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Treatment – Cause – Operation

Hallux rigidus

In this article, learn everything you need to know about hallux rigidus from the hallux rigidus expert OÄ Dr. Beatrice Hanslik-Schnabel. Based on her own practice in Vienna and Klosterneuburg, she explains how to recognize hallux rigidus, what causes hallux rigidus can have, as well as various treatment options that help to get the pain of hallux rigidus under control again. The foot expert and orthopaedist from Vienna and Klosterneuburg talks on the one hand about non-surgical therapy options such as hallux rigidus exercises, physiotherapy and pain therapy, but also about the various surgical methods and surgical materials for hallux rigidus. It is important that you find out before an operation which surgical method achieves the best results for you and talk to your orthopaedist you trust about whether a second operation for metal removal can be avoided during your operation by screwing from human bones, such as the Shark Screw®.

Reading time: 6 min

Author of the article: OÄ Dr. Beatrice Hanslik-Schnabel
OÄ Dr Beatrice Hanslik-Schnabel is a specialist in orthopaedics and an expert in foot surgery. Among other things, she is an expert in foot surgery in Vienna and Klosterneuburg.
Updated 26.08.2022

What is 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.

Hallux rigidus and hallux valgus what is the difference?

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

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

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

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

Are you unsure whether you have hallux valgus or hallux rigidus? Click here to access your personal hallux valgus guide. Are you looking for a specialist? Here you will find designated hallux rigidus & hallux valgus experts.

What are the symptoms of hallux rigidus?

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

Work with a trusted podiatrist to determine if your symptoms are caused by hallux rigidus and work with them to create a treatment plan that will help you manage your symptoms.

What can be the causes of hallux rigidus?

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.

Ursachen eines Hallux rigidus

How is the diagnosis made by the doctor?

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 3 stages of hallux rigidus:

Stage 1:

Initial pain occurs in the big toe. When rolling the foot, the restriction of movement and the resulting pain is noticeable. Patients therefore often try not to put too much strain on the foot during the rolling process, and women in particular already have problems wearing shoes with a raised heel at this stage. In the early stages, however, it is still possible to improve the symptoms of hallux rigidus symptomatically with conservative therapies such as exercises, insoles or special shoes, provided that the osteoarthritis has not progressed too far.

Stage 2:

As the restriction of movement increases, there is also increased pain when rolling the foot. Hallux rigidus is also visually noticeable.

Stage 3:

In the final stage, the osteoarthritis has fully developed and the entire metatarsophalangeal joint has severely limited motion. Normal movement is almost no longer possible due to the painful restriction of movement. Patients at this stage can no longer roll the foot normally due to hallux rigidus, and walking is difficult for them. Furthermore, visible calluses appear on the sole of the foot.

How to treat hallux rigidus?

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!

Surgical therapies for hallux rigidus & osteoarthritis of the big toe

If no improvement is achieved with conservative therapies, surgery for hallux rigidus should be considered. Depending on the stage of hallux rigidus, different surgical techniques are used. It is therefore essential to clarify with your doctor in advance which surgical technique is to be used for you and whether the use of bone screws (screws made from human bone) can completely eliminate the risk of a second operation to remove the metal. These are in fact colonized by the body’s own cells and are thus incorporated and remodeled into the body’s own bones.

Common surgical techniques for hallux rigidus

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.

Surgical materials of hallux rigidus surgery

Material

Vorteile

Risiken

Shark Screw® / Schraube aus menschlichen Knochen

Integration in Knochenumbauprozess | Keine Metallentfernung | Keine Wetterfühligkeit bekannt | Geringe Schmerzen nach der Operation

Besondere Vorsicht bei der Belastung des Fußes 1 - 4 Wochen nach der Operation erforderlich

Schrauben aus Metall / Metalllegierungen

OP-Methode einfach für jeden Chirurgen

Metallentfernung möglich | Einsatz bei Allergikern & Wetterfühligkeit vermeiden

Plattensysteme

Hohe Festigkeit und Stabilität

Metallentfernung wahrscheinlich | Trägt auf | Einsatz bei Allergikern & Wetterfühligkeit vermeiden | längere Heilungsdauer & schwerer Wunderverschluss möglich

Heal naturally - Shark Screw® for hallux rigidus

Numerous surgeons rely on the use of the Shark Screw®. The great advantage of Shark Screw® in contrast to metal plates, metal screws and bioreactive implants is that Shark Screw® is integrated into the natural bone remodeling process. This is made possible by the so-called Havers channels in the bone screw, in which bone cells and the body’s own vessels settle. Eventually, Shark Screw® becomes the body’s own bone. Thus, no further surgery is required to remove the metals, patients thus save a 2nd surgery.

Tip:
Do you have hallux rigidus? We would be happy to recommend a doctor in your area who can provide you with Shark Screw® or give you a second opinion on the condition. All surgeons recommended by us regularly attend surgical courses and training to provide the best possible care for your hallux rigidus.

Field report hallux rigidus surgery

Often, testimonials on the topic of hallux rigidus or before and after pictures on hallux rigidus are hard to find. Here you can read the testimonial of a patient who suffered from arthrosis of the metatarsophalangeal joint of the big toe and who was able to get her pain under control again by means of surgery. In the video, sufferer Ms. Koblinger talks about how she has fared with her hallux rigidus and why she decided to have hallux rigidus surgery.

Aftercare for hallux rigidus

In the first 4 weeks after hallux rigidus surgery, only the most necessary activities should be performed, and the foot should be given some time to heal and regenerate after surgery. It is important that the operated foot should be elevated when sitting as well as lying down. Your foot needs rest after surgery to heal as best as possible. If possible, do not put any weight on the foot!

Physiotherapy and lymphatic drainage play an essential part in the aftercare. This builds stabilization and strengthening of the foot after surgery. Physiotherapy helps to achieve a safe gait pattern after hallux rigidus surgery.

Sporting activities can also be performed without restrictions after hallux rigidus surgery and correct follow-up treatment. It is best to clarify with your treating orthopedist when sport is possible again without restrictions.

In the first 4 weeks after hallux rigidus surgery, only the most necessary activities should be performed, and the foot should be given some time to heal and regenerate after surgery. It is important that the operated foot should be elevated when sitting as well as lying down. Your foot needs rest after surgery to heal as best as possible. If possible, do not put any weight on the foot!

Physiotherapy and lymphatic drainage play an essential part in the aftercare. This builds stabilization and strengthening of the foot after surgery. Physiotherapy helps to achieve a safe gait pattern after hallux rigidus surgery.

Sporting activities can also be performed without restrictions after hallux rigidus surgery and correct follow-up treatment. It is best to clarify with your treating orthopedist when sport is possible again without restrictions.

OÄ Dr. Beatrice Hanslil-Schnabel

The author - OÄ Dr. Beatrice Hanslik-Schnabel

OÄ Dr. Beatrice Hanslik-Schnabel has been a senior physician at Hera since 2005, providing surgical and conservative care. In the course of her residency at the University Clinic for Orthopedics in Vienna, from 1999 to 2004, she completed the following specialty teams: endoprosthetics, sports orthopedics, spine, pediatric orthopedics and tumor orthopedics. She is also gaining a lot of experience as an assistant leader of the rheumatology team.

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