What is a hallux rigidus?
Hallux rigidus (also hallux limitus, hallux flexus, hallux non extensus) is an arthrosis of the big toe. In this wear-related disease, the rolling movement is difficult. The consequences can be complete joint stiffness or painful bone spurs.
Hallux rigidus: Causes and risks factors
Wear and tear leading to hallux rigidus occurs in the big toe joint between the first metatarsal bone and the proximal phalanx of the big toe. Why some people develop a hallux rigidus and others do not is not known in detail. Possible causes of arthrosis in the big toe are hereditary factors, injuries, inflammation, excessive strain and deformities. Sometimes hallux rigidus is also a secondary disease in the case of gout.
The following risk factors can be derived from the suspected causes of hallux rigidus:
- Poorly fitting, tight footwear
- Foot deformities
- Flat foot arch with inwardly turned heel
- Incorrect or excessive strain, for example, due to abnormal gait pattern or overweight
- Traumas such as bone fractures and tissue injuries Inflammations
Symptoms and signs – how to recognise hallux rigidus?
The following symptoms, among others, indicate a hallux rigidus:
- Pain in the big toe joint during rolling movement while walking
- Stiff big toe
- Swollen and reddened big toe joint
- Increasing tightness in the shoe
- Worsening of symptoms in cold weather
- Subsequent discomfort at the knee and hip joints due to overstrain
Therapy for hallux rigidus
In order to make the diagnosis, the doctor will check the patient’s medical history thoroughly. He will also examine the big toe joint manually and under x-ray. Often there are already changes in the joint space (narrowing due to abrasion of the cartilage) or bone spurs.
The aim of the treatment is to prevent the progression of the disease, alleviate the symptoms and enable the patient to walk as painlessly as possible. The doctor will determine the therapy according to the stage of the disease. There are conservative, drug and surgical treatment measures available, depending on the nature of the disease.
Conservative and medicinal therapy for hallux rigidus
Conservative and medicinal treatment methods include:
- Special insole restorations
- Orthopaedic shoe adjustments
- Physical therapy, such as balneotherapy (sulphur and radon baths)
- Anti-inflammatory drugs, painkillers
- Injection treatments, such as hyaluronic acid or cortisone-containing medication
Shoe insoles for hallux rigidus
An immediate start of therapy with load-relieving shoe insoles is recommended – if possible even before the toe begins to become stiff. Patients can benefit from orthopaedic insoles – such as medi footsupport Control or medi footsupport Control slim – which are tailored to the needs of patients with hallux rigidus: When walking, the foot is stabilised and is naturally cushioned; the rolling movement is supported, and the pressure is minimised. This will give you noticeable relief in the big toe joint.
For people who have hallux complaints and wear medical compression stockings, there are special versions, such as those with a hallux relief zone.
Hallux rigidus operations
If conservative measures are not successful or the disease is too advanced, the orthopaedist may consider surgery.
In severe arthrosis, the artificial surgical stiffening (arthrodesis) of the big toe joint is currently the method of choice. The fusion of the two bones contributes to freeing the patient from pain. The adjacent joints and an orthopaedic roller on the shoe sole compensate for the associated loss of movement.
Bone spurs (osteophytes) are removed in the case of mild hallux rigidus. This procedure is called cheilectomy. In severe forms, this can be combined with a corrective osteotomy (also called a repositioning osteotomy): The surgeon cuts through (osteotomise) a bone to restore the normal anatomy of the bone, joint or extremity and to relieve joint parts.1
1R. K. Marti, R. J. van Heerwaarden: Osteotomies for posttraumatic deformities. AO-Foundation Publishing. Thieme-Verlag Stuttgart 2008 (ISBN 978-3-13148671-4)
eurocom e.V., Einlagenversorgung, 2. Auflage 2012, Hallux Rigidus. S. 26
Thieme.de, Spiraldynamik-Hallux Rigidus, Online veröffentlicht unter: www.thieme.de/de/gesundheit/spiraldynamik-hallux-rigidus-51958.htm (last access: 18.05.2018)
www.medon.de/uebungen_hallux_rigidus.html (last access: 18.05.2018)