Hallux rigidus

Hallux rigidus: description

Hallux rigidus is the second most common disorder of the big toe after hallux valgus. It usually arises because the joint wears out due to increased stress (arthrosis). The great toe (hallux) can then move only in pain and limited (limitus). If the disease progresses, the metatarsophalangeal joint may also completely stiffen (Hallux limitus).

Hallux rigidus often occurs in the elderly. Although slightly more men are affected overall, women usually have earlier complaints because they often wear high heels.

Hallux rigidus: symptoms

Hallux rigidus usually affects only one foot. Initially, the short foot muscles may twitch more frequently. The big toe has a swelling and can be moved only limited and in pain up. Sometimes you can even hear that cartilage and bone pieces rub against each other (crepitus). Also, the appearance with the ball of the foot is painful, which is why the patient does not roll off the foot properly while walking. Instead, the foot is put on with the foot outside edge. Due to the altered gait, painful calluses may form on the outer edge of the foot. On the back of the foot may form over the big toe bony outgrowths, which are often painful.

In the course of the disease sometimes small joint body dissolve. If they get into the joint space, the joint can be blocked. As the hallux rigidus progresses, the metatarsophalangeal joint increasingly stiffens. Finally, the big toe can not be moved up or down.

Hallux rigidus: causes and risk factors

So far, it is not clear why a hallux rigidus develops. However, various factors are discussed that promote the joint wear (arthrosis) in the big toe and thereby promote this disease. These include:

• Shoesthat do not have the right foot shape
• foot shape: narrow, long feet, long big toe
• deformities like flatfoot, foot tilted inwards, deformity after paralysis
• Faulty or overloaded due to an abnormal gait or overweight
• Trauma: Injuries, fractures, inflammation, complications after foot surgery
• Metabolic or growth disorders

Osteoarthritis in the metatarsophalangeal joint narrows the joint space. The articular surfaces ossify and may become inflamed (synovitis). The partially swollen joint can only be moved under pain and restricted. As the hallux rigidus progresses, the joint space can be completely closed by remodeling. The joint is then completely stiffened.

Hallux rigidus: examinations and diagnosis

The doctor examines how mobile the metatarsophalangeal joint is. Pain, swelling and rubbing of bones and cartilage indicate a hallux rigidus. He also assesses the callus formation on the foot and the gait pattern. In the advanced stage of the disease, partial bone dislocations occur on the back of the toes. Their palpation causes pain to the patient. An X-ray does not provide evidence for Hallux rigidus until very late. The doctor can tell whether the joint space is narrowed and the articular surfaces are ossified.

Hallux rigidus: treatment

Depending on the stage of the disease, there are various ways to treat Hallux rigidus. First, you try to relieve the pain. Help on the one hand pain medications, to the other aids that the Keep your foot steady, In addition, various physical treatments such as Balneo- and electrotherapy used. Help in the long term Hallux rigidus shoes with the right foot shape and special insoles. If these measures are not effective, a Hallux rigidus surgery be considered.

Hallux rigidus: pain treatment

In severe pain, you can take pain medication or apply as an ointment on the joint. Particularly suitable for this purpose are pain medications, which additionally inhibit inflammation and have a decongestant effect (anti-inflammatory drugs).

In addition, the so-called infiltration therapy in Hallux rigidus can help against the pain. Here a local anesthetic and a cortisone preparation are injected into the painful region at the foot. The anesthetic relieves the pain, the cortisone inhibits the inflammation. Because it can easily lead to infections in this treatment, it should be done by an experienced doctor.

Pain management allows some patients to perform the physiotherapy exercises that are indicated for hallux rigidus.

Hallux rigidus: immobilization

By immobilizing the toe joint through a splint or plaster, one can relieve the joint and inhibit an inflammatory response. This usually relieves the pain. However, this therapy is only used for a temporary period. Once the acute inflammation has subsided, other orthopedic aids such as Hallux rigidus inserts are recommended.

Hallux rigidus: shoes, insoles and orthopedic remedies

With a Hallux rigidus a suitable footwear is very important. The shoes should correspond to the individual foot shape. Otherwise, the gait pattern may change, favoring hallux rigidus. The sole of the shoe may become stiffened under the forefoot. This can relieve the pain of rolling the foot and promote a normal gait pattern. There are also certain Hallux rigidus inserts, They are reinforced under the big toe, so they relieve the toe joint and dampen shocks.

Hallux rigidus: physical therapy

In physical therapy, physical stimulation (such as heat, electricity, etc.) stimulates the body to stimulate the self-healing of the body and positively affect the disease process. Hallux rigidus uses the following physical therapies:

• balneotherapy: Sulfur baths are said to counteract inflammatory joint complaints and signs of wear and tear. A so-called Radonbad to relieve pain. For this purpose, the radioactive noble gas radon is used. This therapy can only be used for a limited time.
• Electrotherapy: Direct current or alternating current in different frequencies should influence the vessel width. The aim is to improve blood circulation at the treated site and to relax the muscles. Overall, the pain should subside.
• hydrotherapy refers to the application of water. Foot baths, washes, wraps and alternating warm sitz baths can promote healing.

Hallux rigidus: surgery

If the non-surgical measures do not adequately relieve the symptoms, hallux rigidus surgery may be necessary. Depending on the symptoms and age of the person affected, a choice is made between different surgical interventions:

• Cheilotomie: This operation is used in the case of painful hallux rigidus with bony promiscuity on the instep in the area of ​​the metacarpophalangeal joint when the joint itself is undamaged. The bony extractions are removed. As a result, the big toe should be able to move upwards again without pain. Cheilotomy offers the advantage that later on occurring complaints can be treated with arthrodesis or resection arthroplasty.
• osteotomy: In this form of hallux rigidus surgery, the metatarsal bone is shortened. In addition, the articular surfaces of the metatarsophalangeal joint can be adjusted so that the big toe is directed further down. This operation is intended to relieve the great toe joint and prevent the hallux rigidus from progressing further.
• Arthrodesis of the great toe joint: This hallux rigidus operation is recommended for young and active people with hallux rigidus who have already destroyed the metatarsophalangeal joint. The joint is stiffened in a certain position. The big toe is directed upwards inside. As a result, as the foot rolls off, power can be transferred to the big toe without causing pain.
• resection arthroplasty: This is a surgical procedure for older and less active patients with advanced arthrosis of the big toe joint. A piece of the lower big toe bone is removed. In addition, the surgeon forms a small flap from a part of the joint capsule and fixes it in the joint space.
• Endoprosthetic care: Similar to a knee joint prosthesis here is a part of the bone and the articular surface of the big toe replaced by a metal prosthesis. The success of this hallux rigidus operation is controversial because the toe is loaded with great force when walking. This allows the prosthesis to loosen or even loosen.

Hallux rigidus: disease course and prognosis

Hallux rigidus does not recede by itself, but usually proceeds without treatment. With suitable treatment methods, however, one can alleviate the symptoms and positively influence the disease process. Here above all a good orthopedic supply with Hallux rigidus deposits and suitable shoes is expedient. There are also various operation options at one Hallux rigidus.