination. If you suspect anything, seek help from an expert in your area to clarify the cause of the symptoms,” advises OÄ Dr. Beatrice Hanslik-Schnabel.

Both hallux rigidus and hallux valgus are conditions that affect the base joint of the big toe. Although they are 2 different clinical pictures, mixed forms of both diseases can still occur. Hallux rigidus and hallux valgus differ in the following characteristics:

Hallux rigidus is a stiff, rigid joint wear in the metatarsophalangeal joint of the big toe. The joint is difficult to move and painful.

Hallux rigidus -> Hallux = toe, rigidus = stiff, immobile, heavy

Hallux valgus is an often painful deformity of the metatarsophalangeal joint of the big toe.

Hallux valgus -> Hallux = toe, valgus = crooked, bent

Initially, hallux rigidus causes swelling and inflammation of the joint mucosa. As a result, the big toe can only be moved to a limited extent and with pain. This stiffening is increasingly reinforced by the constant abrasion of the cartilage. It is also possible that the rubbing will become audible. During this process, pieces of cartilage and bone rub against each other, a process known as crepitation occurs. See here a testimonial from a hallux rigidus patient.

The following symptoms may indicate hallux rigidus:

• Schmerzen beim Gehen, vor allem beim Abrollvorgang
• Swelling of the big toe
• Inflammation of the metatarsophalangeal joint of the big toe
• Altered gait pattern
• Callus formation on the sole of the foot
• Formation of bone spurs (osteophytes)
• Friction noise during movement
• Difficulty to find suitable shoes

The exact cause of hallux rigidus has not yet been clearly determined. However, there are some factors that can promote the development of hallux rigidus. However, a fundamental contribution is usually made by a lack of or very one-sided movement itself. In addition, often the wrong footwear: rigid and solid shoes but also infrequent barefoot walking can contribute to the development of arthrosis. However, there are other factors that promote hallux rigidus. Incorrect or excessive stress, trauma, malpositioning of the feet, but also metabolic diseases can promote hallux rigidus. In some cases, however, the shape of the foot may have been altered from birth in such a way that deformities such as hallux valgus or hallux rigidus can form more easily. It has also been proven that women have arthrosis in the metatarsophalangeal joint of the big toe more often than men.

First, the doctor examines what is causing the pain and localizes it. In addition, he checks how much the mobility of the big toe is restricted. Now there are some factors that are crucial for the correct diagnosis:

• How much is the mobility of the big toe restricted?
• Does pain occur mainly when rolling the foot?
• Did the gait pattern change?
• Does pain occur on top of the joint, especially when wearing tight shoes?
• Does the big toe feel numb or numb due to compressed nerves?

If the doctor presses on the upper part of the big toe joint, the pain is especially noticeable there. It may also be that the doctor palpates directly through the bone spurs. If the doctor bends the toe upwards, pain will also be felt there. Another important point for the diagnosis of hallux rigidus is the examination of the interphalangeal joint. If this also exhibits osteoarthritis, the treatment options are severely limited. In case of joint stiffening, only one of the two joints may be stiffened. If both were stiffened, the gait would be too severely affected.

The corresponding treatment option always depends on the respective degree of hallux rigidus. Thus, in earlier stages of arthrosis of the metatarsophalangeal joint of the big toe, conservative therapy can still be used. Initially, pain is relieved by pain medication, injections, exercises, insoles, shoe fitting or physiotherapy. For long-term freedom from pain, usually only surgery of the hallux rigidus helps. Conservative treatment options do not stop osteoarthritis in the metatarsophalangeal joint of the big toe, but only slow down the progressive process of stiffening. Later surgery of the metatarsophalangeal joint of the big toe is necessary in many cases.

You should discuss whether conservative therapies can still help or whether hallux rigidus surgery is advisable, if possible with your trusted orthopedist. If you are still looking for a doctor in your area, we will be happy to help!

Arthrodesis of the metatarsophalangeal joint of the big toe / hallux rigidus Arthrodesis

In this surgical method, the entire joint is stiffened in a specific position. This surgical method is often used in young, but especially active patients, in whom the metatarsophalangeal joint of the big toe is already destroyed. The goal of this arthrodesis is to completely eliminate the pain. Screws made from human bone or metal plates are often used in this surgical technique. Metal plates sometimes need to be removed during a second metal removal surgery. Arthrodesis is the most common surgical treatment for Hallux rigidus.

Endoprosthesis of the joint at the base of the big toe

A prosthesis similar to a hip or knee prosthesis is inserted into the joint.

Cheilectomy

This surgical technique is used for mild hallux rigidus where the joint is not yet damaged.